Doctors Come Clean contd. - No Free Lunch - UK Confessions

Every year, fellows at out program get to attend annual american society of hematology( ASH) 0r ASCO meetings. Funds for this, upto a 1000 dollars per fellow, come entirely from the pharma companies. While there, we are dined and wined to a shameful extent by these guys and given all sorts of trinkets, some pretty expnsive. Every month, we can \"earn\" upto 300 dollars for filling out "surveys". I try to keep my conscience clear by: -accepting nothing more then pens. -filling out surveys with junk data -sending all survey money to charities. Haven’t been able to kick the habit of attending conferences at their expense yet, but have taken the step to avoid socializing with them while there.

We do not declare these trips......

“I am a consultant and have been to a number of international conferences. I attended a 5-day conference in the USA recently. I received £500 directly from Pharma Company that makes drugs in my clinical area. Other money came from the “department research fund” theses funds are generated through conducting research for Pharma companies.Other UK consultants ( about 50 in total) received total funding from Pharma companies to attend this international meeting. Essentially this meant the flights, airport transfers and hotel accommodation. During the conference a social event was organised every night that included drinks and food. These meetings was allocated as “study leave” and are not a taken from normal leave allocation. This has been the format for all my international meetings in the past. We do not declare these trips or hospitality on the hospital register as they are deemed educational. We need Pharma to sponsor theses meeting or else they could not be held. You give us a better system!”

It feels great. Try it!

“I am a consultant respiratory physician and in my first 3 years in post I was taken each year to the american thoracic society annual conference, by the two largest pharmaceutical companies making respiratory drugs. The hospitality was lavish: 5 star hotel rooms, expensive restaurants every night and the exorbitant registration fee for the conference paid in full. By the third year I was feeling very uncomfortable with the excessive hospitality and have declined all offers since. I have cancelled the weekly lunch reps used to provide at our XRay educational meetings and no longer see any reps at all. I don\'t eat the sponsored lunch at our grand rounds and don\'t pick up even a pen. It feels great. Try it!”

I am not anti-drug companies

“I first became interested in how drug companies market their products when as a medical student working with Oxfam, I learned of many questionable marketing practices in developing countries. I soon realised that similar, if not so blatant practices happened here….. I think it is useful to emphasise that I am not anti-drug companies but it is important to realise that the first loyalty of a company is to it’s share-holders and their desire for profits. This can lead to excesses on behalf of their sales reps and these are obviously sanctioned by those at higher levels…. I remember one occasion when a rep was trying to persuade me to use her particular statin. When I replied that we were in the process of compiling a formulary and taking advice from a local cardiologist, she paid a visit to him attempting to persuade him to recommend her product. Such pressure is unacceptable………….. Drug companies can often be generous and supportive when educational events are being arranged …... however it cannot be acceptable for the company to dictate what the educational topic is or what is taught at such meetings. There must be distance between lecturer and company …. companies can support useful projects but those involved need to exercise great care that the drug company is not dictating the agenda. This is especially important when a drug company finances lobby groups or patient support groups. The boundaries between “normal” and “disease” can be obscured in many cases.”

Myself and my boyfriend work security

I wonder if you were aware of the Diabetes conference ? Myself and my boyfriend work security, and he had the pleasure of working at one of the post conference functions at the hotel last night. I warned him what it would be like and boy was i right! He had spoken to one of the event organisers from the hotel, who said that the various drug companies had approached her and asked what they could get for an exorbitant sum. Well, my boyfriend saw all manner of entertainment including can-can dancers and flamenco dancers, lots of wine, fireworks, live music etc. Although not a medic himself, he has listened to my rants and agreed with me how osbscene this event was. I cannot understand how well paid professionals can be wined and dined etc like this and still naively believe that this does not influence them! I also cannot belive how immoral it is that these people who are capable of paying for themselves get treated to wine while folk die of malaria!!!!I also wish a system could be implemented like MP's have where they declare gifts, hospitality etc. I'm sure that if this was implemented the public could be made more aware of the whole sordid affair.

Why did I stick my neck out?

Like many medical students I naively saw drug reps as a great source of pens and other freebies. However by the time I became a junior doctor I began to question my integrity at accepting these “free” gifts-my solution (on a budget) was to nail varnish over the drug names! General practice was awash with reps. Drug reps were and are part of the accepted system. They are timetabled into the normal working week as if they are as important as discussions with the health visitor or having a practice meeting. The reps seemed a bit like car sales men (in my limited experience of the latter) –flashy, well dressed, equipped with glossy charts and an over friendly smile. For a while I went along with the system, after all they were only people doing their job, but after a while I tired of the rigmarole- it was wasting time and I really wasn’t listening to the speeches that come with each rep. I refused to see any more reps. this was seen as a really odd thing by everyone in the practice as if I was daft to be “missing out”. I don’t go on "rep nites" out or have food at drug lunches. I’ve tried to remove all traces of freebies from my room but they keep sneaking back in as if they are determined to keep the advertising show on the road!

