Most doctors get money, gifts from industry

[AnotherGreenWorld]

Virtually all doctors in a national survey of six specialties reported some sort of relationship — from free lunches to payments for consulting and lecturing — with medically related industries such as those for drugs or medical devices, a report says today.

Researchers mailed surveys and a $20 check to a random sample of 3,167 practicing anesthesiologists, cardiologists, family practitioners, general surgeons, internists and pediatricians in late 2003 and early 2004. Slightly more than half responded. Among the findings, reported in The New England Journal of Medicine:

•Cardiologists were more than twice as likely as family practitioners to receive payments from industry.

•On average, family practitioners reported meeting 16 times a month with industry reps — the most of any specialty surveyed.

LINK: Policy forum

•Factors significantly linked to higher odds of receiving payments from industry included being male, having a patient population with fewer than a quarter on Medicaid or uninsured, and playing a role in training doctors or developing practice guidelines.

More than a quarter of respondents said they were paid by industry. "That to me is a pretty high percentage," says lead author Eric Campbell, assistant professor of health policy at Harvard Medical School...

Doctors tell him they can't be bought with a free pizza, Campbell says, but social science research shows that even inexpensive gifts can influence behavior.

Link:

http://www.usatoday.com/news/health/2007-04-25-docinfluence_N.htm

[Donnachaidh]

1. Do doctors figure in the *goodies* when they figure their incomes?

I wouldn't hold my breath for an answer.

[Stuckinthebush]

2. The answer is "no"

The stuff is not reported.

[Donnachaidh]

3. I knew that ;-)

So basically, the doctors that toss out that magical figure of 140K (this is magical because all of the debates I've seen has this figure, or close to it) are basically lying. Which leads to my second question -

Some years back, we had a huge kerfuffle about waitress's not claiming their tips on taxes. It got to a point that the tax laws were changed, and employers were even dragged in, so that the IRS would get some idea as to how much someone making LESS than minimum wage was making on tips.

How is THIS situation different?

[Stuckinthebush]

4. Technically, they are supposed to declare

anything over a certain value. The majority of "gifts" are little trinkets that are passed around the office. I have more pens, pencils, erasers, notpads, etc. with drug names on them than I can count. Then there is the food given to the staff. Every week drug reps will compete to see who can bring in the best meal for the staff. The main goal is the doc, but if you make the staff happy then you get to the doc. My wife is a physician and is vegan. She says it is hillarious how the reps will struggle to find vegan food to bring in and she rarely has time to eat it. She has made a point to tell them to bring non-vegan food so the staff can eat.

Then you have the drug dinners. These things are interesting - you have a number of physicians and their spouses who are invited to attend a function at a very nice restaurant. You eat and then are bombarded by a dog and pony show regarding the drugs. As a researcher, I like going because they rarely have the correct statistical information up there and I point it out to the docs sitting with me. Kinda fun. Actually, a couple of years ago the rules changed and they can't invite spouses so they get a lower turnout now.

Then there are trips that are given in the guise of speaking/consult trips. Only the high end docs get offered these, and only a small percentage go on them. They write them off as business expenses unless they are straight up gifts and then I think most report those on IRS returns.

It is an interesting relationship between docs and drug companies for sure.

[juno jones]

5. Drug Dinners LOL!

I once worked at a small deli that did a lot of business with the drug reps and the local doctors(we were in a city with a large med school). One time we were asked to do a traditional Indian meal for the local Indian physicians and their wives. Since I had some background in cooking other than sub sandwiches, my boss asked me if I would plan the menu and cook. I was proud to. Then the night came. None of the doctors brought their wives. They ate my meal while listening to the rep drone on about Paxil or Prozac or one of the other SSRI's. Then the party started. Seems the rep brought along a case of Johnny Walker Blue (about $100 a bottle). The docs pretty much divvied up one apiece and proceeded to get slammed. At one point, as these pillars of our community are raging like frat boys in the front room, my boss and I wound up hiding behind the ice machine for about 30 minutes, because every time we'd poke our head out, they wanted more beer for chasers, or more food 'off' the menu. I remember our nervous smiles...we were both seasoned restaurant dogs, some partying motherfuckers in our day, but these doctors had us beat...and they scared us...

