14 ms·

Association between gifts from pharma group to drug prescribed by French doctors

133 points by hokkos 7y ago

techaddict009 7y ago
Its pretty open in India. Drugs prescribed by a Doctor can be bought and is mostly available only from the store he mentions in the prescription. Big doctors have their own store. You go anywhere else very rarely you can find the same drug. Most of the times doctors will prescribe additional 2-3 generic seasonal medicine which you mostly do not need just to achieve targets so that they can claim their gifts (TVs, Foreign Trips, etc.) This a serious issue in India which no one is batting an eye on.
- johnchristopher 7y ago
  What kind of drugs do they prescribe ? Alopathic ? Ayurvedic ? Do they favour one over the other ? If only a particular doctor can prescribe his own brand of drugs, does it mean he designs and manufactures them or is there a pool of common recipes from which any pharmacist can make the drug and sell it under very different names ?
  - techaddict009 7y ago
    1 - Allopathic. 2 - No much clarity on that. But think these guys (these = pharma company) sell area wise. Say if they tied up with pharma store A for x medicine. They will not sell the same in any other pharam store in that area. And will tie up with Doctors in that area to sell that medicine. I will try to get more info on this. Each company has MR (Medical Representatives) they meet docotor every week on one day and present their schemes and offers.
- hereiskkb 7y ago
  Can confirm. It is pretty abhorrent how widespread this practice is in India. IMO, the practice ought to be made unlawful. Medicine is a life-critical sector. As such regulations need to be the tightest around it.
  - Scoundreller 7y ago
    One way or another, it’s widespread everywhere. The exact degree may vary, but it happens everywhere. Usually the laws and regulators allow prescribers tons of discretion, which is often subject to abuse that costs time/money/outcomes to somebody else.
- r_singh 7y ago
  You're right about this being an epidemic. However, due to rising awareness in recent times, there is a reverse trend. I live in an expensive neighbourhood in a TIER 1 city in India and can confirm that many general physicians now prescribe medicines by their generic names. That being said, it doesn't change the fact that the practice is still widespread. For e.g. I have never been to a dermatologist who will not insist on purchasing a particular often over priced brand, many even have their own pharmacy at their clinic. I'm often shocked by the leniency of laws subject to doctors in India.
- Iv 7y ago
  In France, the prescription is valid in any pharmacy and the pharmacy seller (who has a degree in pharmacology) can and often do propose the generic version of the prescribed drug. There has been some marketing to present generics as cheap knockoffs of bad quality, leading to many people choosing to pay for the prescribed drug (which will be reimbursed anyway) but it all comes down to the patient's behavior.
  - linuxftw 7y ago
    Generics might be cheap knockoffs. It's uncertain if the purity, formulation, method of production, and quality control for a generic will yield the same benefits (or any benefits) for a particular drug. There are countless stories about how some people like some brands of generics better than others. There was some reporting around these parts recently that generics don't really undergo any kind of efficacy studies, they are assumed to just work, and there's really not much oversight whatsoever.
    - Iv 7y ago
      Hmmm, I must confess I don't know the specifics of the laws and controls, but box of medicine have to state the composition: the molecules present and their quantities. Got prescribed 3 mg of TradeMarked(tm) <moleculeXXX>, a generic would be 3mg of NoName <moleculeXXX>. I think labeling a generic incorrectly would result in pretty heavy fines.
      - linuxftw 7y ago
        Consider magnesium supplements. You can get magnesium in a variety of forms: magnesium oxide, magnesium citrate, magnesium taurate, magnesium glycinate. Each one of those formulas is going to contain magnesium, but the magnesium is bound to another molecule. One form of magnesium maybe be more effective than another for any given individual or condition. Some products are labeled as just "Magnesium" and it's unclear what form the magnesium is in. Then there's a consideration of yield and purity. If you're making a compound through a given process, it's going to yield X amount of the desired compound, and Y amount of something else (other compounds or unconverted materials). Some of this is going to make it into the end product. If two companies are using totally different processes to create the same end compound, everything is going to be different. > I think labeling a generic incorrectly would result in pretty heavy fines. Who's watching? I don't recall hearing much about generic manufacturers of prescription medications facing much scrutiny.
- legulere 7y ago
  In Germany doctors are not allowed to sell you prescription drugs, or tell you to which pharmacy to go to. The doctors have to select the cheapest of comparable medications and the pharmacy has to replace with the cheapest available medications. All this just applies for public healthcare. Private healthcare is basically an unregulated Wild West.
simosx 7y ago
It should be common in most European countries that have national health systems. edit: Source: https://blogs.mediapart.fr/emmanuel-kosadinos/blog/310818/novartis-greece-scandal-unveils-permanent-scandal-pharma-industry https://blogs.mediapart.fr/emmanuel-kosadinos/blog/310818/no...
- icebraining 7y ago
  Maybe, but this study is about GPs who worked exclusively in the private sector (the NHS just subsidized the prescriptions), not about NHS doctors.
- jacquesm 7y ago
  It actually most likely isn't common. In the past it was, but there was a serious crackdown on doctors improving their golf handicaps in luxury resorts on the dime of big pharma and all variations on that theme. Surprised to see this make a recurrence.
  - rscho 7y ago
    It's not a recurrence. It never really stopped.
  - Scoundreller 7y ago
    Sometimes that crackdown is because the big pharma companies are happy with their current positions, so they propose cutting all of these expenses across-the-Board. Then they maintain their incumbency and reduce a lot of their costs without a huge hit to revenue. And if you’re a new pharma company with a truly awesome product, good luck getting anyone to prescribe it when you didn’t buy them a round of golf a decade ago because you didn’t exist.