Why did I stick my neck out? It seemed obvious to me early on (maybe I got cynical fast) that drug companies are not giving stuff away out of the kindness of there hearts-it’s all about profits and we doctors are just pawns in the game. Well I might be a pawn but I can still stand up to the sharks! Various factors have led me to this conclusion and as time goes on and I read more my ideas are reinforced. Firstly I travelled; saw life on the other side of the world and poverty at its rawest. I saw the effects of multinationals on ordinary people, drug companies included, advertising baby formula milk in shanty towns with no running water, pushing their own expensive brands of drugs when local generics do the same job. I’ve read about people with AIDS dying a horrible death because drug companies won’t bring down the price of medicines to an affordable level or let generics be produced. Drug reps are part of the drug company multi nationals who put profit before people. When the main consideration is profit driven my patients are unlikely to benefit from unbiased fair assessment, after all their main consideration is to be well, not to be rich.

Having read about No Free Llunch in the BMJ- a mainstream journal not some lefty mag!- I have rejoiced to know there are like-minded people out there – watch out all you sharks the pawns are getting stronger!

Restaurants full of drunk doctors........

"What I have s seen and heard goes along these lines: Restaurants full of drunk d#s; d#s going out weekly to expensive restaurants; trips away to Paris with little or no education and d#s given “spending money”; business class transatlantic flights with 5 stars hotels as “fact finding”trip; d#s bragging about only ever travelling “business class”; education trip where d#s don’t go to any lectures; dinners with your wife/husband; “Dining Clubs” of d#s who go out weekly at ph# expense; d#s admitting that they change what they say at meetings dependent on the sponsors drug; ph# representatives whispering the word “money” in doctors ears.on and on and on"

I think it is time a halt was called on this........

Confession........I sit on the Lothian GP subcommitee and LMC as sessional GP rep., for approximately the past year due to problems with our health authority venue we have been meeting in the headquarters of the Pfizer drug company in Edinburgh and very flash it is too.So every month before the meeting food is served and the usual marketing stall.I find this weird, I seem to be the only person who does find it objectionable, and have not openly opposed it , apart from refusing food and conversation,.The week that rofecoxib was withdrawn there was plenty of promotional stuff for celecoxib on offer,( coinciding with our local prescribing guidelines suggesting that we avoided using it.) I think it is time a halt was called on this, please send any ideas to Dr Tessa Pyne.email seabird@sandycove.fslife.co.uk

In the UK GPs have a particularly close relationship with drug reps........

“The plain truth is that drug companies make and sell drugs and spend millions collectively on advertising. They have years of experience interacting with doctors and know our frailties. They are the experts and have the historical advantage of having such easy and close access to doctors. We should be intellectually honest and admit that we can be manipulated, and that time is precious.
In the UK GPs have a particularly close relationship with drug reps; quite often the contact starts at the registrar stage and continues for years. One explanation for this is that drug reps have traditionally subsidised and arranged educational meetings for GPs, which was preferable to having to make one's own arrangements. They also helped by donating equipment and providing stationery, pens, and even loaning out audit nurses to help run chronic disease management clinics. Personally, I found the relationship difficult and tried to find ways out of seeing reps. Did I really need all those freebies? Finally as a practice we made the honest decision 2 years ago that we really didn't need drug reps and simply said no. The local reps were told not to phone to arrange appointments or arrive at the desk. This freed up receptionist time and gave more GP time to devote to repeat prescription checks (thus leading to safer and more rational prescribing). It is probably no coincidence that we now closely follow our practice formulary with a high rate of generic prescribing (80%) and lower than average prescribing costs. This is despite the fact that we are keen prescribers of expensive drugs such as statins in secondary and primary prevention of CHD. As for education, we now arrange this locally with other practices on a half-day, with clearly defined educational aims. The quality is excellent and has led to the development of evidence-based guidelines and fostered closer working relationships between practices. My advice to colleagues is to take the plunge and say no; there are much more important things to do with your clinical time. “

funded entirely by all the main big drug companies........

I would like to register my concern about a conference I went to recently organised by Pri-Med. It was FREE, endorsed by the RCGP and yet must have been funded entirely by all the main big drug companies who had stands there. I studiously avoided their stands, but by the end of the day's "education" had been convinced that i should prescribe more statins, glitazones, sildenafil etc.... This was less obvious drug company pressure than the normal i feel.

"Symbiosis"

“I’ve been a "pharma cynic" ever since a good friend (rep for losec in its early days) retired in his thirties to his coastal hideaway in North Devon. This was not always the case and I must confess to a former life as a "freebie junkie". As a junior doc and mess social secretary I (and many others) milked reps for all their worth. In retrospect this was fairy classic symbiotic relationship. Thanks to reps the (heavily funded) mess bar was the centre of our universe at that time. Their sales pitch seemed in vain - we'd never remember it by the next day anyway. In retrospect, the bar's supply of freebie hangover cures (ppi's,nsaids, gaviscon etc) was their clever marketing. Following our anecdotal trials of n=1 "Losec" and "Arthrotec" certainly rolled off the pen easily. Do I regret it? Well...no. But times have changed. I no longer see reps as a GP but I must confess to having a heavily sponsored (though mostly out of date) first aid kit!”

It is almost "no free lunch" hell

Drug reps are in and out of the practice here: time is taken out of the day to see them and courses are sponsored and attended because they are free without thought of the potential bias in the presentation. It is almost "no free lunch" hell. And this is not the only place where this is occurring: a recent day seminar run by the independent evidence based medicine organization was cancelled due to lack of interest- others would rather have their info from Big Pharma than from an objective source. I am stunned and absolutely disgusted:

via nofreelunch-uk.org

Posted via email from Jack's posterous