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Wednesday, November 28th 2007

Docs As Drug Reps

It may come as a surprise the relationships some physicians have with drug companies. Thousands of physicians, practicing physicians, maybe your physician, serve as Vaudevillians for a host of drugs. Psychiatrists are especially guilty of this, but they’re not alone. In a New York Times piece one psychiatrist goes into how he was dragged into the mess.

How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.

The first talk I gave brought me back to earth rather quickly. I distinctly remember the awkwardness of walking into my first waiting room. The receptionist slid the glass partition open and asked if I had an appointment.

“Actually, I’m here to meet with the doctor.”

“Oh, O.K. And is that a scheduled appointment?”

“I’m here to give a talk.”

A light went on. “Oh, are you part of the drug lunch?”

Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep. Eventually, with an internal wince, I began to introduce myself as “Dr. Carlat, here for the Wyeth lunch.”

During my first few talks, I worried a lot about my performance. Was I too boring? Did the doctors see me as sleazy? Did the Wyeth reps find me sufficiently persuasive? But the day after my talks, I would get a call or an e-mail message from the rep saying that I did a great job, that the doctor was impressed and that they wanted to use me more. Indeed, I started receiving more and more invitations from other reps, and I soon had talks scheduled every week.

The entire process is fishy, no doubt. But why I’m posting on it is the role organized medicine is playing in such. The level of detail the drug companies have on what your doctor is prescribing is pretty remarkable. Don’t fret, they don’t have info on patients or on who is getting what. But they can certainly tell that this doctor prescribes Zoloft 80% of the time for depression, then a drug rep from the maker of Effexor busts in and tries to convince the doctor that Effexor is better than Zoloft.

Where is all this data coming from? The doctors aren’t just turning it over.

The process is called “prescription data-mining,” in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies.

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money.

True organized medicine membership is falling, but the AMA’s database remains the best source for identifying specific physicians. Trouble is, if you are an AMA member you’re automatically enrolled. You have to opt out.

The AMA justifies the program in such ways as,

Collecting prescribing data can also benefit physicians by providing them with a self–evaluative tool that helps them compare prescribing data to evidenced-based guidelines.

We know this is baloney. The millions made off selling the data is what keeps the database open, little else.

I’ve been a shill for DTC and drug reps, in the sense I don’t think there’s a place for the government regulating such. But I can’t help but come to the conclusion that there is something inherently flawed about the current relationship between physicians and big pharma. And that’s just from the sideline, even those up close are troubled by it,

I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.

There has been a movement towards self regulation within pharma, to a small degree. Likely only because they see the heavy hand of government coming. But shouldn’t the medical community, including the AMA hold themselves to a higher standard?