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/Relax_Dude_]

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.

[u/VrachVlad → u/Relax_Dude_]

I'm a physician as well and I agree with everything you've said here. Especially if the Pharma rep buys lunch for the entire office that's going to be $300 per lunch and typically we'd have a rep in once a week. Seeing someone have >$10,000 per year from this is honestly not unusual. The last rep I had was trying to get me to prescribe Xarelto and I was asking a whole bunch of questions about it since Eliquis is substantially better in every single way except it's twice a day dosing and much more expensive. My drug prescribing habits don't change because of these reps in terms of what I will typically reach for. What I will say is that the rep reminding me of a drug being on the market is probably the more instrumental thing that these reps do. Especially the biologics because now there's becoming quite a lot of them.

[u/treehugger100 → u/VrachVlad]

I work in a professional field where accepting lunches/meals like that is considered highly unethical. I’ve never understood why it isn’t considered unethical in healthcare. Also, I’m not going to disagree with you about what you do but it seems highly unlikely, if not impossible, that those meals and reps don’t create bias in prescribing broadly. The companies wouldn’t do it if it didn’t.

[u/thinkbetterofu → u/treehugger100]

im glad it strikes you as weird that doctors are literally commenting "yeah we take bribes but its totally fine because im asking REPS FROM THE DRUG COMPANIES ABOUT THE DRUGS AS IF THOSE EMPLOYEES ARE NOT BIASED"

like HELLO?

[u/WillSupport4Food → u/thinkbetterofu]

Calling free lunch a bribe seems a bit intellectually dishonest. Doctors are still beholden to their licensing boards and ethical oversight so implying that they'd all compromise their standard of care for a $20 meal from Chipotle is a little insulting. Not saying it doesn't happen, but it's far cry from pharmaceutical companies sliding a doctor a big bag of money with a dollar sign on it like laypeople often portray it. If your employer pays for your lunch during a company meeting would you also consider these a bribe?

Continuing education is a vital part of medicine so that you don't end up with doctors who graduated 30 years ago and never updated their practices in that time. If a new treatment comes out, doctors in the field need to update their knowledge on that treatment. That generally requires taking time off work or traveling to where the lecture is held. All of that costs money and often times either your workplace or the host of the lecture will cover some or all of the associated fees. Otherwise you get into the situation where people don't want to/can't afford to take time off work to travel to these continuing education lectures.

[u/sneakypiiiig → u/WillSupport4Food]

Just because the continuing education of the field is wrapped up in the corruption doesn’t justify the situation. That’s insane. It seems like the perfect situation for a predatory pharma company to snake their way into to justify their bribes. And we’re not just talking about one lunch, obviously.

[u/WillSupport4Food → u/sneakypiiiig]

For continuing education credits to be considered valid they generally need to be approved by an independent third party associated with your licensing board so it's not like these are just random sales reps giving misleading/overly biased lectures.

The fact of the matter is experts in their field don't just take weeks off work to lecture everyone in their field every time there's a new treatment option. Literally no matter how you format the system, unless you force experts to provide their consultation for free, someone will be getting paid for CE.

The entire argument here boils down to people not trusting that doctors can make unbiased conclusions about new research just because someone paid for their lunch or their plane ticket to a lecture they took off work to see. Which at that point if you have so little faith in their scientific integrity or objectivity, no system will fix that because it's the doctors themselves you don't trust.

[u/treehugger100 → u/WillSupport4Food]

It’s like you are ignoring that doctors are people. People are influenced by the activities that you are describing. It’s like you guys were never taught human psychology.

[u/WillSupport4Food → u/treehugger100]

Doctors are people and people are fallible. But being trained to recognize bias and critically evaluate new information is something doctors are explicitly trained to do. As a veterinarian I had multiple courses exclusively about recognizing sources of bias in scientific literature, common flaws in methodology, and how to form your own professional opinion. That doesn't mean doctors are magically absolved of biases, but I'd argue that's a lot more training in recognizing and mitigating bias than non-medical professionals considering their continued licensing and likely sole source of income depends on it.

When the consequence for not doing your due diligence and recognizing conscious or unconscious biases is potentially killing someone and/or destroying your career, schools tend to place great emphasis on teaching you how to mitigate those biases and think critically about new information.

The system isn't perfect as I mentioned in a different comment. In a perfect world, an independent third party would review all new treatments and medications, all research would be funded independently, and experts in the field would present that info to practitioners free of charge and in convenient locations/times. But we don't live in that world and experts and researchers in their fields rarely work for free

[u/treehugger100 → u/WillSupport4Food]

Thank you for your response. Considering the volume of repeated problems with doctors not doing their due diligence when prescribing the training you describe isn’t leading to impact at the level that would happen in a decently well functioning system.

I don’t expect a perfect world but I want a healthcare system not driven by pharmaceutical company profits. Other countries don’t allow this and I think the US should ban it as well.

[u/WillSupport4Food → u/treehugger100]

I would love for healthcare and research overhauls as well. Sadly the US seems to be regressing at a rapid rate(and already wasn't great to begin with) which create the perfect system for a few bad actors to profit massively at the expense of the general population and concurrently erode trust in medical professionals.

[u/Rikula → u/sneakypiiiig]

As a social worker, our continuing education that we are allowed to receive in our hospital is usually tied to food as well. We can get education without food, but there is usually less attendance since the CEUs happen during lunch breaks. Local companies will sponsor/provide the lunch while someone separate provides the education.

[u/happyflappypancakes → u/thinkbetterofu]

Well the answers are backed up by whatever studies they have performed. Its up to the listener to determine if the evidence is worth it. These are huge trials produce most of the high quality studies that we use in medicine to drive new standards of practice.

[u/babige → u/happyflappypancakes]

Sure like all those negative cigarette studies and Teflon studies that were buried by the companies, and the favorable ones shown to the world.

[u/happyflappypancakes → u/babige]

Well the quality is there in the study. You just have to look. You can usually tell if one is dubious.

[u/treehugger100 → u/happyflappypancakes]

And yet many in this thread are basically saying they don’t have time to read the studies and get the information they need from the company reps.

[u/son_et_lumiere → u/treehugger100]

What the reps can and cannot say is highly regulated.

[u/treehugger100 → u/son_et_lumiere]

And regulations are always followed I’m sure.

[u/son_et_lumiere → u/treehugger100]

They are because they're heavily fined if not. There are legal teams at these pharma companies who are very adamant and particular about following the letter of the law. Any promotional material has to go through FDA review and approval. And there will be random checks at events by FDA folks.