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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by pseudoname on May 23, 2006, at 16:07:21
I went to the Toronto convention of the American Psychiatric Association. In the huge exhibit hall, there were hundreds of displays & booths rented from the APA by various companies.
Several hospitals & state agencies were trying to hire pdocs. Posted salaries were $140k to $180k per year plus "up to" $88k in student-loan payments.
I was assumed to be a pdoc if I didn't correct them. (And I sometimes didn't.)
A man selling a computer-based attention test said it would "help my billing." I could have a non-professional staff member set up and administer the test, then have the patient take a Ritalin (or whatever). Two hours later, you repeat the test, and see if the patient does a lot better. If so, you have "proof" that the drug helps and you write a prescription.
But, he explained, you can charge $59 for the first test, $59 for the second, and something like $100 for the two hours in between (I didn't quite understand that). So you're up to $218 in billing for a few minutes' work by a non-professional and the doc doesn't have to do anything!
After that, I asked at almost every booth, "How does this help my billing?"
Every sales rep knew the answers cold. Up with fees; down with time.
One company had a "chart generation" program. The doc just clicks on various laptop icons while doing a patient interview, and a chart record of the visit is automatically generated in flowing prose like she'd stayed up all night typing: click icons for compliant, depressed, looks sad, worry, & family — you get this: “My patient, Mr. William Demarest, states that he has been compliant in taking his Effexor XR twice a day in the 4˝ weeks since our last appointment together. Bill states that he is still depressed. He looks sad. His appearance thus accords with his stated mood. Bill reports that he has lately been overcome with worry and has had family-related stress....”
(That program was $300 to install and $90 / month to use.)
Another program, by Valant, keeps track online of all billing & accounting for private practice pdocs for 8% of total receipts.
You can get an in-office clinical EEG kit with the electrodes connected to a shower cap thingie for just $20,000. Give one exam per business day, and it'd pay itself off in less than 2 years.
Cyberonics(?), the one that makes the vagal nerve stimulator (VNS), had a huuuuge display. They also bought a little booth across the aisle for one of their successful patients who had written an inspiring hardcover book about his experience. He was there, giving autographed copies away. It wasn't obvious that the one was paying for the other.
A few sales reps volunteered their work histories: 2 were clinical social workers who turned in their welfare clientele for potential multi-$100k salaries in drug sales.
Many of the sales reps were in uniforms: embroidered yellow oxford button-downs for the sleeping pill men. They ran around the hall in packs. They could've been waiters at Chili's gathered to sing happy birthday. Matching green wool suits for the Namenda guys. All of them young, trim, outgoing, and kinda hot. The women also were, I suppose, but I wasn't looking.
In Toronto, I saw the movie "Thank You for Smoking". In it, a fictional tobacco lobbyist always flies coach so that he can talk to young people on the plane. If he gets just ONE of them to try cigarettes, profits from the resulting lifetime of purchases will more than pay for the lobbyist's plane fare, round trip.
If the (I'm guessing) $200,000 booth and the flown-in sales team and all that cr*p they give away get just 35 docs to write scripts for just 20 patients each over the next year for a new drug, with at least a 2-month trial per patient... Yeah, that would pay for the plane fare and everything else. (I assume the $520 cost of my last Effexor bottle was mostly markup.)
Thanks for reading this far. :-)
Posted by pseudoname on May 23, 2006, at 16:11:49
In reply to pdoc convention exhibits, posted by pseudoname on May 23, 2006, at 16:07:21
…and bitter.
I wish I had some way of balancing out my unfavorable reactions to the drug & device marketing.
I'm very glad I went on the trip to Toronto. I almost bailed. I was still in bed 2 hours after I was supposed to leave. But I took a Metadate and an hour later, I was going. (Actually, I saw another methylphenidate drug display, but none for Metadate.)
I can't even express how much good the trip did me – especially meeting Bob & seven other Babblers. It was my first real trip in 10 years.
Posted by ed_uk on May 23, 2006, at 16:33:46
In reply to That sounded cynical…, posted by pseudoname on May 23, 2006, at 16:11:49
Dear PN
There are so many reasons to be cynical. Thank you for your post. It was hilarious........in a depressing kind of way! :S
I loved the bit about the automatic chart generator.
Ed
Posted by Larry Hoover on May 23, 2006, at 16:34:40
In reply to That sounded cynical…, posted by pseudoname on May 23, 2006, at 16:11:49
> I can't even express how much good the trip did me – especially meeting Bob & seven other Babblers. It was my first real trip in 10 years.
Wowzers, dude! A decade.
Trip on! Butter tarts forever!
