6 ms·

The American medical system is truly bizarre. I've been to private practices where every day at lunch or near end of day there would be some drug rep with food

by Brybry 5y ago

The American medical system is truly bizarre. I've been to private practices where every day at lunch or near end of day there would be some drug rep with food for all the staff. And a psychiatrist that had stacks of free samples of drugs. Even contact lenses are marketed with free samples.

listenallyall 5y ago
Everyone talks about the relationship between drug reps and doctors like it's the most incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a doctor is going to spend his limited downtime perusing the PDR (which no longer exists, and was always heavily influenced by the drug manufacturers anyway)? Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.
- nextaccountic 5y ago
  > How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.
  - listenallyall 5y ago
    Who is teaching the courses? Where do they get their info? Given the very limited oversight of "continuing education", it's trivial for Merck or Pfizer to ensure their advocate teaches the class or records the online seminar -- with zero requirement that they disclose that fact. At least when a drug rep visits the office and buys lunch, you know the source.
    - nextaccountic 5y ago
      At this point we need public policy to stop such bad actors. Or you mean we should give up and do nothing? But why?
- Jabbles 5y ago
  Scrubs covers this: https://www.youtube.com/watch?v=JVTWoPeMWSQ https://www.youtube.com/watch?v=JVTWoPeMWSQ
- colinmhayes 5y ago
  In Illinois Doctors have to go to a one week conference every year that is supposed to talk about this stuff. They also have to take board exams every few years that make sure they're staying caught up on new advances.
  - listenallyall 5y ago
    It's 60 hours every 3 years, of which webinars are acceptable, and no records need to be submitted with the renewal application. There are no tests or exams. The "new advances" they must keep up on include Sexual Harassment Prevention and Implicit Bias. https://www.isms.org/CME/Medical-License/License-Requirements https://www.isms.org/CME/Medical-License/License-Requirement...
- afandian 5y ago
  Is there no continuing training throughout the career of a doctor? And if not, how are they qualified to evaluate the claims of a sales rep?
- rafale 5y ago
  It's their responsibility to stay up-to-date. If a dev can keep up with front end tech stacks, doctors, who are much more elite in their education, should keep track of latest treatment breakthroughs in their domain of expertise.
  - listenallyall 5y ago
    First of all, the vast majority of devs do NOT stay "up to date." Most know one language or even just one platform... i.e. "WordPress developer" or "Oracle admin". Secondly, how do you think YOU hear about new technologies... usually due to marketing. Did React just come out of nowhere? No, Facebook marketed it relentlessly. Did people discover Kotlin on their own? No, JetBrains and Google hit people over the head with it. Etc, etc
    - makapuf 5y ago
      Is it really the case that Facebook marketed heavily React? Why? What do they gain from it? Real question, or not like react was an entry point to their API?
      - krageon 5y ago
        It was fairly obvious when it was an up and coming thing. They sent out engineers to talk about it, you had these articles popping up about it more or less out of nowhere, etc. If you weren't there (which I'm guessing you're not, otherwise why would you ask), it is hard to imagine. Perhaps it makes more sense when you consider how normal "advertorials" are now.
  - divbzero 5y ago
    Continuing medical education not only a responsibility but also a requirement to maintain a medical license in many states (e.g. California [1]). [1]: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Renew/Current-Status/Continuing-Medical-Education.aspx https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Ren...
    - 5y ago
- austinjp 5y ago
  Part of the job, as stipulated by medical regulators around the world, is keeping up-to-date with evidence. This can be achieved by reading journals and attending conferences, in theory. But.... journal publishers exploit their monopolies, and conferences are funded by corporate sponsors. So perhaps they're not so different.