Nothing against Indian doctors, most of these guys I'm talking about were born here. Docs and reps are pretty much the same all over. It's just the wildest example of the over-the-top weirdness that is pharm rep ass-kissing that I have encountered. My time in that town definitely made me see doctors in a whole new light. That includes time working as a 'simulated patient' at the med school. I sold my body to science while I was still in it. 30% of med students are good and will make fine doctors. 60% are doing it because they think it a 'good career', and the money is decent, but otherwise have no real draw to healing. The last 10% are scary, they only want the status and the money and have no empathy whatsoever. And because of the their status, they don't have to follow the rules you and I do. Funny. They will drug test a bus driver or the assembler of your shitty Taco Bell Grande, but doctors are never checked out. Have fun with that at your next surgery.

[Stuckinthebush]

7. Great story!

Johnny Walker Blue - wow.

Yes, the reason some people go into medicine is sad, but there are those who go in for the right reasons. I kid my wife about that. She is in indigent psychiatry. I told her that she chose the lowest paying field in medicine damn it! She laughs and says she didn't get in it for money. She'll go out and walk under the overpasses looking for her patients. Crazy psychiatrist!

But yes, there are those who go into it for the money and prestige. They turn out to be surgeons or radiologists from what I understand, so they don't have to worry about dealing with patients one on one as much.

[AnotherGreenWorld]

11. Just 10%? I don't know...

"Docs and reps are pretty much the same all over. It's just the wildest example of the over-the-top weirdness that is pharm rep ass-kissing that I have encountered. My time in that town definitely made me see doctors in a whole new light. That includes time working as a 'simulated patient' at the med school. I sold my body to science while I was still in it. 30% of med students are good and will make fine doctors. 60% are doing it because they think it a 'good career', and the money is decent, but otherwise have no real draw to healing. The last 10% are scary, they only want the status and the money and have no empathy whatsoever. And because of the their status, they don't have to follow the rules you and I do. Funny. They will drug test a bus driver or the assembler of your shitty Taco Bell Grande, but doctors are never checked out. Have fun with that at your next surgery."

I think it might be a little higher than 10% that are only in it for the money and have no empathy whatsoever. As someone with leukemia, I go to a lot of doctors, and my experience is that most fit that description, especially what you later add: 'And because of their status, they don't have to follow the rules you and I do.'

And since Republicans, under the guise of fighting 'frivolous lawsuits,' have chipped away at your right to sue, most doctors know there's essentially no means of holding them accountable.

[IronLionZion]

17. A lot of doctors abuse prescription drugs

probably more than you might suspect. They caught if they write it for themselves, so they just write if for each other and it's all good. Vicodin is a big one.

[AnotherGreenWorld]

20. That's true.

[Donnachaidh]

8. I see this as a problem

What you call an *interesting relationship*, others who are not in this little club look at this as a sleazy little party. Why is it that doctors and bankers (as another person posted) accept gifts and gratuities from drug companies or other businesses, with NO or little accounting of these things - while waitresses and waiters were hounded about tips they received?

I overheard one doctor giggling with a drug rep about a cruise the drug company had sent his family on. This doesn't seem totally UNETHICAL to doctors?

Why is it that people in lower paid jobs are required to list virtually every cent they make, while doctors and their offices are given office supplies, dinners, etc., and then look at them as "goodies"?

And I'm sure the pot gets pricier at Christmas, because then the articles given can then be officially be called GIFTS with a capital "G".

It's amazing how much corruption and graft gets overlooked these days at certain levels, all because it's labeled with a different name. :puke:

It's only the working class or the poor that get called to pay up.

