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

[u/FunnyGamer97]

https://www.eurekalert.org/news-releases/1095648

[u/thedukeofwhalez]

I appreciate your perspective Doc, and you did bring a lot into perspective for me. But as a pharmacist who then has to deal with the hellscape physicians have caused with their over indulgence in the Pharma industry, you dont need to worry about the special bits that stir you towards prescribing it. Pharmacists can help you. We are part of your team. We are in the same buildings as you and are only a phone call away. We can help. Pharma doesnt need to help you with better understandings. You dont need to be given the value of thousands to trip out and dine fine to learn more about the product. Especially when all of those thousands come from the patients whose copay is $500+ because it wasn't actually fully covered, and continually makes the Pharmaceutical industry a butt load of pure cash profit. A pharmacist can happily help you and our patients will only get better.

[u/jsfuller13 → u/thedukeofwhalez]

I have done cognitive assessments on a good number of people who have been harmed by the prescribing habits of physicians. Certainly not all physicians, but I've seen enough to argue that we should be extremely cautious about particular classes of medications and ready to discuss prescribing practices. The number of potentially problematic prescriptions according to the Beers criteria that I find is concerning. The flagrantly irresponsible prescriptions are frankly upsetting.

Furthermore, we know how programs like this work psychologically (Not my area of expertise, but happy to pull sources). Large payoffs tend to be less effective for long-term behavior change. This sort of seemingly trivial exchange is nefarious and well-targeted to change prescribing behaviors. These practices by pharma should be illegal.

[u/Relax_Dude_ → u/jsfuller13]

In my opinion, Beers list compliance might be the worst criteria to use to judge physicians. Firstly its not an absolutely contraindication to prescribe those drugs, they are to be used with caution. Second, the list is so extensive, there are MANY conditions that are impossible to treat without violating the beers list.

[u/jsfuller13 → u/Relax_Dude_]

The criteria include recommendations along several lines, with varying levels of evidence and strength of recommendation. I feel comfortable with patients being prescribed medications on the list. In my capacity I tend to reach for the list as support when I see clear evidence of bad behavior by prescribers. Last week I wrote up an assessment for a patient prescribed a high dose of an opioid that had been prescribed for 20+ years, a high dose of gabapentin, a benzodiazepine, and several others that were on their own or in combination concerning. We should have room for clinical decision making. Excesses are regular and impactful on patients' health.

[u/Relax_Dude_ → u/jsfuller13]

Yea that sounds bad but I can probably venture to guess that the patient has debilitating neuropathy and or chronic severe back pain, and anxiety. If they never attempted to wean the patient down and try alternatives then yea thats poor management. And if that doc is willy nilly prescribing high dose opiates and benzos to all his patients then yea, investigate. I would be willing to bet those discussions have been had between the doc and the patient, did he not? This is a classic n=1 situation IMO. And back to topic, opiates, benzos, gabapentin are all generics. I have never during my career heard of a pharma sponsered talk of opiates, benzos, or gabapentin taking place. Which beers list violations do you think are actually influenced by pharma?

[u/jsfuller13 → u/Relax_Dude_]

I see similar profiles about once a month. Within that pattern, what I described is fairly moderate. It is often older physicians, particularly psychiatrists, with concerning practices along these lines. With the pattern of referrals I get, I can't confidently say that it's a pervasive practice for any particular physician, but we can certainly start to understand someone's judgment by particular clinical decisions. Edit: to your edited comment, I can only speak to my own areas of knowledge. I would not presume to speak to pulmonary impacts of any intervention. I can and will speak about cognition. To the issue of opioids (the preferred term these days) in particular as being implicated in misconduct by pharmaceutical companies, this is a well-established issue. If you would like some citations, I’m happy to provide. Edit 2; also, benzos are not indicated for chronic anxiety, nor are opioids indicated for chronic pain.