nraynaud 7y ago
And French doctors have access to a periodical about drug that is anal on not taking money from big pharma ( https://en.wikipedia.org/wiki/Prescrire https://en.wikipedia.org/wiki/Prescrire ).
Ididntdothis 7y ago
I bet the doctors’ lobby will deny that payments will have any impact on their behavior. The same way they deny that working 24 hour shifts and being sleep deprived has no impact on their performance.
- rjkennedy98 7y ago
  Its amazing how the people we trust with understanding science and evidence-based medicine are completely unable to unable to act in accordance with evidence when it comes to themselves. Good lesson for anyone who trusts our medical system.
  - rscho 7y ago
    Doctors are not scientists. Doctors understanding basic science are 1:1000, and the rest of us follow EBM practices blindly similarly to a religion. However, it's not scientific ability that makes a good doc. Scientific ability is really not a criteria for adjusting your trust in a particular practitioner. I'd even say it's often that supposedly doctor-scientists (academics) are the worst.
    - Scoundreller 7y ago
      From what I’ve seen in those doctor review sites and some pharmacy experience, what makes a good doctor in a lot of patient’s minds is whether they get whatever they want or not. Telling patients that a requested test/referral/intervention isn’t supported by evidence really upsets people. And being nice goes a long way.
      - rscho 7y ago
        Indeed. And 'flexibly sticking to guidelines' goes a long way too. There's a balance to find between pleasing your patient and doing the 'medically correct' thing. That's where the difficulty lies.
  - linuxftw 7y ago
    Now apply this same line of skepticism to a certain class of inject-able drugs and be labeled a crackpot.
rscho 7y ago
GP in France is such a shitty job that people will go to great lengths to avoid that sector. French GPs earn ~25$ (base price) per patient, so they have to work their ass off to have a decent lifestyle. The people here talking about golf courses and living the life just have no idea what they're talking about. It's VERY different from the issues of the american system and it's no wonder this is happening.
- Ntrails 7y ago
  > French GPs earn ~25$ (base price) per patient My GP sees ~10 people per hour, ~7 hours a day. That sounds like it would be worth 1750 per day. Assume 250 day working year for the ease of my mental maths, you've got ~450k revenue? Assuming tests/drugs etc are all extra, and that the surgery takes a sizable chunk - it still feels a decent distance from the breadline?
  - rscho 7y ago
    Yes and no. You are forgetting unpaid (compulsory) on-call work and the necessity to pay administrative staff if you want to work full-time (the amount of papers is such that you can't do without). So far from the breadline on objective criteria, yes. Far enough that people wouldn't do anything to work in another specialty or do something where you have a better lifestyle, no. So GPs are usually not doing that by choice.
  - 343254356 7y ago
    My GPs in France would see me for at least 30 minute each time, taking great care to check everything. It was quite a shock when I arrived in the UK and my GP would show me the door after 10 minutes. The downside is that the French GP will never take you on time for your appointment, but you will feel that you are taken care of, unlike in the UK system. I came once just for a quick health check before start a new sport, and I got an electro-cardiogram (to check for heart murmur, for free obviously), simply because I never had one in my life. They will often ask if your vaccinations are in order, how do you feel, things like that.
    - 7y ago
guerby 7y ago
Data point according to: https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobbying https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobby... In 2003 pharma industry was pending more than 20 000 EUR per year per doctor in France. Not far for a full time employee per doctor. One quarter of revenue on marketing, more than for research. Most of this is because of government granted monopolies aka patents. Alternatives are proposed, see Dean Baker for example https://www.nytimes.com/roomfordebate/2015/09/23/should-the-government-impose-drug-price-controls/end-patent-monopolies-on-drugs https://www.nytimes.com/roomfordebate/2015/09/23/should-the-... http://cepr.net/publications/briefings/testimony/drugs-are-cheap-why-do-we-let-governments-make-them-expensive http://cepr.net/publications/briefings/testimony/drugs-are-c... https://www.ncbi.nlm.nih.gov/pubmed/15346683 https://www.ncbi.nlm.nih.gov/pubmed/15346683 (yes nothing new :) Book : https://deanbaker.net/books/rigged.htm https://deanbaker.net/books/rigged.htm Blog : http://cepr.net/blogs/beat-the-press/ http://cepr.net/blogs/beat-the-press/
- rscho 7y ago
  I very much doubt it's 20'000 EUR for GPs. It's likely much lower, because what you are citing includes data for surgeons, dermatologists, ophtalmologists, etc. who all are much higher priority targets for pharma marketing.
- friedman23 7y ago
  >One quarter of revenue on marketing, more than for research. They wouldn't be spending money on marketing if those expenses didn't bring in more dollars. Which in turn means more money for research...
mirimir 7y ago
In a previous lifetime, I had access to pharmaceutical industry data, at the level of individual products, which reported the relationship between detailing (visits to doctors by drug reps) and prescription behavior (for target drugs and competitors). Bottom line, pharmaceutical manufacturers employ drug reps because they increase sales. For up-and-coming brands, detailing is a major promotional component. And it's carefully managed.
ajudson 7y ago
"During this outbreak, Muyembe has also made a decision many thought unthinkable even a few years ago. He decided that all of the blood samples collected during this Ebola epidemic will stay in Congo. Anyone who wants to study this outbreak will have to come to his institute." not sure if this is a good idea
pkaye 7y ago
In the US, you can look up your doctor here https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/ Apparently drug and medical supply companies are required by law to report anything they gift to doctors or hospitals.

