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/thinkbetterofu → u/Relax_Dude_]

so, you, as a doctor, would be totally comfortable telling any patient you are prescribing a drug for, a full disclosure that you had previously entertained these outings, dinners, or paid speaking events, or trips, from the pharma companies of the drug you are prescribing?

[u/Relax_Dude_ → u/thinkbetterofu]

I wouldn't mind a but i would need the time to explain all yhe above which would add another 10 min of back and fourth discussion which there isn't time for.  And fyi, all of these "payments' including food or whatever are all publically available information.  You can look up any individual, institution, or company and see who is paying who for what purpose down to the exact date. 

I also want to say there is often a preconceived bias favorable to the drug before a doctor attends the event.  For example I went to a Tezpire dinner because I wanted to prescribe it.  I'm sure neurologists are going to dinners of these new MS drugs because they are already interested in it.  I think this part gets completely missed is these discussions.   

[u/pswissler → u/Relax_Dude_]

I understand what you're saying here but in my job (professor at a public university) we're not even technically allowed to take free swag from suppliers at conferences due to the perceived conflict of interest it would result in. Honeraria for talks given is common but it's the sort of things we need to report to our ethics office.

When I worked in industry these sort of supplier lunches were more common, but the fundamental difference is that any induced bias started and ended internally, rather than propagating outward to the public at large. 

"Everyone does it so it's not a big deal" is a poor argument and can only serve to erode trust in your profession. The fact that you acknowledge that it would require a detailed discussion with patients shows that you recognize this. I understand that entrenched field standards are difficult to change (especially since the status quo results in some nice perks for those in the field), but it's something that your field needs to start recognizing as a problem.

[u/Relax_Dude_ → u/pswissler]

I totally understand but I also don't want to give into popular opinion if I strongly believe it's just wrong. All I really care about is my relationship and trust with my patients which I feel like I have. I know for a fact that I only make decisions with my patient's best interest in mind, and they know I go above and beyond for them. And if we're on the subject of erosion of trust in doctors, I would say a much larger percentage of that has to do with social media misinformation for clicks and it has to do with doctors not explaining their decision making or having the time to do so. Maybe 30 years ago if a doc told you to take this medication for your blood pressure, you'd take it no questions asked. Nowadays you have to explain what hypertension is, the consequences of untreated hypertension, what the drug does, less common side effects, etc. Theres nothing wrong with that but its often a time issue. Example: I had a friend's mom tell me the other day that her pulmonologist put her on an antibiotic to take long term. She feels like she doesn't have an infection and her sisters daughter is a nurse and told her she should never take long term antibiotics because it builds resistance and that that doctor didn't know what he was doing. She felt better when she was taking it but then stopped because of her nurse friend. So now they dont trust their doc and dont know what to do. I saw her med list and it was azithromycin 3x per week, it was for bronchiectasis. I explained to her that this is a perfectly good treatment, I explained why and how it works, and told her I would've done the same. I told her she should also be on certain other breathing treatments. She told me she was already on them. What I advised was exactly the same as what that pulmonologist advised. In one interaction theres mistrust, in the other interaction theres trust and comfort. I think those things factor more into mistrust than this idea that doctors are getting kickbacks, which btw are illegal and can get your medical license taken away.