Lar
Posted by Phil on May 23, 2006, at 16:54:46
In reply to pdoc convention exhibits, posted by pseudoname on May 23, 2006, at 16:07:21
"After that, I asked at almost every booth, "How does this help my billing?"
Haha! Good going. Kind of place that makes you feel that you should have brought along a snake bite kit.
Posted by yxibow on May 23, 2006, at 17:39:42
In reply to That sounded cynical…, posted by pseudoname on May 23, 2006, at 16:11:49
> …and bitter.
>
> I wish I had some way of balancing out my unfavorable reactions to the drug & device marketing.
>
> I'm very glad I went on the trip to Toronto. I almost bailed. I was still in bed 2 hours after I was supposed to leave. But I took a Metadate and an hour later, I was going. (Actually, I saw another methylphenidate drug display, but none for Metadate.)
>
> I can't even express how much good the trip did me – especially meeting Bob & seven other Babblers. It was my first real trip in 10 years.
Sounds like you got quite an eyeful of the convention -- though if you convert this to any other professions' trade convention, you're likely to see booths and people trying to sell their cr*p as well. Some years back I went on a gratis ticket to a digital graphics and audio convention -- I forget the name again, and the usual sets of booths and all. 140-180k, depending on the part of the country (or countries) is actually a fairly low salary for a p-doc, at least in major urban centers that have an affluent enough population in the US. It might be a midwest salary but it isn't a west or east coast salary by any stretch for seasoned psychiatrists.Toronto itself is a city I'd like to visit though, glad you got the chance -- I've been to various Canadian cities, and they're generally fairly cosmopolitan, especially Vancouver.
-- tidingsJay
Posted by linkadge on May 23, 2006, at 18:50:53
In reply to Re: That sounded cynical… » pseudoname, posted by yxibow on May 23, 2006, at 17:39:42
Yeah, it was a once in a lifetime opportunity, and I missed it. I'll be kicking myself. I wanted to meet Dr. Bob.
Anyhow, glad you thought it was worthwile.
Linkadge
Posted by pseudoname on May 23, 2006, at 20:12:05
In reply to Re: That sounded cynical…, posted by linkadge on May 23, 2006, at 18:50:53
> it was a once in a lifetime opportunity, and I missed it.
Not true! I'm sure (all else being equal) there will be more Babble birthday parties with Bob. I think he really enjoyed meeting Babblers under those circumstances.
And Bob said he would be thinking about possibly doing maybe another Babble presentation like this in the future. This one seemed to go over really well with the 5-6 pdocs & 1 social worker in attendance.
> Anyhow, glad you thought it was worthwile.
Thanks, linkadge.
Posted by linkadge on May 23, 2006, at 20:39:53
In reply to maybe not once-in-a-lifetime » linkadge, posted by pseudoname on May 23, 2006, at 20:12:05
oo, but it probably won't be that close to where I live.
I was less than 2 hours away, but could find no transportation.
Linkadge
Posted by pseudoname on May 24, 2006, at 1:07:54
In reply to Reasons to be cynical » pseudoname, posted by ed_uk on May 23, 2006, at 16:33:46
> I loved the bit about the automatic chart generator.
It didn't have an icon for “interesting”, so I don't know how it could chart *me*!
> Thank you for your post.
Thanks for telling me.
Posted by pseudoname on May 26, 2006, at 14:14:20
In reply to pdoc convention exhibits, posted by pseudoname on May 23, 2006, at 16:07:21
John McManamy, of McManWeb, the bipolar site, has also been reporting "live" from the APA in Toronto. He's got a lot more on the bipolar sessions.
blogs.healthcentral.com/bipolar/johns-bipolar-stories/reporting-live-from-the-american-psychiatric-association-2006-05-22
[Note: All the posts and comments were 100% civil as of this time, but since they're open, there's a possibility that uncivil comments may be added later.]
Posted by helpme on July 9, 2006, at 13:08:15
In reply to pdoc convention exhibits, posted by pseudoname on May 23, 2006, at 16:07:21
Oh my god, I hate pharmaceutical reps. I hate them at the doctors' offices, with their carts full of samples and them insisting on all kinds of imaginary diseases. Their drugs causing side effects that they got other drugs to treat....They pay for their own studies and don't bother to publish any negative ones. Manipulative. I really wish the industry was handled in a more responsable manner.
Posted by gardenergirl on July 9, 2006, at 15:22:47
In reply to Re: pdoc convention exhibits, posted by helpme on July 9, 2006, at 13:08:15
> and them insisting on all kinds of imaginary diseases.
