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Is your physician making money when prescribing?

Discussion in 'Pharmacology' started by bostonnew, Jun 30, 2010.

  1. bostonnew

    bostonnew Silver Member

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    I was just told that in the U.S. doctors make a buck or two every time they prescribe a medication, say Adderall, to a patient. Is that true? Does he get money from the pharmaco or what? Isn't that bribery/kickback? Is it happening legally and transparently or in the dark?

    For non-Americans, what's it like in your country?
     
  2. Soheil123

    Soheil123 Newbie

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    Swim lives in the Uk, and as far as I know nothing like that goes on here. However, it would make sense that not many people know, as not many people are doctors and they wouldn't really want them to know.
    Not sure about the US.

    If it's true it sucks though.
     
  3. bostonnew

    bostonnew Silver Member

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    I think it really sucks too. When I lived in the US my girlfriend at that time was prescribed a ton of amphetamines and benzos because of her add. I've read a lot about the side effects of those drugs and it's serious stuff if taken in large doses. It makes me upset to think that her doctor might have profitted financially from over-medicating her.

    They even give these drugs to preteens without the parents necessarily understanding that their kids are put on speed and what not. Makes me sick if it's true about the kickback.
     
  4. Potter

    Potter Platinum Member & Advisor

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    that sounds like paranoid talk. I'm pretty damn sure such kickbacks would be HIGHLY illegal in the states.
     
  5. coolhandluke

    coolhandluke Titanium Member

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    swim saw a tv program about a drug that was aggressively marketed by the manufacturer, and was later recalled by the FDA. he forgets the exact drug, but believes it was pfizer who made it, but is not certain. anyway they gave doctors bonus incentives for "prescribing" it to patients. the company also promoted a slew of off label uses, and the drug sold very well. anyway he wishes he could recall more, but it was a few months ago, he'll see if he could find a little more online.

    heres what swim found on wikipidia

    "The case is the largest civil settlement against a pharmaceutical company as well. Pfizer paid a $1 billion civil fine to settle allegations it had illegally promoted the drugs for uses that were not approved by the u.s. food and drug administration (FDA) and caused false claims to be submitted to Federal and State programs including but not limited to medicare and medicaid. Under the false claims act, damages can be assessed for violations of the federal Anti-Kickback statute, 42 U.S.C. § 1320a-7b(b) and the off-label marketing provision within the Federal Food, Drug, and Cosmetic Act ("FDCA"), 21 U.S.C. §§301-97. Six whistle blowers will receive $102 million for their participation in the civil investigation, and John Kopchinski, a former sales representative, will receive $51.5 million for his allegations involving the marketing of Bextra"

    was the case swim was thinking of

    also looked up the federal anti-kickback statute, it states that if the product, or service can be covered by medicare or medicaid, then the doctor may not be paid for such thing.

    so it is illegal, but doesn't mean it hasn't happened. also there is a loop hole

    "While the anti-kickback law is broad, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services issued "safe harbor" rules in 1991, identifying specific types of activities not subject to enforcement actions under the anti-kickback statute as long as various conditions are satisfied (56 Fed. Reg. 35951 [1991], 42 C.F.R. § 1001). "

    all in all swim thinks swiy is most likely fine, and would really only apply to anything new enough to only be made by a single company(different pharmacies carry different manufacturers of the same medicine) . who really knows how much the "safe harbor" rule is applied, but none the less its in there.
     
    Last edited: Jun 30, 2010
  6. Moving Pictures

    Moving Pictures Titanium Member

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    It is very much illegal for docs to get paid to prescriped drugs in the US. Pharm companies do go to doctors office and give out free samples and try to convince the docs to prescribe their drugs though. They do things like taking doctors out to expensive lunches and things like that which isn't illegal. It is frowned upon by many though.
     
  7. Jasim

    Jasim Gold Member

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    They give out a lot more than just free samples of medications to doctors. I don't know about any actual monetary exchange, pretty sure that IS illegal, but everything from pens, cups, notepads, nice dinners, and even hotel stays are used by big pharma to get doctors to push their meds.
     
  8. godztear

    godztear Silver Member

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    Paid doctors have paid their way threw school.

    They are not getting "under the table" pay as they are trying to work their way out of debt in order to be rich.

    Moral of the post: Nothing is Free
     
  9. KingMe

    KingMe Newbie

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    the following is true to swims knowledge for his country (romania)

    swim know this for a fact that agessive marketing by pharmaceutical companies does take place, but generally it is not in the form of money given directly to the doctor on a case by case basis. instead, there are a couple of strategies used to lure doctors towards giving out certain medications.

    one such strategy is to sponsor the doctor, either via paying for congress participation fees on his behalf (which can get pretty damn expensive (think 1000e/summit when a doctors salary is around 500e/month), and are compulsory at times because doctors have to undergo continuous education) or by free samples, free tech, free courses in the use of said medicine. Sometimes this type of relationship can be mutually beneficial, especially in the private sector where patients are less likely to care that much about medication price.

    another strategy is to lure the people responsible for aquisition of medicine for entire clinics/hospitals. these can be doctors, but not necessarily so, also pharmacists. there are noted cases of expensive gifts (off the record of course) that some recieved from anonymous generous people ahead of or folllowing a deal for medical supplies. This kind of strategy is more damaging, as it can lead to excessive spending of goverment funds.

