I have never blogged before, so I hope that this post ends up in a semi-logical area. . .
I finally finished the book today (better late than never), and the chapter about pharmaceutical and medical device marketing really stood out to me. Just this morning I saw a commercial encouraging men to speak to their doctors about low testosterone, and in my head I thought "Oh man, here is the next big medical fad." Then I read chapter 9, and I thought it provided some great insight into the current operations of the medical and pharmaceutical marketing industries. As pharmacists, we are often the ones dealing with the patient's prescription insurance, not the physicians doing the prescribing. When I see all of these me-too drugs, or "improvements" on older drugs (think Nexium vs. Prilosec), I always wonder "do these doctors know how much more this costs?!?!?!" I understand that most community pharmacists won't have time to make cost-saving interventions on every brand name prescription they receive, so I was relieved to see this issue addressed in the book, and I'm glad that physicians are thinking critically about the necessity of these drugs and whether their increased expense can be justified.
I also find the allegation that the pharmaceutical industry is trying "to create a clinical disorder by medicalizing normal changes and challenges in life" very concerning. Especially when the chapter explains that the existence of andropause is unproven, but testosterone replacement prescriptions continue to rise sharply. I feel like this is putting patients at risk for adverse effects while providing them with no clinical benefit beyond the placebo effect. Does anyone else have thoughts on this?
Thanks Shelly for starting a new thread, I was a little too challenged to figure it out. I shook my head at this chapter too, because this is starting to get a little personal for me. I am reaching age (40 in month) where I really can tell I am not 25 anymore. I exercise a lot, which almost makes it worse, because I am reminded all the time. I can see why people sell "hope", if I really thought I could look, act or feel younger why not? I agree with you, I personally think this is really unethical, profiting from people's hope. What is really sad, little research goes into improving many types of therapy, for example anti-biotics, because it costs too much to make a product that likely won't be more effective than those on the market. Investing heavily into treatments with no medical relevance makes money, unfortunately. I am with you, I am glad Groopman took a chapter to focus on this. We see people on the other end of this in pharmacies, and I have wondered why a doctor would write for something that has no chance of being covered by insurance. I guess now I know why.
ReplyDeleteShelly, how did you start a new thread? A couple of us were wondering how to do it.
ReplyDeleteThe issue of having these new me-too drugs comes up often at the pharmacy I work for as well. At least the insurance companies don't just pay for some of these drugs. It would not make sense to pay for a more expensive drug that does not show much improvement over a cheaper option. This chapter makes me wonder how physicians know what to prescribe. How thorough is a physician's training in medications? Do they learn broad classes of meds over one semester or do they learn more? If I knew how doctors think when they prescribe medications, I would feel better about stepping in. If they really only prescribe two dozen medications as it says in the book, this would make a great case for more pharmaceutical care.
ReplyDeleteWhen I signed in (and only after you sign in) a little tiny link appears in the upper right hand corner that says "new post." I just clicked on it and hoped for the best, and it seemed to have worked.
ReplyDeleteSo it's funny that you brought up the statement about the pharmaceutical industry is trying "to create a clinical disorder by medicalizing normal changes and challenges in life" because I go to the area high schools and talk to them about STIs but after my talk I always let them ask any questions. One day a few months back this high school student came up to me afterwards looking for a battle of wits. He asked me about this exact situation, how I can feel good about becoming a pharmacist when I make money off of peoples suffering. I was shocked, mainly because I've rarely met a high school student who was so confrontational to someone talking about sexual diseases but also because of the negative stigma he had about the profession. I responded that physicians also make money off of medical problems but more importantly I would love to live in a world where people didn't need medication and my job was unnecessary but unfortunately there will always be infections... Have any of you come across this same attitude?
ReplyDeleteI know I feel it the most with elderly patients wondering how pharmaceutical companies can get away with charging so much for medications. I try to explain that research for new meds is a large portion of the cost but they seem to not care.
Also, as far as marketing goes, does anyone know why ALL of the erectile dysfunction med commercials end up with the couples in separate bath tubs? I keep trying to figure out how they got this marketing strategy, why you would magically find two bath tubs out in the middle of the wilderness and who did they poll to find out that this would be an effective strategy? Think about it the next time you watch TV, at least it provides a little humor.
ReplyDeleteLaura, I've come across a lot of similar attitudes and it is disheartening, to say the least. I feel like many of us chose this profession because it was a way for us to help people, but oftentimes I feel like we are perceived very differently. I have actually had numerous arguments with two ex-boyfriends who failed to see the helpfulness of pharmacists. It is also difficult to talk to elderly family members who pay large sums of money for their medications and don't understand why. I've had people make me feel absolutely evil for being attracted to this profession, but I am confident that with the advancement of pharmaceutical care and the development of new, groundbreaking drugs, that the public perception of pharmacy will take a turn for the better.
ReplyDeleteIn response to both of your comments, I don't think our profession is very well understood. Maybe a lot of medical professionals jobs aren't, but the only one I can speak about is ours. I get asked lots of odd questions, and I also think that the profession has changed so much in recent history, that almost nobody understand our place in health care. My Grandparent, even parents, grew up with "druggists". Now, I agree with the statement above, the pharmaceutical industries have come to stand for a lot of greed, whether that is fair or not I don't know. I usually try to explain to people the expense and time to develop new drugs, and that pharmaceutical companies are a business, not charities. Either way, that doesn't have anything to do with an actual pharmacist working in the community, hospital, or any other care setting.
