Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Should We Stop Suggesting Physicians are "Bought" by Pharma Gifts?

Should We Stop Suggesting Physicians  are "Bought" by Pharma Gifts? | Pharmaguy's Insights Into Drug Industry News |

Every few months, another study is released with the same general theme: Gifts from pharmaceutical companies compel docs to prescribe more costly drugs.


Last June, it was JAMA Internal Medicine suggesting that a single meal swayed doctors’ prescribing habits. Now, a review of Washington, D.C.-based physicians is again painting the entire profession in a bad light.


In a study published in the journal PLOS One, 2,873 Medicare Part D prescribers in the nation’s capital were analyzed based on their prescribing habits. The study found that 39% of the docs received gifts from pharmaceutical representatives in 2013—ranging from meals to ownership interest in products.


These physicians wrote 2.3 more prescriptions per patient claim, prescribed $450 more in medications per claim and prescribed 7.8% more branded drugs compared with those who did not receive a gift. The study also cited internal medicine and family medicine as two of the specialties most associated with significantly increased average cost of prescription claims.


[BTW, these were not physicians. Read “Nurse Practitioners and Physician Assistants are Also Swayed by Gifts from Pharma”;]


… to simply claim that “gift equals increased prescriptions” is not only disingenuous, it’s offensive to all doctors throughout the U.S. (not only those based in D.C.) And it is just unnecessary information to share with patients without explaining more of the details of these exchanges, which is simply not available in every case.


Physicians will do what is best for their patients. It’s time that studies like this start putting some facts behind their inflammatory research.

Pharma Guy's insight:

I think research results go beyond "suggesting" - there's proof! You know, based on data. Similar to how pharma is able to "suggest" that drugs work :)

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Oncologists Can Be Influenced By Small #Pharma Payments for Meals, Travel, Consulting

Oncologists Can Be Influenced By Small #Pharma Payments for Meals, Travel, Consulting | Pharmaguy's Insights Into Drug Industry News |

In the latest attempt to examine financial ties between physicians and drug makers, a new study finds that oncologists who received payments for meals, travel, and consulting were more likely to prescribe medicines sold by the companies who provided the largesse.


Specifically, the odds were 78 percent greater that oncologists would prescribe certain brand-name drugs for treating renal cell carcinoma if they had received some type of payment from one of the manufacturers. And the odds were 29 percent higher they would prescribe certain brand-name medicines for treating chronic myeloid leukemia if they had received a payment.


The pattern is troubling because the cancer drugs can have significant side effects and high monthly costs, according to Dr. Aaron Mitchell, a fellow in the UNC School of Medicine division of hematology and oncology and the lead author. The preliminary findings will be presented at the American Society of Clinical Oncology Annual Meeting 2017 in Chicago on Saturday.


The average amount of general payments made to oncologists who prescribed brand-name drugs for renal cell carcinoma was $566, and the average was $166 for those who prescribed chronic myeloid leukemia meds. Mitchell acknowledged these are small amounts that constituted little financial benefit, but said “it’s probably more of a marker about a subconscious feeling of obligation or connection.”


The researchers did not detect the same trend among oncologists who accepted research funding.

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The Provider Gift Ban: What Happened to All Those #Pharma "Tchotchkes?"

The Provider Gift Ban: What Happened to All Those #Pharma "Tchotchkes?" | Pharmaguy's Insights Into Drug Industry News |

For years, pharma helped keep the manufacturers of Lipitor pens, Prevacid golf club head covers, and other promotional items in business. But when the Pharmaceutical Research and Manufacturers of America (PhRMA) imposed a voluntary ban in 2009 that relegated these and similar tchotchkes to the promotional netherworld of eBay auctions and displays in physicians' offices, nobody expected them to have much of a collectible afterlife.


The decision to enact the ban was a no-brainer. PhRMA was not alone in sensing a need to clean up the industry's image by addressing the ethics of providing an array of branded gifts to physicians. Gimmicky marketing mementos like Post-it notes and pens may have seemed harmless enough, but the prescribing influence they carried came into question.


“These items were constantly in view and intended to keep specific drug names uppermost in physicians' subconscious. And it worked,” says Dr. Adriane Fugh-Berman, an associate professor in the departments of pharmacology and physiology and family medicine at the Georgetown University Medical Center. Fugh-Berman is also director of PharmedOut, a Georgetown research and education project that, per its website, “promotes rational prescribing and exposes the effect of pharmaceutical marketing on prescribing practices.”