[Stuckinthebush]

10. I hear you...

Any physician who accepts a fully paid cruise for his or her family without declaring it is acting outside of ethical behavior. I contend that this happens in a small fraction of cases.

The pharma reps are salesmen. Their job is to get the physician to use a certain medication. My father in law is in management at a manufacturing plant. He gets stuff from sales reps like pens, pencils, office goodies as you call them - in the hopes that he will use a certain raw material or nut or bolt or electrical housing for their machines. He distributes them to his staff like the docs do.

As for the stuff from pharma reps, the majority of it goes to office staff. The docs aren't hording notepads. The lunches are given to all the staff. The drug dinners are now only given to docs and they have a steep price - spend a night with a bunch of stiffs listening to an hour long lecture on Paxil. Hardly worth an overcooked steak and glass of bad wine.

From an IRS perspective, there is a difference between hard cash given as tips to wait staff who make a lower hourly wage in the expectation of tips, and office supplies given to physicians' offices or lunches to staffs. Are there inequities based on class distinction? Absolutely. Are there benefits to the relationship? Certainly. The benefits are shared between staff members usually but also indirectly one can make the case that patients benefit from a physicians' better understanding about a drug or class of drugs. Docs have little time to delve into the latest research so the reps' information is valuable. They are usually critical consumers and will ask the hard questions and look at the research, but it is nice to have every rep who represents a class of drugs coming to them with research and info about their drugs. It ultimately helps you and me by giving our docs info.

I wouldn't call office supplies (most of which suck) and pizza lunches graft or corruption, but the docs must always be aware that there are some reps who will try to cross the lines of ethical behavior and offer up a cruise or all expenses paid golf outing. It is up to those docs to not cross the line. Most docs don't.

[Donnachaidh]

12. of course you wouldn't call it graft or corruption - but it is

And *distinctions* you list does not change that.

I'm sure the underpaid waitress who has to serve the doctors *suffering* through a meal bought and paid for by drug reps really understands your *pain*. :sarcasm:

Changing the language to re-assign guilt, doesn't change the fact that certain areas of our society feel entitled to perks. Sharing office supplies with office workers does not change the fact that the doctor that accepted the supplies still *benefits* from a *freebie*. It's one less out of pocket expense for them. Now if they turned around and sold those supplies, and then gave the CASH to the office workers -- then perhaps I would buy the *generosity* of the doctor. But that doesn't happen, does it?

Lunches given to the office staff still BENEFITS the doctor -- why shouldn't that be listed as an income by the doctor? Again, it's something that is not an out-of-pocket expense - there is a value to it - it should be considered income to be taxed.

This is the same sort of scrutiny that was applied to lower wage working people, that is not applied to business professionals. Why should business people be *above* this?

[Stuckinthebush]

16. Mountain out of a mole hill on this one

This is not graft. This is a salesman giving stuff to staff as a thank you for their time. It usually doesn't work. As much as some may wish to believe it, docs don't use meds because some slick pharma rep gives them pens and sticky pads. Docs can't stand drug reps. Their time is money and the reps demand time. So, if you want the doc to declare his or her $50 worth of pens and sticky pads over the course of a year, then he or she should be able to write off the time spent with a drug rep. They don't do this.

Wait staff get paid a lower wage with the understanding that they will make tips as real income. Social Security and Medicare is at play here.

The reality is that this is capitalism. I have something to sell to you because you have money. I need to get in the door so you can hear my pitch. To get in the door I think I must give you something for your valuable time which is billable at $100 to $500 per hour. I give you a handful of Paxil pens valued at $2 as a thank you for your time. I'm not giving you pens as a bribe to use my product. The pens or pads or lunch or dinner are much less valuable than the docs or staffs' time and the sales reps know this.

Don't be mad at the docs because they don't declare pens. The greater issue here is income tax. Working class people should not have to pay the same rate as others, especially someone who makes $100 to $500 per hour.

