5 Steps to prevent Heart Disease

Monday, March 21, 2016

Response to Doctors on the take from Big Pharma

Full text and my response to Dollars for Docs 
by Ornstein

Below is a short version of my comments to Ornstein's article. 

My comments in purple. 

"Doctors who got money from drug and device makers—even just a meal– prescribed a higher percentage of brand-name drugs overall than doctors who didn’t, our analysis showed."

This type of data is very important.  As in twitter:

To be sure, our analysis didn't show causation (it wasn't intended to) and more research needs to be done. 17/x

As a retired Internist who practiced in a golden age of Medical discovery, it would have been very difficult for me to learn how to use all the new medications if not for the help of the drug company education process.  The Pharmaceutical companies would bring Professors to Topeka to answer our questions about the new drugs.  The sales reps themselves, when they came to the office often had very helpful information that they picked up from other offices about using the new drugs.  This may shock the media but allow me to quote the definition of evidence based medicine:

Definition of Evidence Based Medicine by David Sackett:

“integrating individual clinical expertise with the best external evidence”.

"Indeed, doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty.
Doctors who received more than $5,000 from companies in 2014 typically had the highest brand-name prescribing percentages."
This is the group that must be looked at.  More importantly, Professors who give talks at National meetings should not only disclose their conflicts but also how much money they have received from those conflicts. 
 Expert witnesses at malpractice trials should also disclose their payments.
I suspect the greater than $5,000 group are those that give talks to Doctors? 
 They deserve it. I also gave talks though I never made that much.  
I was talking for Lipitor once with one Doctor and the Sales rep asked me in front of the client what statin I used.  I said I use Crestor personally.  He swallowed hard and I said, you asked. 
 I never got another speaking arrangement with Lipitor.
In fact I prescribed mostly Crestor because at the time I thought it was the strongest and safest statin.  Crestor never hired me for speaking. 
 My Crestor sale reps were so happy with my numbers they couldn’t help themselves by buying me a bottle of scotch at Christmas privately.
Now that Lipitor is generic it is my first choice among statins.

"Among internists who received no payments, for example, the average brand-name prescribing rate was about 20 percent, compared to about 30 percent for those who received more than $5,000."

Times are changing.  There are so many excellent generic drugs now.
I am type 2 diabetic. I take the following very cheap generic brands:
4-Lovaza now is generic.
However my Obamacare type Platinum plan pre-approved these expensive drugs:
5-Invokana (extremely expensive but I got off Insulin and lost 20 lbs with it)
6-Victoza (also expensive but covered under DM while the higher dose Saxenda for weight lose is not)
Finally the shame that Obesity drugs are not covered
7-Qsymia (lost another 28 pounds with this drug since June.)

How did I learn about Qsymia? Not from the drug companies.  
I took the Obesity boards in Dec 2016.
The 4 new diet medications for lifelong treatment of the Chronic disease of Obesity is so exciting that I am going back into part-time private practice to treat Obesity.  I was not influenced by any free dinners.  
I was influenced by the new science.  I believe that is true for the majority of physicians.

"And those who do probably have greater skepticism about the value of brand-name medications. Conversely, doctors have to work to cultivate deep ties with companies—those worth more than $5,000 a year — and such doctors probably have a greater receptiveness to brand-name drugs, he said."
“You have the people who are going out of their way to avoid this and you’ve got people who are, I’ll say, pretty committed and engaged to creating relationships with pharma,” Baron said. “If you are out there advocating for something, you are more likely to believe in it yourself and not to disbelieve it.”

In 2009 I wrote a book which advised a combination of generic simvastatin and over the counter Endur-acin(wax-matrix niacin).  (I said Slo-niacin could be substituted for Endur-acin but I had less experience with it.) I had no financial conflicts with any of these drugs. 
 I advised them because the total cost for the year was  $100 and in combination at low doses was unlikely to have any side effects.  
If the goal of non-HDL-c less than 80 to 100 was not reached, one half tablet of Zetia could be added each day.  
Once Lipitor became generic I switched the recommendation to Atorvastatin because it is stronger and safer than Simvastatin.  
Obviously the Media did not jump on my Tubby Theory from Topeka

Why not?  Nobody was going to make money on it.

I proposed finding out if patients had early atheroma with inexpensive tests not covered by medical insurance,  CAC and CIMT. 
 If they had disease, take cheap medicine early in low dose for safety in combination. 

Since I wrote this advice, Braunwald, Sniderman, Robinson & Stone guidelines suggest the future of reducing residual risk in cardiovascular disease is to treat earlier and longer with medications.  
The Media only listens to academics, who get research money from Big Pharma?  Can we follow their money and advertising? I am not saying there is a causation.  Publishers with contacts with the media tend to get all the media coverage they want for books on non-scientific ways to lose weight and lower cholesterol? Why is that?  Something to do with advertising? Not that there is a causation.
"Dr. Felix Tarm, of Wichita, Kansas, likewise prescribed more than twice the rate of brand-name drugs than internal medicine doctors nationally. Tarm, who is in his 70s, said he’s on the verge of retiring and doesn’t draw a salary from his medical practice, instead subsidizing it with the money he receives from drug companies. He said he doesn’t own a pharmacy, a laboratory or an X-ray machine, all ways in which other doctors increase their incomes.
“I generally prescribe on the basis of what I think is the best drug,” said Tarm, who received $11,700 in payments in 2014. “If the doctor is susceptible to being bought out by a pharmaceutical company, he can just as easily be bought out by other factors.”
I have heard Dr. Tarm speak a couple of times.  He is unbiased and is a great lecturer.  He earns his money. I have learned a great deal from him.  He performs a service to other physicians they can get nowhere else.  His experience is invaluable.

Full disclosure:  To my surprise I am also on the take! 

I looked myself up at https://openpaymentsdata.cms.gov/

However, I am retired so it may not yet affect my prescribing habits. It may affect my blog?

I have no idea what these bribes are. I finished an Obesity course on April 26, 2016. 

On 6-18-16 I was at home.  I guess I need to dispute these charges?  How do I do that?

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