133 points by hokkos 7y ago

Its pretty open in India. Drugs prescribed by a Doctor can be bought and is mostly available only from the store he mentions in the prescription. Big doctors have their own store. You go anywhere else very rarely you can find the same drug. Most of the times doctors will prescribe additional 2-3 generic seasonal medicine which you mostly do not need just to achieve targets so that they can claim their gifts (TVs, Foreign Trips, etc.) This a serious issue in India which no one is batting an eye on.

johnchristopher 7y ago
What kind of drugs do they prescribe ? Alopathic ? Ayurvedic ? Do they favour one over the other ? If only a particular doctor can prescribe his own brand of drugs, does it mean he designs and manufactures them or is there a pool of common recipes from which any pharmacist can make the drug and sell it under very different names ?
- techaddict009 7y ago
  1 - Allopathic. 2 - No much clarity on that. But think these guys (these = pharma company) sell area wise. Say if they tied up with pharma store A for x medicine. They will not sell the same in any other pharam store in that area. And will tie up with Doctors in that area to sell that medicine. I will try to get more info on this. Each company has MR (Medical Representatives) they meet docotor every week on one day and present their schemes and offers.
hereiskkb 7y ago
Can confirm. It is pretty abhorrent how widespread this practice is in India. IMO, the practice ought to be made unlawful. Medicine is a life-critical sector. As such regulations need to be the tightest around it.
- Scoundreller 7y ago
  One way or another, it’s widespread everywhere. The exact degree may vary, but it happens everywhere. Usually the laws and regulators allow prescribers tons of discretion, which is often subject to abuse that costs time/money/outcomes to somebody else.
r_singh 7y ago
You're right about this being an epidemic. However, due to rising awareness in recent times, there is a reverse trend. I live in an expensive neighbourhood in a TIER 1 city in India and can confirm that many general physicians now prescribe medicines by their generic names. That being said, it doesn't change the fact that the practice is still widespread. For e.g. I have never been to a dermatologist who will not insist on purchasing a particular often over priced brand, many even have their own pharmacy at their clinic. I'm often shocked by the leniency of laws subject to doctors in India.
Iv 7y ago
In France, the prescription is valid in any pharmacy and the pharmacy seller (who has a degree in pharmacology) can and often do propose the generic version of the prescribed drug. There has been some marketing to present generics as cheap knockoffs of bad quality, leading to many people choosing to pay for the prescribed drug (which will be reimbursed anyway) but it all comes down to the patient's behavior.
- linuxftw 7y ago
  Generics might be cheap knockoffs. It's uncertain if the purity, formulation, method of production, and quality control for a generic will yield the same benefits (or any benefits) for a particular drug. There are countless stories about how some people like some brands of generics better than others. There was some reporting around these parts recently that generics don't really undergo any kind of efficacy studies, they are assumed to just work, and there's really not much oversight whatsoever.
  - Iv 7y ago
    Hmmm, I must confess I don't know the specifics of the laws and controls, but box of medicine have to state the composition: the molecules present and their quantities. Got prescribed 3 mg of TradeMarked(tm) <moleculeXXX>, a generic would be 3mg of NoName <moleculeXXX>. I think labeling a generic incorrectly would result in pretty heavy fines.
    - linuxftw 7y ago