    Generally though, doctors presribe only the medication they think the patient needs anyway, and do not overprescribe just for the sake of it. Also, writing a prescription is one thing, but the pharmacist himself is allowed to suggest changes if the drug prescribed is unavailable or the patient desires a cheaper (usually generic) one.
     
  10. coolhandluke

    coolhandluke Titanium Member

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    come to think of it, swim thinks the company wasn't giving monetary bonuses, but were sending doctors on vacation and doing things like that.
     
  11. Jasim

    Jasim Gold Member

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    Yep. That's what I was referring to with the hotel stays comment. They call them retreats. They will do this under the guise of education. They may have a lecture or two, but the point is to encourage the doctors to push whatever new medication they just got approved. Play around with google "pharmaceutical marketing doctor retreat" should return some relevant results.
     
  12. RQ_user

    RQ_user Newbie

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    SWIM knows her doctor makes money either way -- SWIM has to visit month;y for scripts. If SWIM was not medicated the dctor would not see her as often so in that way a profit is made.
     
  13. sol_adore

    sol_adore Newbie

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    A system that financially rewards prescribing certain drugs would cause a major conflict of interests it makes me think it cant be the case.

    I know that pharmaceutical companies have effectively bribed prescribers with 'gifts' in the past, and that it still probably occurs today, but prescribing habits are monitored and if a doc gets carried away they are sure to arouse suspicion.
     
  14. bostonnew

    bostonnew Silver Member

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    I just found the other thread on 'Glorified drug dealers' where this whole thing us discussed in detail. It seems the pharmaco gives tons of gifts, retreats, consulting fees, etc. in order to influence behavior. My question is if the companies have any way of knowing if it works. Do they ask the physicians how much they've prescribed of their drugs? In that way they can reward retrospectively. A secret kickback.
     
  15. chibi curmudgeon

    chibi curmudgeon Gold Finger Gold Member

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    The pens, etc., were recently banned in the U.S., which a lot of people think is silly, but research has shown that it really does make a difference for most people. (Full disclosure: I love my giant Tamiflu mug, and it's great for mock chicken soup, but even if I could prescribe, I sure wouldn't hand the drug out like candy.)

    Most of the pharmacists I've worked with are highly skeptical of anything a drug rep says, and mock their more outrageous claims behind their backs or occasionally call bullshit (in more polite terms) to their faces.

    Health care professionals with brains know they're talking to salespeople and take what's said with a toaster-sized halite crystal. But they're in the minority and some are really gullible as shit. Some are lazy and don't do their own research on a drug to find the real truth.

    afaik, drug companies can still sponsor information sessions, these can be on Caribbean cruises and they can provide lodging free to doctors, but the doctors are under no obligation to even pay attention at the seminars, let alone prescribe the drugs advertised. Ultimately, it is their decision and a good doctor will consider all the evidence, not just the flashy brochures.

    So this is compensation for listening to advertising. Compensation for prescribing is totally illegal and will get your license yanked. Because of confidentiality laws, drug companies can't access a prescriber's patients' records to find out if they're getting a certain drug.

    A prescriber can, however, volunteer that information and say he/she has 5 patients on Zyprexa, for instance. And a Lilly rep would then be more likely to invite that prescriber on a cruise. They can't check to see if the prescriber's lying, though...
     
  16. bostonnew

    bostonnew Silver Member

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    This is insightful. Do you have a sense to what extent such conversations take place? If I was a greedy pharmaco head of sales I would tell all my sales reps to ask physicians how much they've prescribed and then "reward" them massively the day after (trips, gifts, etc.) if their numbers were high. Physicians would quickly learn the benefits to themselves of over-prescribing to their patients. We would have wealthy doctors and companies while public health deteriorates.
     
    Last edited: Jul 3, 2010
  17. chibi curmudgeon

    chibi curmudgeon Gold Finger Gold Member

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    I'm not a physician, but I've been in conversations where drug reps directly asked pharmacists or prescribers how often a drug's used in the clinic.

    I'd guess it happens quite a lot, but I wouldn't accuse my doctors of being on the take every time I'm prescribed something; the majority of the drugs out there are generic. It would be pretty easy to pick out a prescriber who insists on brand names, and they'd be looked at cockeyed by their peers. If the treatment guidelines for a condition are overwhelmingly in favor of a cheap generic, only an idiot would use a different drug just to get on the good side of big pharma.
     
  18. IT-290

    IT-290 Newbie

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    There is a really good documentary on youtube called Making A Killing: The Untold Story Of Psychotropic Drugging. Its really interesting. They mention stuff about how psychiatrists were getting incentives like vacations passed of as conferences. One interesting point was how big pharm companies were giving invectives to the highest prescribing doctors

    IT-290 added 38 Minutes and 20 Seconds later...

    I added links to all 10 parts in the Antidepressant videos sections.
     
    Last edited: Aug 25, 2010
  19. Canmedaa

    Canmedaa Titanium Member

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    SWIM would just like to add that while this may be the case in the United States, it is illegal accept incentives or have a conflict of interest while prescribing medication in Canada. Canadian physician's are marketed to in the form of patient charts with brand name drugs on them and such, but they are not rewarded for prescribing any one particular medication by any drug company.

    Cheers,
    -CAN
     
  20. IT-290

    IT-290 Newbie

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    Forgive my ignorance I didn't know that. To be honest I have a mistrust of the medical system as a whole. Especially the USA's fee for service ways. I think its decussating that you must fork over cash in-order to be seen by a doctor.