These relics of the past have a certain value for those on the hunt. One eBay seller hopes to fetch $20 for a blue pill-shaped Viagra promotional clock that doubles as a business card holder, an item that was once a big weapon in the Pfizer sales rep's arsenal of freebies. And those golf club head covers — in the shape of a stomach, designed to somewhat subtly remind docs of Prevacid's utility in treating heartburn — still make occasional appearances on golf courses across the U.S. In fact, AbelsonTaylor president and CEO Dale Taylor recently spotted a set on a Chicago fairway — in mint condition, no less.

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Pharma Don't Need No Stinkin' Guidelines to Woo Veterinarians!

Pharma Don't Need No Stinkin' Guidelines to Woo Veterinarians! | Pharmaguy's Insights Into Drug Industry News |

Rock concerts. Magic shows. Contests in which everyone who plays is a winner.

For five days, the action never stopped at the McCormick Place convention center, as more than 9,000 veterinarians and technicians flocked to see the latest medicines and attend clinical workshops organized by the American Veterinary Medical Association.

Around the show floor, the world's biggest drugmakers had set up exhibits two stories tall, with enough flashing lights and giant twirling logos to resemble a Detroit car show.

The vets, the nation's last line of defense against unsafe drugs getting to animals, were receiving a blizzard of meals, books, electronic gadgets and speaking fees from drugmakers.

The convention revealed just one of the many ways corporate money influences pet health care — from research to treatment to sales — threatening the objectivity of those prescribing drugs to your dog or cat.

That's not to say that those who are doing the prescribing — the nation's veterinarians — don't have animals' best interest at heart, or are especially susceptible to industry money.

But The Star's investigation reveals a greater potential for abuse because the pet medicine industry is allowed to target veterinarians with marketing practices banned from the realm of human medicine.

In recent decades, pharmaceutical companies have been investing billions of dollars in pet medicines for the promise they hold to launch new drugs quickly and profitably. And they treat veterinarians not just as medical professionals, but as an important distribution channel to be wooed every step of the way.

That was on full display at the Chicago conference in July 2013. A glossy, 124-page convention program was packed with ads for animal drugs, workshops sponsored by drug companies and lunchtime sessions, complete with free catered meals, courtesy of a drugmaker.

In one aisle, representatives from drugmaker Novartis Animal Health pulled veteridrnarians from the aisles to take a multiple-choice quiz on fleas and ticks. All who played got a prize: a Brookstone Ultra-Thin Travel Speaker — "for great sound anywhere" — that retails for $39.99.

In another corner of the show floor, drugmaker Merial wooed veterinarians into an exhibit with this display in flashing lights: "Play Ultimate Vet Challenge For a Chance to Win an iPad Mini!"

Virbac, another drugmaker, gave veterinarians a "special decoder" to unlock a safe, with a chance to win an iPad or $100. "Not a winner today?" an exhibit sign said. "Try your code again on each exhibit day."

Pharma Guy's insight:

It's a dog's world after all! And dogs are where marketers can do their thing unfettered by "guiding principles."

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Docs Complain to CMS About ‘Sunshine’ Data Disclosures

Docs Complain to CMS About ‘Sunshine’ Data Disclosures | Pharmaguy's Insights Into Drug Industry News |
A group of medical societies and pharmaceutical industry trade groups is pushing the government to flesh out data that will be published next month showing how much drug makers pay doctors.

They sent a letter today to the Centers for Medicare and Medicaid Services to ask the agency to explain what context will be provided to help the public understand the justification for payments, such as speaking fees and grants used to bankroll clinical research.

The letter is signed by more than 20 medical societies and organizations including the American Urological Association, as well as heavyweight industry trade groups Biotechnology Industry Organization and the Pharmaceutical Research & Manufacturers of America.

The missive was sent as CMS plans to post the payment data in an online, searchable database as required in the Sunshine Act provision of the Affordable Care Act. The provision was passed in response to concerns that medical practice may be unduly influenced by industry.

The law requires most drug and device makers to report to CMS detailed information about payments and gifts provided to U.S. doctors and teaching hospitals. The disclosures are being made in stages, but September marks the debut when payments will appear publicly.

Supporters of the Sunshine Act say the transparency will provide useful information to patients about the relationships their doctors may have with drug or device makers, and serve as a deterrent to the more extreme examples of industry money unduly influencing medical care.