      Consider magnesium supplements. You can get magnesium in a variety of forms: magnesium oxide, magnesium citrate, magnesium taurate, magnesium glycinate. Each one of those formulas is going to contain magnesium, but the magnesium is bound to another molecule. One form of magnesium maybe be more effective than another for any given individual or condition. Some products are labeled as just "Magnesium" and it's unclear what form the magnesium is in. Then there's a consideration of yield and purity. If you're making a compound through a given process, it's going to yield X amount of the desired compound, and Y amount of something else (other compounds or unconverted materials). Some of this is going to make it into the end product. If two companies are using totally different processes to create the same end compound, everything is going to be different. > I think labeling a generic incorrectly would result in pretty heavy fines. Who's watching? I don't recall hearing much about generic manufacturers of prescription medications facing much scrutiny.
legulere 7y ago
In Germany doctors are not allowed to sell you prescription drugs, or tell you to which pharmacy to go to. The doctors have to select the cheapest of comparable medications and the pharmacy has to replace with the cheapest available medications. All this just applies for public healthcare. Private healthcare is basically an unregulated Wild West.

simosx 7y ago

It should be common in most European countries that have national health systems. edit: Source: https://blogs.mediapart.fr/emmanuel-kosadinos/blog/310818/novartis-greece-scandal-unveils-permanent-scandal-pharma-industry https://blogs.mediapart.fr/emmanuel-kosadinos/blog/310818/no...

icebraining 7y ago
Maybe, but this study is about GPs who worked exclusively in the private sector (the NHS just subsidized the prescriptions), not about NHS doctors.
jacquesm 7y ago
It actually most likely isn't common. In the past it was, but there was a serious crackdown on doctors improving their golf handicaps in luxury resorts on the dime of big pharma and all variations on that theme. Surprised to see this make a recurrence.
- rscho 7y ago
  It's not a recurrence. It never really stopped.
- Scoundreller 7y ago
  Sometimes that crackdown is because the big pharma companies are happy with their current positions, so they propose cutting all of these expenses across-the-Board. Then they maintain their incumbency and reduce a lot of their costs without a huge hit to revenue. And if you’re a new pharma company with a truly awesome product, good luck getting anyone to prescribe it when you didn’t buy them a round of golf a decade ago because you didn’t exist.

nraynaud 7y ago

And French doctors have access to a periodical about drug that is anal on not taking money from big pharma ( https://en.wikipedia.org/wiki/Prescrire https://en.wikipedia.org/wiki/Prescrire ).

Ididntdothis 7y ago

I bet the doctors’ lobby will deny that payments will have any impact on their behavior. The same way they deny that working 24 hour shifts and being sleep deprived has no impact on their performance.

rjkennedy98 7y ago
Its amazing how the people we trust with understanding science and evidence-based medicine are completely unable to unable to act in accordance with evidence when it comes to themselves. Good lesson for anyone who trusts our medical system.
- rscho 7y ago
  Doctors are not scientists. Doctors understanding basic science are 1:1000, and the rest of us follow EBM practices blindly similarly to a religion. However, it's not scientific ability that makes a good doc. Scientific ability is really not a criteria for adjusting your trust in a particular practitioner. I'd even say it's often that supposedly doctor-scientists (academics) are the worst.
  - Scoundreller 7y ago
    From what I’ve seen in those doctor review sites and some pharmacy experience, what makes a good doctor in a lot of patient’s minds is whether they get whatever they want or not. Telling patients that a requested test/referral/intervention isn’t supported by evidence really upsets people. And being nice goes a long way.
    - rscho 7y ago
      Indeed. And 'flexibly sticking to guidelines' goes a long way too. There's a balance to find between pleasing your patient and doing the 'medically correct' thing. That's where the difficulty lies.
- linuxftw 7y ago
  Now apply this same line of skepticism to a certain class of inject-able drugs and be labeled a crackpot.