Please don't post anything that could lead others to feel accused or put down. If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civilFollow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
Regards,
deputy gg
Posted by helpme on July 10, 2006, at 11:14:21
In reply to Please be civil » helpme, posted by gardenergirl on July 9, 2006, at 15:22:47
I guess I didn't communicate well. I am very apologetic, didn't mean to offend anyone here..
By "imaginary disease" I am not meaning to say that anyone's experiences or symptoms are in any way imaginary, I refer to the practice of pathologizing conditions that are either not pathologies, or somehow labeling people as defective in some way, especially when they are normal- does that make sense? THATS what I think is offensive.
Ie, rough examples: "PMS incapacitates women so they can't take important positions. It is a disease and they need meds. If you meet an angry woman, it is her disease. Don't pay attention to anything she says- here we got a pill to calm her opinions". "Gay people have a disorder, it is a disease and we have a pill for it." (Homosexuality was an official disease in DSM until recently, and hence certainly a candidate for pills. I'd call that an "imaginary disease".) "We gotta find SOME use for xyz pill now that we developed it and it doesn't work for what we intended-oh that person looks like a deviant of somekind". Is ageing supposed to be a "disease"? Is wilfully staying up late to party or work or do whatever and getting by on 4 hours of sleep per night and the resulting tiredness a "tiredness disease" requiring amphetamines or a behavior/lifestyle/psychlogy issue? If your neighbor is noisy and you can't sleep through the noise do you have a "can't sleep through noise disease"??? A "sleep disorder"? I'd not call that a genuine sleep disorder. Should a pill be developed? And for which person, you or the neighbor?
Did you know all those pills pushed for "GERD" actually result in a loss of stomache acid production and loss of ability to properly absorb nutrition and even more pain? And they rob you of B vitamins? I finally found more relief from my stomache pain by cutting coffee, NSAIDS, and alcohol down. I'm 100% fine when I consume those items in moderation or not at all. Probably better off without them anyway. But my general practitioner thinks I have a "disease", wrote that down, and keeps prescribing the pills so I can drink more coffee.
I've studied some Medical Anthropology in college and that is where this perspective came from. Different peoples have recognized similar physical symtoms and packaged them and treated them in different ways. Very sincerely sorry if I offended.
The only people I am angry with are manipulative drug marketeers who overdose innocent people and thereby harm them with all kinds of drug interactions and side effects.I'm also very sorry that my liver is in such a strain after having so many "diseases" over the years.
> > and them insisting on all kinds of imaginary diseases.
>
> Please don't post anything that could lead others to feel accused or put down. If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
> http://www.dr-bob.org/babble/faq.html#civil
>
> Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
>
> Regards,
> deputy gg
>
>
>
Posted by helpme on July 10, 2006, at 12:33:07
In reply to Please be civil » helpme, posted by gardenergirl on July 9, 2006, at 15:22:47
Can't emphasize enough my remorse for saying something nuanced and complex enough for a dissertation in corse way. Very sorry. I just don't have the ooomph to get into a proper, succinct elucidation of what I meant, so I shouldn't have mentioned it here, but I guess it's too late.
I guess I just harbor a lot of anger against greedy or dishonest drug sales people who tempt doctors with prizes for writing the most prescriptions, and then at those particular doctors who really get in to it. Like the time I went to the doctor with stomache pain, in retrospect I realize it was likely due to drinking about 10 cups of coffee a day whilst working at a coffee shop. After 30 seconds she said, "You have GERD", and she gave me a script on a pad pre-printed by the particular drug company. I read the list of symptioms, but it didn't seem right. Her response was just what the samples' literature said: "symptoms vary widely". The drug did nothing for me, but diet changes and common sense about the coffee did. So for me the disease was imaginary, I suspect for many others too. But I do not in any way question their experience, nor do I discount that such a genuine condition may in fact exist. I just don't think everybody has it, and the "solutions" cause new problems that then must be contended with- like the vitamin absorption problem.. But I do know they are really raking in a ton of cash off these prescriptions.
And the "pms" example- everyone in the US is in on the PMS craze- a terrible disorder apparently suffered by millions of women every month. But I have some friends from other countries who told me "oh- yes of course normal women have monthly hormonal fluctuations. It's a good time to take it easy, or use a heating pad, or a painkiller, whatever is needed, etc. For some it's worse than for others." Many also said, "Oh no, never heard of pms. How can you think these things can be a disease when millions of normal women experience these cycles every month?" I would personally rather have monthly hormonal fluctuations and maye a couple cramps than have an Official PMS Disorder for 50% of my life, and then use it as an excuse for not being able to take on responsabilities, or to have people autiomatically dismiss any of my observations, opinions, or feelings because they are the mental manifestations of a "documented disease." In anthropology class in college I was told that in some Native American cultures there was no "PMS"- rather, there were times when women became psychically sensitive, so much so that they often felt pain easily. They became creative and would go to a special "menstral hut" and ate special food and got so many massages that were envied. Supposedly people consulted with them for they were so sensitive. This is our "PMS Disease"?