But some doctors and companies fear payment data will be misinterpreted by the public, or painted with a broad brush. They say there are legitimate interactions that serve to advance medicine, and that doctors should be compensated for services such as consulting for a company about the development of a new product.

Some medical societies teamed up with industry groups to form Partners for Healthy Dialogues, to defend such interactions between industry and doctors, and some of its members signed the letter sent to CMS.

The medical societies and industry trade group lament what they write in the letter is a dearth of context that accompanied CMS’s milestone release of Medicare Part B payments to physicians earlier this year.

Some medical groups say the data did not include context to show which doctors may be abusing the system and which were receiving big payments because of high overhead costs.

Pharma Guy's insight:

A survey revealed that of the more than 1,000 physicians questioned, over half admitted they didn't know that the law requires pharmaceutical and medical device companies to report on expenditures annually, without physician review of the data to correct any inconsistencies or errors, prior to submission to the government. 63% were deeply concerned that a record of these payments will be available in a publicly searchable database.

Listen to this podcast: Physicians Unprepared for Sunshine Law

Questions/Topics Discussed

  • Background regarding the sunshine law, including important dates for implementation.
  • Survey methodology
  • A summary of survey results and what they tell us -- pharma companies might be surprised!
  • How can physicians review the data before it goes public to correct inaccuracies.
  • What is at stake for pharma companies if they do not work more closely with physicians regarding access to the data?
  • What the industry must do to educate their physician clients about the Sunshine Law
  • Will this new form of "Big Data" eventually lead to a significant decrease in payments of all kinds to physicians by the drug industry?

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Stop Picking on Docs That Receive Free Lunch from Pharma. The Real Problem is Members of Congress Accepting Gifts!

In a recent Washington Post op-ed, Dr. Nicole Van Gronigen made the case that Big Pharma successfully influences physician prescribing behavior via marketing. Specifically, drug reps do with with free lunches provided by the pharmaceutical reps, or educational dinners at nice restaurants. She reported a JAMA study correlating industry-sponsored meals with increased promotion of branded medication to Medicare patients.


It's no surprise that marketing works. If it didn't, Big Pharma would not spend $24 billion per year on it -- more than they spend on research and development. And perhaps, as Dr. Van Gronigen suggests, restricting pharma reps' access to physicians may yield cost savings in healthcare. But is it really that simple?


In my retina practice, if I prescribe an expensive eye drop made by the pharma company that brought Chick-fil-A lunch for my office staff the previous week, I will get usually a call from the pharmacy telling me my patient cannot afford the expensive drop, requesting a cheaper alternative. Problem solved.


In my retina practice, if I prescribe an expensive eye drop made by the pharma company that brought Chick-fil-A lunch for my office staff the previous week, I will get usually a call from the pharmacy telling me my patient cannot afford the expensive drop, requesting a cheaper alternative. Problem solved.


The real question is, why are physicians the only ones under scrutiny for payments received from industry? Over $3 billion per year is spent lobbying Congress and federal agencies to influence laws and government contracts, potentially costing taxpayers hundreds of billions of dollars. They influence members of Congress not with a few slices of pizza for lunch, but with all-expense paid African safaris for lawmakers and their families.


Physician morale continues to decline due to changing payment and delivery models. Going after doctors who accept a free lunch or occasional restaurant dinner, along with a chance to interact with colleagues and hopefully learn something, may be an easy way to save a few dollars. But that's a red herring when it comes to the cost of care. There are already more powerful cost saving mechanisms in place that don't involve beating down members of an already demoralized profession.

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California Senate Moves To Restrict Gifts to Doctors

California Senate Moves To Restrict Gifts to Doctors | Pharmaguy's Insights Into Drug Industry News |

California State Senators approved legislation on Thursday, May 18, 2017, that would restrict pharmaceutical makers and other drug companies from giving gifts to doctors and other medical professionals. The legislation, SB 790, was penned by State Sen. Mike McGuire and passed by a vote of 23-13.


According to ABC affiliate KRCR, SB 790 would prohibit or restrict most gifts from drug makers to doctors. Sen. McGuire said the bill would lower the cost of drugs in California because it would prevent doctors from receiving gifts that encourage the prescription of expensive drugs.


Sen. McGuire told AP reporters that drug companies spend more than $1.4 billion every year on California doctors alone.