rscho 7y ago

GP in France is such a shitty job that people will go to great lengths to avoid that sector. French GPs earn ~25$ (base price) per patient, so they have to work their ass off to have a decent lifestyle. The people here talking about golf courses and living the life just have no idea what they're talking about. It's VERY different from the issues of the american system and it's no wonder this is happening.

Ntrails 7y ago
> French GPs earn ~25$ (base price) per patient My GP sees ~10 people per hour, ~7 hours a day. That sounds like it would be worth 1750 per day. Assume 250 day working year for the ease of my mental maths, you've got ~450k revenue? Assuming tests/drugs etc are all extra, and that the surgery takes a sizable chunk - it still feels a decent distance from the breadline?
- rscho 7y ago
  Yes and no. You are forgetting unpaid (compulsory) on-call work and the necessity to pay administrative staff if you want to work full-time (the amount of papers is such that you can't do without). So far from the breadline on objective criteria, yes. Far enough that people wouldn't do anything to work in another specialty or do something where you have a better lifestyle, no. So GPs are usually not doing that by choice.
- 343254356 7y ago
  My GPs in France would see me for at least 30 minute each time, taking great care to check everything. It was quite a shock when I arrived in the UK and my GP would show me the door after 10 minutes. The downside is that the French GP will never take you on time for your appointment, but you will feel that you are taken care of, unlike in the UK system. I came once just for a quick health check before start a new sport, and I got an electro-cardiogram (to check for heart murmur, for free obviously), simply because I never had one in my life. They will often ask if your vaccinations are in order, how do you feel, things like that.
  - 7y ago

guerby 7y ago

Data point according to: https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobbying https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobby... In 2003 pharma industry was pending more than 20 000 EUR per year per doctor in France. Not far for a full time employee per doctor. One quarter of revenue on marketing, more than for research. Most of this is because of government granted monopolies aka patents. Alternatives are proposed, see Dean Baker for example https://www.nytimes.com/roomfordebate/2015/09/23/should-the-government-impose-drug-price-controls/end-patent-monopolies-on-drugs https://www.nytimes.com/roomfordebate/2015/09/23/should-the-... http://cepr.net/publications/briefings/testimony/drugs-are-cheap-why-do-we-let-governments-make-them-expensive http://cepr.net/publications/briefings/testimony/drugs-are-c... https://www.ncbi.nlm.nih.gov/pubmed/15346683 https://www.ncbi.nlm.nih.gov/pubmed/15346683 (yes nothing new :) Book : https://deanbaker.net/books/rigged.htm https://deanbaker.net/books/rigged.htm Blog : http://cepr.net/blogs/beat-the-press/ http://cepr.net/blogs/beat-the-press/

rscho 7y ago
I very much doubt it's 20'000 EUR for GPs. It's likely much lower, because what you are citing includes data for surgeons, dermatologists, ophtalmologists, etc. who all are much higher priority targets for pharma marketing.
friedman23 7y ago
>One quarter of revenue on marketing, more than for research. They wouldn't be spending money on marketing if those expenses didn't bring in more dollars. Which in turn means more money for research...

mirimir 7y ago

In a previous lifetime, I had access to pharmaceutical industry data, at the level of individual products, which reported the relationship between detailing (visits to doctors by drug reps) and prescription behavior (for target drugs and competitors). Bottom line, pharmaceutical manufacturers employ drug reps because they increase sales. For up-and-coming brands, detailing is a major promotional component. And it's carefully managed.

ajudson 7y ago

"During this outbreak, Muyembe has also made a decision many thought unthinkable even a few years ago. He decided that all of the blood samples collected during this Ebola epidemic will stay in Congo. Anyone who wants to study this outbreak will have to come to his institute." not sure if this is a good idea

pkaye 7y ago

In the US, you can look up your doctor here https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/ Apparently drug and medical supply companies are required by law to report anything they gift to doctors or hospitals.