I also harbor a lot of anger at the particular pharmaceutical people who overemphasize dangerous drugs, conceal the dangers, for some symptoms that can be managed in safer ways via lifestyle or other, safer cheaper drugs. Sometimes absolutely the benefits of dangerous drugs outweigh the harms, but trying to boost sales to make money with these I think is a heinously corrupt thing to do. Maybe x number of people genuinely have condition xyz, but the drug was expensive to develope and there are not enough potential patients to make up the cost of development or to make a profit. So they set their marketing teams out to find new takers. This practice has been documented in a number of books and articles.
I had a bad psychioatrist once who insisted the headache I got from lamictal was a brand new "Migraine disorder"-but it was gone when the lamictal was gone. She also said I was developing real "Psychosis" when I tried zyprexa for resistant depression and it gave me hallucinatory side efects. They too vanished when the zyprexa went away. Better psychiatrist told me "do not create new side efects and then treat them with other drugs and get into even more side efects. Skip the side effects, let's not confuse them with your genuine problem, and lets find the right treatment that works. Simple is usually best for this very reason". Thank god.
I personally have had my physical heath harmed by too many drugs, now all kinds of abnormal kidney and liver blood tests and my stomache is torn up from too much advil, which I ate like candy for 20 years medical personell repeatedly insisted to me it was harmless. Meanwhile, I have friends who had experienced similar symptoms, didn't cionsider them serious medical conditions, made some lifestyle adjustments, and don't have the new problems.
I figure I better choose my real diseases/conditions carefully and selectively. I suffer from depression and anxiety, but I don't want to look for new problems, or pretend that any drug side effects are anything other than that. I don't want to call any drug side effects that I've had "diseases" or treat them with other drugs. I found drugs are nothing to fool around with.
I hope I made myself clearer and less offensive, not dug in deeper.
> > and them insisting on all kinds of imaginary diseases.
>
> Please don't post anything that could lead others to feel accused or put down. If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
> http://www.dr-bob.org/babble/faq.html#civil
>
> Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
>
> Regards,
> deputy gg
>
>
>
Posted by pseudoname on July 10, 2006, at 13:02:44
In reply to Re: Please be civil, posted by helpme on July 10, 2006, at 12:33:07
Hi again, helpme.
Please don't take getting a PBC too hard. Everyone understands that Bob's rules can take some getting used to, and PBCs don't necessarily carry any stigma. Many people have gotten them at some point or other, often for just careless wording, not malice.
A PBC like the one you got is just a reminder or a phraseology memo, not a rebuke for your intentions. I think people understand that.
It's different when PBCs are given for nasty, mean behavior. Your post was not in that category. Be well.
Posted by helpme on July 10, 2006, at 16:58:37
In reply to Please don't take it too hard » helpme, posted by pseudoname on July 10, 2006, at 13:02:44
Thanks, I've been really ruminating over it.
And I thought of a different example of the kind of thing that might illustrate why I felt the marketing was getting out of hand and made the "imaginary" remark: just read about a brand new official psychiatric disorder known as "Internet Addiction", complete with Diagnostic Code for insurance companies. How is that legitimate? Why is it not a manifestation of say, OCD or social avoidance, you see? Or even boredom at work? Will there be tv commercials soon saying, "You might not know, but your internet use is not your fault. It is a terrible, but fortunately now treatable very serious medical condition we can help you with (using our old antidepressent that hasn't been selling well and which we just re-packaged). Millions suffer from it and don't even realize it. Talk to your doctor today, and ask for the treatment. Tell him to call us if he's never heard of this very treatable problem because it can get much much worse if you don't."
I better stay away and go do something else for awhile myself...
> Hi again, helpme.
>
> Please don't take getting a PBC too hard. Everyone understands that Bob's rules can take some getting used to, and PBCs don't necessarily carry any stigma. Many people have gotten them at some point or other, often for just careless wording, not malice.
>
> A PBC like the one you got is just a reminder or a phraseology memo, not a rebuke for your intentions. I think people understand that.
>
> It's different when PBCs are given for nasty, mean behavior. Your post was not in that category. Be well.
This is the end of the thread.
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