tag:blogger.com,1999:blog-7772182113499451603.post3105948953216084316..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: The Increasing High Cost of Generic Drugs George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-7772182113499451603.post-45278876964405507202014-12-13T21:11:52.545-06:002014-12-13T21:11:52.545-06:00Sorry for my delay, I didn't think to look bac...Sorry for my delay, I didn't think to look back at this post after your next one appeared. We agree there are no <i>public</i> safeguards on the objectivity of business consultants, and that "trying to exert influence on... consultants is what business is all about." That's why consultants have professional codes of ethics themselves — <i>private</i> safeguards if you will. That's all I've ever argued for in medicine.<br /><br />I don't know whether a loyalty oath to managed care or "corporate medicine" compromises medical objectivity more or less than canoodling with Big Pharma. Even if the former is worse, and it may well be, two wrongs don't make a right.<br /><br />I agree public disclosure of physician payments can be misleading. However, another hat I wear is chair of CME for my local medical center. When a proposed CME talk features a paid consultant for a "commercial interest," e.g., a physician paid by a drug company or device manufacturer, CME regulations say we need to "resolve" any conflicts of interest we find. It's entirely possibly there won't be any, but we can't assume that going in. When it comes to medical education, being paid by industry is cause for some scrutiny, not for a foregone conclusion of bias. I don't disagree with that.Steven Reidbord MDhttp://blog.stevenreidbordmd.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-27336132960704171962014-12-06T10:56:57.815-06:002014-12-06T10:56:57.815-06:00“Even if Big Pharma did nothing illegal and merely...“Even if Big Pharma did nothing illegal and merely acted as other industries do, it would still be incumbent on us to safeguard our objectivity — just as a consultant paid to advise others about computer purchases should hesitate to accept largess from Dell and Apple.”<br /><br />It is an interesting thought experiment because I know of no public safeguards on the objectivity of business consultants. I would just assume that trying to exert influence on these consultants is what business is all about. IT companies also have highly trained sales staff including sales engineers. My guess is these folks have more technical knowledge than most drug reps and from the lists of openings that there are many of them. Having been a corporate employee myself many times, this is often handled by the employee signing a loyalty oath. That oath usually says that the employee is bound to prioritize the interests of the corporation rather than maintain objectivity. I would argue that in the case of managed care companies such an oath may actually compromise medical objectivity a lot more than eating a piece of Big Pharma purchased pizza.<br /><br />Apart from the influence of marketing and advertising the other aspect here is paid consultants. In this case a company actually pays a consultant to work for them. The current zeitgeist suggests that this also compromises physician objectivity and therefore payment for work determines if a physician is included in the Physician Payment Sunshine Act database. I would argue that the intent of this database is to make physicians look bad. I may be biased by the fact that I have seen these figures used to make psychiatrists look bad when they were involved in legitimate work. Contrast that with any number of math, science, and engineering departments at major universities where similar contracts are expected to supplement academic faculty salary and often worth nearly as much. The naysayers will have the usually excuses about why physicians need to be handled differently. They ignore the overwhelming political biases against the profession in this country.<br /><br />If I am the only guy pointing that out – that’s fine with me. <br /><br /> <br /><br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-81696442788994784782014-12-04T21:18:59.057-06:002014-12-04T21:18:59.057-06:00Dr. Reidbord – Thank you for your continued inspir...Dr. Reidbord – Thank you for your continued inspiration. I decided to post a response to your excellent commentary as a separate blog post. I think that our perceptions of the world may be quite different and I hope I have responded globally and in a way that it is not too tedious. I find that is always a risk with complicated issues that are often spun into political answers. The one that is most bothersome to me is that physicians are incapable of critical thinking and need to be sheltered more from advertising than an average American. I find that idea and its uncritical acceptance quite shocking and probably flowing from a lack of objective analysisGeorge Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-63643988085256426802014-12-04T03:49:58.722-06:002014-12-04T03:49:58.722-06:00Big Pharma isn't merely "blamed" for...Big Pharma isn't merely "blamed" for inadequate disclosure of clinical trials data, distortion of clinical trials data, ghost writing articles for physicians, and misleading marketing practices. They've really done these things, and have been fined many millions of dollars for illegal marketing practices. Also, there's good evidence that Big Pharma unconsciously influences physicians, as well as the public through consumer advertising — or at least they try their very best to do so. Instead of denying it, it's a much stronger argument simply to note that <b>all</b> advertising and product promotion aims to do this. Pharmaceuticals aren't different from cars, breakfast cereal, or soap in that regard. Buyers/prescribers of these products aren't automatons, but we're all influenced at conscious and unconscious levels. The BBC's <i>Century of the Self</i> documentary from 12 years ago is an <a href="http://blog.stevenreidbordmd.com/?p=769" rel="nofollow">excellent</a> primer on the way marketers intentionally appeal to our emotions. It's hubris for physicians to imagine we're immune.<br /><br />Yes, the rise in generic drug prices shows that none of this is "necessary." Who said it was? There are many ways the marketplace can hurt consumers. Criticism of Big Pharma doesn't exonerate "Little Pharma" or vice versa. Even if Big Pharma did nothing illegal and merely acted as other industries do, it would still be incumbent on us to safeguard our objectivity — just as a consultant paid to advise others about computer purchases should hesitate to accept largess from Dell and Apple. None of this changes as generic drug prices rise; it's just that we don't have as ready an alternative anymore. As usual, our job only gets harder. Perhaps investigative journalists need to look at the generics industry (too).Steven Reidbord MDhttp://blog.stevenreidbordmd.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-58538394275666840792014-12-02T22:05:07.429-06:002014-12-02T22:05:07.429-06:00Not at all. I recognize the FDA for what is is - ...Not at all. I recognize the FDA for what is is - a flawed regulatory body that is politically influenced and generally responsible for approving medications that may be somewhat effective and somewhat safe, but nowhere near perfect. The compromise here is that there are interests that want drugs released fairly quickly with minimal associated costs and there are interests that want a more expensive regulatory system with a greater burden on manufacturers. At the level of generics, there are also interests who want expeditious approval of generics to keep down costs. The compromise results in post marketing surveillance and late complications in some cases (like a lack of bioequivalency).<br /><br />I thought the case of higher priced generics was interesting because of all of the associated arguments the Big Pharma critics make - most notably that there is a conspiracy among certain physicians, an undue unconscious influence on other physicians, in addition the the various overtly dishonest behaviors by the industry to create very expensive blockbuster drugs.<br /><br />I think it is clear that none of that is necessary as evidenced by extremely expensive generics. I would go so far as to say that "the appearance of conflict of interest" that seems to drive all of this is nothing more than a conspiracy theory. At least in the concrete case that any physician who talks with a drug rep or eats a piece of pizza paid for by a drug rep becomes a prescribing automaton for that drug. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-16673053487000815092014-12-02T21:25:30.596-06:002014-12-02T21:25:30.596-06:00Recent article about lack of bio-equivalency of an...Recent article about lack of bio-equivalency of another generic:<br /><br />http://www.raps.org/Regulatory-Focus/News/2014/11/13/20734/FDA-Says-it-Discovered-Problems-With-Generic-Version-of-ADHD-Drug-Concerta/<br /><br />I'm not sure what this means from your perspective. <br /><br />Is it that all drug companies, brand and generic alike, abuse the system the FDA created? That this system is a hot mess which fosters issues instead of preventing them?RBnoreply@blogger.com