r/science • u/FunnyGamer97 • 1d ago

Medicine Most US neurologists prescribing MS drugs have received pharma industry cash | Nearly 80% of US neurologists prescribing drugs for multiple sclerosis (MS) received at least one pharma industry payment, with higher volume prescribers more likely to be beneficiaries, 5 year study finds

https://www.eurekalert.org/news-releases/1095648
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u/NinjaLanternShark 1d ago

So how much are these docs getting paid?

The average individual amount received was US$779, but 10% of recipients amassed US$155.7 million between them

Holy snot! The average amount is $779 but among the top 10%, the average amount is $268,448!

US$50 was associated with a 10% greater likelihood of prescribing that company’s drugs

OK, this feels like it could be education. Come to a conference, learn about a drug, have a few drinks on us.

US$5000 with a 50% greater likelihood

And that's a kickback.

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u/Relax_Dude_ 1d ago edited 1d ago

As a physician I can maybe shed some light on this. I'm a pulmonologist, received maybe about $1500 in my lifetime from pharma. None in cash, just lunch and dinners. They might bring lunch for the entire clinic staff or trainees. They might host a dinner session where an expert will speak on the subject while we attend, ask questions, and get a free dinner. It adds up over the years. Lunch might be $20-30 while dinner might be a bit more. It can add up to a few hundred per year and over several years it can certainly add up to the thousands. The ones that are in the tens of thousands or hundreds of thousands are not because they're getting kickbacks for prescribing, it's usually some combination of consulting fees and/or flying them out to give talks. So it's not hard to imagine if theres some renounced expert who strongly believes in the drug would be willing to give educational talks to other neurologists about it. If they get flown out, their travel, hotel, food, and speaking fee will be paid for. That usually amounts to fees in the tens of thousands range over several years. The ones getting 100k+ are most likely to be in the form of research grants or consulting fees. A research grant can easily be 100k for each individual grant. Thats just the reality of things. And while all this seems sketch to outsiders, I think there is some benefit to us attending these dinners and educational sessions. If theres new medications that actually work well and we're interested in prescribing them, we can pick the brains of these experts who are actually using it as well as the manufacturers themselves can guide us on how to get it through insurances. In my field, I was prescribing biologics for asthma. A new one came out a few years ago that I thought was fantastic on paper, could help alot of people for whom the other biologics weren't working. Theres some benefit in attending a dinner to ask them questions about the logics of administration, teaching, insurance coverage, dosing, certain adverse events to look for, etc. And of course for some of the more basic meds like inhalers they often give free samples which we're constantly giving them away to patients, preferably ones that are really tight on budget. I may give them samples to see if a certain inhaler works well for them before making them pay hundreds every month to maintain it. It's easy to say, "doctors are getting their pockets lined by big pharma" and get clicks but the reality is 99% of docs are just ordinary people who genuinely want to learn about the drug while also having a nice dinner with colleagues and de-stress a bit. Theres certainly bad apples out there, but thats the case with anything.

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u/NinjaLanternShark 1d ago

The data specific excludes consulting fees and research grants.

And no amount of "trust me, I'm a doctor" condescension will convince me that the best way for physicians to learn about new drugs is to have drug company salespeople wine and dine them.

The system is corrupt to the core.

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u/Relax_Dude_ 1d ago

I dont see where they excluded consulting fees, they include the consulting fee data in their tables. They only excluded research grants. Generally "Travel and lodging" for speaking is not categorized under "consulting fee". So thats sorta consistent with what I said that travel and lodging is the highest category, just like the study. I do think this is a 'correlation not causation', just my opinion. In my case I'm more likely to prescribe that biologic having attending the dinner and having gotten comfortable with it. If I didn't have anyone else to talk to about it, I might have referred my patients to someone else to do it, and that someone likely did have some contact with the company. You can believe whatever you want but believing this is a big conspiracy and doctors are somehow paid under the table just makes you sound like the crazy one.