Posted by JLM on June 12, 2003, at 5:06:34
In reply to Re: Abilify (aripiprazole) cost is PROHIBITIVE! » JLM, posted by JLM on June 12, 2003, at 4:51:34
I guess I better toss this in for good measure too:
https://www.family.org/physmag/issues/a0024894.html
Drug Rep Evangelism
By Paul C. Reisser, M.D.
A little humility goes a long way.--------------------------------------------------------------------------------
On Dec. 17, 2002, a study in the following day?s edition of JAMA became a prominent story on all three national network evening news broadcasts. The massive Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, otherwise known as ALLHAT, had demonstrated (among other things) that the lowly thiazide diuretic chlorthalidone outperformed an ACE inhibitor (lisinopril), a calcium channel blocker (amlodipine) and an alpha-blocker (doxazocin). Why all the news coverage? Because, as Lawrence J. Appel, M.D., of Johns Hopkins noted in JAMA, ?The most effective therapy was also the least expensive. . . . The ALLHAT results provide compelling evidence that thiazide diuretics should be the initial drug of choice for patients with hypertension, especially compared with those agents that were directly tested in this trial.?That is precisely what we were told to do 25 years ago. So why did most of us depart from this standard operating procedure? For one thing, the diuretic doses we once used were too high, leading to brisk sales of potassium supplements. Also, some patients didn?t care for the increased urine output, and more than a few experienced changes in insulin resistance and glucose levels. But no doubt we were also affected by learning about the latest ?hot? anti-hypertensive?and receiving those all-important samples?from our friendly pharmaceutical representatives.
Recently, a number of observers have raised concerns about who actually sets the prescribing agendas for the average physician. In the United States, in 2000?the last year for which statistics are available?the pharmaceutical industry spent some $15.7 billion (up 43 percent from 1997) promoting their products to physicians, not to mention another $2.5 billion advertising them directly to the public. We see their ubiquitous ads in both prestigious journals and throwaways, wade through dozens of advertisements arriving in the mail every week, and sometimes marvel at the creative ways in which products are paraded before us. The pens, Post-its, clocks, calculators and clipboards, while useful, can easily make an office resemble a stockcar bedecked with ads from its sponsors.
Equally (if not more) influential are the 80,000 representatives deployed to our offices and clinics. Along with their detail pieces,
presentations and samples, they offer good cheer, appreciation and invitations to pleasant experiences. In bygone days their offers included sports events, live theater, a round of golf, even a weekend at a plush resort. More recently, under tighter guidelines promoted by the AMA and others, these have been toned down to more modest educational lunches or dinners (minus spouses), though usually presented at upscale restaurants and occasionally accompanied by consulting fees offered in exchange for feedback about the company?s current advertising campaigns.A growing body of research confirms that interactions with drug reps, especially those that involve gifts and other pleasantries, affect the prescribing habits of residents and seasoned physicians alike, and some observers worry that this can compromise objective decision-making. After all, how can anyone on the receiving end of such favors not feel obliged, or at least be influenced, to recommend the medications that have been highlighted? Are patients helped or hindered when we reach for samples of the new product we just heard about, especially if the next issue of the Medical Letter dispassionately points out that it shows no superiority to far less expensive predecessors? Are some of us in danger of inhabiting a parallel universe of CME provided by speakers hired by pharmaceutical companies who are informative, but whose presentations may filter the current literature through a grid favorable to those who are picking up the tab?
A few critics insist that the best response to these issues is for physicians to detach themselves completely and abstain from any interaction with drug companies and their representatives.
While everyone must draw his or her own boundaries on this issue, I find this approach a bit extreme. Instead, a little discernment, skepticism and common sense can go a long way in weighing drug company overtures. I generally take a drug representative?s claims of product superiority with a grain or two of salt, knowing that a competitor?s rep will show up with an equally compelling claim. I also periodically reassess my interactions with the pharmaceutical industry, including a reality check on my own motives and potential blind spots. Are my treatment strategies driven by objectivity and an overriding concern for a patient?s clinical and financial welfare?or by the samples currently on my shelves? When a representative pays a visit, however, I do gain some insight into another arena of my life that is far more important: the way I represent my faith to others. I realize that a decision to prescribe a particular medication and a decision to follow Christ are light-years apart in significance. But in a very real sense we are ?reps? for our God (see 2 Corinthians 5:20), entrusted with presenting the most important message on the planet in the most attractive way possible. We need to be prepared, to take the initiative, to ?know our stuff? without flaunting it, to avoid talking too long (or too loud), to listen, and to present His case (not ours) without being pushy.
Several months ago I attended a dinner presentation on lipid-lowering therapy during which the speaker demonstrated a formidable command of hundreds of statistics from the current literature on this subject. His was also the most slanted medical presentation I had ever heard, insinuating that the sponsor?s product was the only rational choice in its class, based on current evidence. I left the meeting feeling insulted and humiliated.
Since I use a number of products in this class of drugs, I obviously must be one of those dumb slugs in the trenches who doesn?t have the time to master this particular topic. I retaliated by refusing to prescribe the sponsor?s product for several weeks, and when I finally ventilated to the rep who had organized the meeting he was mortified to hear that I had been alienated rather than won over by the presentation.
One thing I gained from this experience was a reminder that no one wins any converts by overpowering them intellectually (or any other way) and that the primary fruits of such effort are resistance and resentment. ?Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have,? exhorted the apostle Peter. ?But do this with gentleness and respect? (1 Peter 3:15). The gospel is not a sales pitch or an argument to be won; rather, it is good news, first and last, spread by one grateful beggar telling another where he has found food, clothing and shelter.
poster:JLM
thread:129761
URL: http://www.dr-bob.org/babble/20030609/msgs/233371.html