"While we have witnessed the cost of drugs rise over the past decade, industry profits have also grown significantly," said the Senator from west of Sacramento. "We shall be all standing for seniors and taxpayers to drive down the cost of prescription drugs."


SB 790 would still allow doctors to be paid salaries for running clinical trials, and companies can still pay for meals, as long as the costs are below $250 per year per doctors. Even with these exceptions, the bill is still fiercely opposed by the pharmaceutical industry's main lobbying group.


Further Reading:

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Should Doctors Wear Sponsor Uniforms? Big Pharma Courtship Goes Public

Should Doctors Wear Sponsor Uniforms? Big Pharma Courtship Goes Public | Pharmaguy's Insights Into Drug Industry News |
Big Pharma is notorious for seducing doctors and medical institutions. The facts are finally out, and the amount spent marketing drugs to doctors is overwhelming. David Michaelis commentary.

I want to know — and I’m sure you do, too — what conflicts of interest my general practitioner has. Are they prescribing me the best medicine, or the one that sponsors them? Maybe you should ask your doctor if they will wear this uniform, just so we’re all clear on where they are coming from.

Pharma Guy's insight:

I suggested this in 2008 BEFORE the sunshine law was a glimmer in lawmakers' eyes: "Come to think of it, this might be a good way for doctors to supplement their incomes AND it would be transparent to patients from which companies their doctors received gifts." Inspired by a New Yorker cartoon: 

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Aussie Docs to #Pharma: "No Advertising Please"

Aussie Docs to #Pharma: "No Advertising Please" | Pharmaguy's Insights Into Drug Industry News |

A group of GPs are launching a new campaign to stop doctors from meeting drug company sales representatives.

Doctors and academics devised the No Advertising Please campaign to combat the hard sell used by pharmaceutical companies.

Australia's pharmaceutical industry has an annual turnover of more than $23 billion, with a large part of the marketing budget spent on sales representatives.

There are concerns drug representatives influence what medications doctors prescribe, resulting in patients getting drugs they do not really need or a certain brand being prescribed over others.

The No Advertising Please campaign is calling on all GPs to make a pledge and display a sign saying they will refuse to see drug company sales representatives.

Although the Australian Medical Association (AMA) says the companies make a valuable contribution to education and research, campaigner Dr Justin Coleman wants doctors to stop seeing drug company representatives completely.

"The pharmaceutical representatives are essentially marketing drugs and what we're after is doctors deciding which drug is best based on the best evidence, as opposed to their best marketing," he said.

GP Dr Geoff Spurling, who has reviewed 58 international studies looking at the impact of pharmaceutical marketing on the prescribing habits of doctors, said doctors who saw drug representatives were much more likely to prescribe the promoted drug than those who had not.

AMA representative Dr Brian Morton said he is visited by sales representatives at his Sydney medical practice most days, but does not see any need to stop the meetings.

"I think the campaign is a bit silly, it's insulting to doctors, it's also rather naive; our world revolves around education and information and the pharmaceutical companies are an important source of money for research, so every Australian will benefit from that research and pharmaceutical promotion," Dr Morton said.

"There is very little they can offer as an inducement any more and that is quite a good thing, it keeps everyone honest. The types of things are a simple meal, lunch, an educational meeting after surgery.

"If it were lunch at a hotel with wine etcetera that would be totally inappropriate, but a sandwich from a sales rep and a chance to sit with colleagues and discuss issues allows me to also be educated properly."

Pharma Guy's insight:


What about Free lunch for patients!

Think about it!
  • There are no guidelines, ethical or otherwise, about free lunches for patients that I know of.
  • Each free patient lunch can come with product logos emblazoned on the napkins or sandwich wrappers (I already reserved the Web and am prepared to offer that service to pharma clients). This will help drive prescriptions because, unlike physicians, patients areinfluenced by such advertising -- why else would there be so much DTC advertising?
  • Add free trial coupons to the patient lunch box as a value-added surprise!
  • Not only will free patient lunches give pharma companies an opportunity to get their product logo in front of patients at the point of care, they will ensure that patients support pharma free lunches in general, including free lunches for physicians. That way, negative articles like the one in the New York Times will have much less effect on the public who will say "Leave those poor pharmaceutical companies be! No free lunch can 'interfere with the independence' of me or my physician."
  • When the weather is nice, invite the whole office -- physicians, staff, and patients -- outside for a picnic! Sales reps can then easily work the crowd and enhance the patient-physician relationship!
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