[AnotherGreenWorld]

19. "Doctors tell him they can't be bought with a free pizza, Campbell says, but...

social science research shows that even inexpensive gifts can influence behavior."

[The Backlash Cometh]

6. Bankers too.

[IronLionZion]

9. My Dad gets lots of free stuff, but he's still very anti-drug

He is a doctor and you're not going to get a prescription from him unless you are about to die. He turns down drug-seekers left and right (drug ads say ask your doctor about XYZ). He always warns about known and unknown side effects. It's pretty tough to get a prescription from him even if you do need it(or just think you need it) since your body is a very effective disease fighter and many drugs actually end up prolonging diseases (ie fever-reducing drugs) or make you feel worse (especially if you are taking several).

But I have definitely encountered doctors who don't spend much time diagnosing you at all and are way too quick to just write you prescriptions for whatever. I have prescriptions for Vicodin and Lexapro that I did not fill (because I sure as hell don't need them) but I keep the papers as a reminder of how easy it is to get strong drugs that people can abuse to get high.


Yeah, you can get all kinds of stuff: office supplies, electronics, etc. I would hope that there are more doctors out there who refuse to be influenced by gifts.

[Atman]

13. It seems everything in our house has a drugco logo on it.

From zen fountains that say "PAXIL" to a stash of pens holding enough ink to draw lines to Mars and back. Heck, we even have years' worth of sunscreen and lip balm "compliments of (insert drug name here)." Oh, and Altoids. I never have to buy breath mints. Most of the "gifts" are actually quite petty, just trinkets that you might otherwise pick up at any trade show booth.

However, my wife has prescription authority and is thus a prime "target" of the drug reps. She is invited out to dinner so often that we don't really even bother going out to nice restaurants on our own anymore...the thrill is gone. Most of them are "educational" dinners. The drug reps make a ten minute presentation or Power Point presentation while noshing on appetizers and cocktails, followed by a nice leisurely dinner wherein all the docs talk shop.

It has gotten "better," better being defined by your particular side of the argument. In the past, spouses were allowed to attend the dinners, too, but that's pretty much been eliminated, though occasionally (albeit rarely) I get to attend. When I do, I turn the tables on them and bring my own cards and promotional material for my healthcare comic strip, HOO Cares!


HOO Cares! Copyright 2006-07 by Rob McGrath, all rights reserved

.

[Beausoir]

14. 16 times a month?! That's insane.

My husband is a doctor. He doesn't do drug dinners. In fact, I don't even think they hold them anymore. He gets a tin of gourmet nuts at Christmas, he might get a chinese take-out lunch in his office once a month and he uses some ball point pens. That's the extent of it.

He gets more gifts from his patients than from drug reps. Homemade jams, breads, etc.

No free travel. No speaking fees. It's a non issue for his practice.

[Romulox]

15. Who cares? The same industry's $$$ buys off our presidential candidates too...

“I have been saying that based on my 35 years of fighting for what I believe in, I don’t think anybody will think I will be influenced .”

And here the boos broke out.

“I have been waiting ,” Clinton said with a smile. “It gives me a real sense of reality in being here. I have a good idea about bringing about change. I wish it were as simple as doing this or that. I will take money from lobbyists, because some represent real Americans like nurses and social workers, and they represent businesses that employ a lot of people. And I ask you to look at my record. I do want to be the president for everybody.”

[AnotherGreenWorld]

18. I think it's widely known

that most politicians are corrupt. It's not widely known that most doctors are corrupt, however.

[BlackVelvet04]

21. Pharmaceutical companies

send in lunch for the staff at local Carillon clinics EVERY DAY.

[Vinca]

22. In addition to the gifts, pharmaceutical companies sponsor most

of the continuing education for doctors . . . just in case you ever wondered while they try to ram Lipitor down everyone's throat.