  - listenallyall 5y ago
    Medical conferences basically would not exist if it wasn't for suppliers and drug companies paying for sponsorships, trade show booths, opportunities to speak, etc. Not really any different than any industry's trade conferences.
    - throwawayboise 5y ago
      Sounds just like every technology conference I've ever been to. A bunch of software and hardware vendor booths, and most of the speakers being authors hawking their latest books.
- deleted 5y ago
  [deleted]
- matheusmoreira 5y ago
  > How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? They are supposed to study. Continuously.
  - listenallyall 5y ago
    Study what? Even the New England Journal of Medicine is full of articles funded by drug companies. And for good reason -- the results of drug trials should be communicated to physicians. Buying them lunch may be less prestigious, but it's essentially the same thing. Merck, Dec 2021: https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 AstraZeneca, Jan 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2112431 https://www.nejm.org/doi/full/10.1056/NEJMoa2112431
    - matheusmoreira 5y ago
      There's more material available, not just scientific journal articles. The medical specialty associations periodically release detailed guidelines covering new criteria, methods, treatments. For example: https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15026 https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.... There are courses available if you wish to be taught. There are events where people present new developments. There are paid sites like UpToDate. Even textbooks eventually get new editions and there's always plenty of fundamental science in them that doesn't change
      - listenallyall 5y ago
        Did you check the Disclosures section of your article? Are there any drug companies NOT included there? Like it or not, private companies fund the vast majority of medical research in the U.S., and any doctor who wants to stay up to date cannot (and should not) ignore it all. The authors have no conflict of interest to declare, but declare lecture honoraria or consulting fees as follows: T.U., Bayer, Boehringer Ingelheim, Hexal, Vifor Pharma; C.B., Servier, Menarini, Merck Pharma, Novartis, Egis, Daichy Sankyo, Gilead; N.R.P., Servier, Pfizer, Sanofi, Eva Pharma; D.P., Torrent Pharmaceuticals; M.S., Medtronic, Abbott, Novartis, Servier, Pfizer, Boehringer-Ingelheim; G.S.S., AstraZeneca, Menarini, Pfizer, Servier; B.W., Vascular Dynamics USA, Inc, Relypsa, Inc, USA; Daiichi Sankyo, Pfizer, Servier, Novartis, Menarini, Omron; A.E.S., Omron, Novartis, Takeda, Servier, Abbott.
Scoundreller 5y ago
> Even contact lenses are marketed with free samples. I mean, yeah? If a shoe company required you to buy a shoe before trying it on without free returns, the shoe may as well not exist.
cosmodisk 5y ago
I used to see this in our country, where 10 people are queueing outside doc's office ( this is public health system) when some well dressed man goes straight into the office not even bothering to ask if there's anyone in there and fast forward a few min and the doctor is 'on break', whilst drinking coffee with the sales rep, while all those people sit and wait. Eventually it got outlawed.
- matheusmoreira 5y ago
  That's extremely rude. How could he just barge into the doctor's office? A physical examination could be taking place. In my experience at a specialized neurology practice: they wait outside until the doctor is free, then knock on the door and ask if they have a moment. They would almost always get straight to business, never wasted more than half a minute of people's time socializing.
matheusmoreira 5y ago
Drug companies offer a lot of free samples. It's the same drugs the psychiatrists were going to prescribe anyway, they're just trying to get them to prefer one brand over the other. Sertraline, for example, is first line treatment for depression, anxiety. Getting free sertraline samples reduces costs for patients and really helps them out. Especially in my country where generic medication is often found to not be of the same quality as those manufactured by big pharmaceutical companies.