ReplyDeleteOn a lighter note, it sure is fun watching football on Sundays, I am pretty sure who the target audience must be for Flomax, Cialis, etc and no, I cant say I've ever seen two bath tubs over looking a cliff...
I think it's always difficult for me to hear such a negative opinion of pharmaceutical companies because I am looking at a career in industry. Maybe it's because I've been to Abbott labs and seen how much money it costs to produce one effective medication for the thousands that fail but I tend to take it personally when companies are considered evil. I'm not selling my soul to a pharmaceutical company for an income, I prefer to think of it as a cost saving situation especially with these "me too" drugs. We've learned in Pharmcare that most people don't need to be on PPIs long term so why should a PBM pay for Pantoprazole when they haven't even tried Omeprazole? Sometimes formularies are a pain but in some ways they save physicians from just prescribing whatever shiny, new medication is presented to them by the reps.
ReplyDeleteI've also considered a career in industry, and it has come to the point where I am almost afraid to tell people because the reactions are rarely favorable. The word insurance is almost synonymous with the word evil in people's minds, and I feel like this is one issue that has been so personal for so many people that it is nearly impossible to change perceptions at this point. I agree that formularies do seem like a huge pain, and I'm sure patients see them as another way to deprive them of the drugs that they desperately "need," but I think that formularies are actually a great way of getting patients medications that are less expensive and just as efficacious. I feel like this is one place where community pharmacists could really help out by explaining brand vs. generic, citalopram vs. escitalopram, etc. But as we all explored in the posts about the radiology chapter, time for an average community pharmacist can be pretty hard to come by.
ReplyDeleteI actually worked for a drug manufacturing company before I started pharmacy school, so I take it personally when people have a complete negative attitude towards pharmaceutical companies. I was amazed at the amount of money and time it took to get a drug approved by the FDA. There were so many test protocols and clinical trials done to prove that the process and drug really worked. It was surprising to see how much was produced then thrown into the trash until the drug was approved. The company was doing great things in developing new drug delivery systems that end up really helping patients in the end. Of course, profit is always in the equation, but that doesn't mean the industry is bad overall. I would encourage a career in industry. There was a speaker at MPSA that talked about a industry fellowship at Rutgers that sounded amazing. Being able to influence the drug development process at the very beginning would be really interesting. You don't have direct patient care, but the work you do would affect many patients.
ReplyDeleteI agree with Julie about the prospective of drug companies. I don't know about you guys, but I cringe every time I heard Dr. Feick say this drug showed potential but the drug company didn't think it could make any money off said compound. Once a drug does make it to market, it seems like there's a little known side effect that the drug company becomes responsible for and gets sued. I don't know a good way to fix the problem, but hopefully with all this health care reform, drug development is addressed.
ReplyDeleteI have not really explored the thought of working for a pharmaceutical company, but I admire those that pursue it. I especially feel it is important for PharmD's to work at pharmaceutical companies, as we can utilize our education and have justifications for our decisions. I used to believe that formularies are a huge obstacle at work, but I have realized in pharmacy school that they exist for a reason. When we are behind our computer running an insurance claim, sometimes we forget that pharmacists were involved in creating the formulary. I understand the frustration a patient can have when I tell them their insurance would prefer a different product, but I feel more comfortable helping them now that I have a justification.
ReplyDeleteI have also run into issues with the insurance company but I find it is more the people who answer the phones than the PA committee. At the discharge hospital we have a lot of transplants, c. diff and other illnesses that require the high dollar meds. At times I've had to have the on call pharmacist for the insurance company who reviews the paperwork so I could send them home with the full amount. That being said I also get to handle discharge meds and since almost any med can be given in house the residents have no clue about what is a first line med. I know at Fairview we try to educate the new residents about typical changes (eg pantoprazole to omeprazole) but how do they get out of school with no practical training in this area?
ReplyDeleteLike many others, I work in a retail pharmacy and everyday at work I am confounded by the number of daily medications that we dispense routinely. There are so many people on anti-anxiety and anti-depressant medications that I truly wonder if they are necessary for all of these patients. How did we survive decades ago when these drugs were not so commonly prescribed? Is the pharmaceutical industry really trying to create a clinical disorder by “medicalizing normal changes” or is it just responding to the needs or demands of the public? I think one can make argue for both points. I think the practice of pharmaceutical reps promoting their particular drugs with doctors should be more stringently controlled. And it is really true that pharmaceutical companies contract with drugstores to learn physician prescribing patterns? That seems illegal to me although the book makes it seem as though it’s perfectly legal.
ReplyDeleteI am not sure about the drug store contracts, but I agree, it sounds ridiculous. Although drug companies do influence physician decisions, there are other components that play into the decisions that physicians make. For example, direct to consumer advertising is highly influential to patients. For example, a patient sees a commercial on TV, and asks specifically for that product because they saw how it helped the actor in the commercial. The physician may just "give in" and prescribe the product (an example of commission bias). This is where pharmacists can step in and point out that there are better options. Most cases, the medications advertised on tv are not the best choice anyways.
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