by Brybry 5y ago

listenallyall 5y ago

Everyone talks about the relationship between drug reps and doctors like it's the most incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a doctor is going to spend his limited downtime perusing the PDR (which no longer exists, and was always heavily influenced by the drug manufacturers anyway)? Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.

nextaccountic 5y ago
> How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.
- listenallyall 5y ago
  Who is teaching the courses? Where do they get their info? Given the very limited oversight of "continuing education", it's trivial for Merck or Pfizer to ensure their advocate teaches the class or records the online seminar -- with zero requirement that they disclose that fact. At least when a drug rep visits the office and buys lunch, you know the source.
  - nextaccountic 5y ago
    At this point we need public policy to stop such bad actors. Or you mean we should give up and do nothing? But why?
Jabbles 5y ago
Scrubs covers this: https://www.youtube.com/watch?v=JVTWoPeMWSQ https://www.youtube.com/watch?v=JVTWoPeMWSQ
colinmhayes 5y ago
In Illinois Doctors have to go to a one week conference every year that is supposed to talk about this stuff. They also have to take board exams every few years that make sure they're staying caught up on new advances.
- listenallyall 5y ago
  It's 60 hours every 3 years, of which webinars are acceptable, and no records need to be submitted with the renewal application. There are no tests or exams. The "new advances" they must keep up on include Sexual Harassment Prevention and Implicit Bias. https://www.isms.org/CME/Medical-License/License-Requirements https://www.isms.org/CME/Medical-License/License-Requirement...
afandian 5y ago
Is there no continuing training throughout the career of a doctor? And if not, how are they qualified to evaluate the claims of a sales rep?
rafale 5y ago
It's their responsibility to stay up-to-date. If a dev can keep up with front end tech stacks, doctors, who are much more elite in their education, should keep track of latest treatment breakthroughs in their domain of expertise.
- listenallyall 5y ago
  First of all, the vast majority of devs do NOT stay "up to date." Most know one language or even just one platform... i.e. "WordPress developer" or "Oracle admin". Secondly, how do you think YOU hear about new technologies... usually due to marketing. Did React just come out of nowhere? No, Facebook marketed it relentlessly. Did people discover Kotlin on their own? No, JetBrains and Google hit people over the head with it. Etc, etc
  - makapuf 5y ago
    Is it really the case that Facebook marketed heavily React? Why? What do they gain from it? Real question, or not like react was an entry point to their API?
    - krageon 5y ago
      It was fairly obvious when it was an up and coming thing. They sent out engineers to talk about it, you had these articles popping up about it more or less out of nowhere, etc. If you weren't there (which I'm guessing you're not, otherwise why would you ask), it is hard to imagine. Perhaps it makes more sense when you consider how normal "advertorials" are now.
- divbzero 5y ago
  Continuing medical education not only a responsibility but also a requirement to maintain a medical license in many states (e.g. California [1]). [1]: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Renew/Current-Status/Continuing-Medical-Education.aspx https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Ren...
  - 5y ago
austinjp 5y ago
Part of the job, as stipulated by medical regulators around the world, is keeping up-to-date with evidence. This can be achieved by reading journals and attending conferences, in theory. But.... journal publishers exploit their monopolies, and conferences are funded by corporate sponsors. So perhaps they're not so different.
- listenallyall 5y ago
  Medical conferences basically would not exist if it wasn't for suppliers and drug companies paying for sponsorships, trade show booths, opportunities to speak, etc. Not really any different than any industry's trade conferences.
  - throwawayboise 5y ago
    Sounds just like every technology conference I've ever been to. A bunch of software and hardware vendor booths, and most of the speakers being authors hawking their latest books.
deleted 5y ago
[deleted]
matheusmoreira 5y ago
> How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? They are supposed to study. Continuously.
- listenallyall 5y ago
  Study what? Even the New England Journal of Medicine is full of articles funded by drug companies. And for good reason -- the results of drug trials should be communicated to physicians. Buying them lunch may be less prestigious, but it's essentially the same thing. Merck, Dec 2021: https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 AstraZeneca, Jan 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2112431 https://www.nejm.org/doi/full/10.1056/NEJMoa2112431
  - matheusmoreira 5y ago
    There's more material available, not just scientific journal articles. The medical specialty associations periodically release detailed guidelines covering new criteria, methods, treatments. For example: https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15026 https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.... There are courses available if you wish to be taught. There are events where people present new developments. There are paid sites like UpToDate. Even textbooks eventually get new editions and there's always plenty of fundamental science in them that doesn't change
    - listenallyall 5y ago
      Did you check the Disclosures section of your article? Are there any drug companies NOT included there? Like it or not, private companies fund the vast majority of medical research in the U.S., and any doctor who wants to stay up to date cannot (and should not) ignore it all. The authors have no conflict of interest to declare, but declare lecture honoraria or consulting fees as follows: T.U., Bayer, Boehringer Ingelheim, Hexal, Vifor Pharma; C.B., Servier, Menarini, Merck Pharma, Novartis, Egis, Daichy Sankyo, Gilead; N.R.P., Servier, Pfizer, Sanofi, Eva Pharma; D.P., Torrent Pharmaceuticals; M.S., Medtronic, Abbott, Novartis, Servier, Pfizer, Boehringer-Ingelheim; G.S.S., AstraZeneca, Menarini, Pfizer, Servier; B.W., Vascular Dynamics USA, Inc, Relypsa, Inc, USA; Daiichi Sankyo, Pfizer, Servier, Novartis, Menarini, Omron; A.E.S., Omron, Novartis, Takeda, Servier, Abbott.

Scoundreller 5y ago

> Even contact lenses are marketed with free samples. I mean, yeah? If a shoe company required you to buy a shoe before trying it on without free returns, the shoe may as well not exist.

cosmodisk 5y ago

I used to see this in our country, where 10 people are queueing outside doc's office ( this is public health system) when some well dressed man goes straight into the office not even bothering to ask if there's anyone in there and fast forward a few min and the doctor is 'on break', whilst drinking coffee with the sales rep, while all those people sit and wait. Eventually it got outlawed.

matheusmoreira 5y ago
That's extremely rude. How could he just barge into the doctor's office? A physical examination could be taking place. In my experience at a specialized neurology practice: they wait outside until the doctor is free, then knock on the door and ask if they have a moment. They would almost always get straight to business, never wasted more than half a minute of people's time socializing.

matheusmoreira 5y ago

Drug companies offer a lot of free samples. It's the same drugs the psychiatrists were going to prescribe anyway, they're just trying to get them to prefer one brand over the other. Sertraline, for example, is first line treatment for depression, anxiety. Getting free sertraline samples reduces costs for patients and really helps them out. Especially in my country where generic medication is often found to not be of the same quality as those manufactured by big pharmaceutical companies.