Monday, May 7, 2007

what well paid lobbyists can do

WASHINGTON (MarketWatch) -- A Senate vote on Monday likely assures that U.S. borders will remain shut to lower-priced prescription-drug imports, marking a major victory for pharmaceutical manufacturers.
The Senate voted 49-40 to approve an amendment to a bill dealing with the Food and Drug Administration, which would require the secretary of the Health and Human Services Department to certify that drug imports would pose no safety risk to American consumers before allowing pharmacies to import prescription drugs from Canada and other countries. Health officials have said they can't provide that level of assurance.

Thank god, the drugs from Canada cannot come into our great safe and well protected country! I must have missed those newsflashes about the rampant deaths among the elderly, the children and in general the frail in Canada following ingestion of Canadian drugs...
We all know that the difference between drugs in Canada and the US is just the price (and the profit for the manufacturer). The drug manufacturers are the same in Canada and here, the production standards are the same, the hygiene standards are the same, the pharmacies have the same quality standards! Hey, this is Canada - we are not talking Afghanistan here.
But, the profits are less in Canada, and we cannot let that happen! So, the pharmaceutical companies give a few millions to lobbyists, and voila, the billions of profit continue to go into pharma's pockets.
This is a point where the HMOs should flex their muscle. Where were they when we needed them? Why have they not paid their lobbyists enough? Where were their millions?
This kind of obvious corruption is sad. Laws are maid by the wealthy and for the wealthy. Realistic, but very sad.
You understand now why I do not see pharmaceutical representatives? they get paid by the very same people who pushed this law through. Not only do pharmaceutical reps waste my time, they consistently overcharge my patients. And that is harmful.


jb said...

So you go to a restaurant with a date. Say, Ruby Tuesday. Nice, all you want salad bar. Date orders salad bar. You order glass of water, large, with slice of lemon. Sugar is on the table, free, so you get free lemonade. Date shares lemonade. Date goes up to salad bar numerous times, and you continually mooch off date's plate, until you have eaten all you want. Two meals, with lemonade, all for the price of one salad bar.

Ruby Tuesday=USA
You=every one in the world who wants something without paying for it.

Please understand that today's "dirt cheap generic" was yesterday's "obscenely priced blockbuster." Maybe you're not old enough to remember when ibuprofen was sold only as Motrin, and only by prescription. When Tagamet, the first of the H2 blockers, was the most profitable drug out there. Now it's a generic on the grocery store shelf, as is ibuprofen. These drugs come from the same source as today's over-promoted, over prescribed, but valuable additions to our formulary. I'm old enough to remember when we had to keep ruptured appendix or diverticulitis patients hospitalized for 10 or more days. Now one Levaquin every morning gets them back out and sometimes even to work. Yes, Levaquin may be overpriced and is certainly overprescribed, but at $10 or so retail it covers maybe a half hour or so of the cost of a day's hosptitalization.

Do your patients know of your policy of not prescribing a drug if it's been promoted by reps or ads? Are there no cases when the promoted drug is actually the most effective and efficient way to treat a condition?

ObGynThoughts said...

Hi, JB
Interesting approach. I am old enough to remember brand name Motrin and a few other brand names.
I do not believe Canada is taking advantage of the US as the date in your example is taking advantage of Ruby Tuesday. Prices for identical drugs are lower in Canada due to government regulations or negotiations. Drug companies still are selling their good in Canada, so I assume that they must make at least a small profit.
My point is that companies prefer to make a big profit over making a small profit and do everything they can to achieve this, including paying lobbyists.
I do not have to contribute to the profits of pharmaceutical companies more than necessary and therefore prescribe mostly generics. I also prescribe for other reasons - convenience for example. I prescribe Zithromax Tripak (brand name, non generic) because it works great and is incredibly convenient. I do not have a "policy" not to prescribe advertised meds, it is a trend.
The reason behind this are the far too transparent marketing moves and maneuvers of pharma reps.
A prime example is Jasmin. By far too many patients ask for Jasmin, simply because they see the ads on TV. Thoughtless colleagues hand out the samples and patients come requesting refills.
When I tell them that all birth control pills are pretty much the same and that the most relevant difference is how an individual patient tolerates a specific pill, they often choose to get the generic and they hardly ever regret it.
Pharmaceutical companies are trying to sell for the biggest profit, I try to get meds for my patients at the best price.
And I do not feel sorry for huge companies worth hundreds of billions when a little doc in a little practice prescribes a little less expensive drug that works quite as well as the expensive shiny new one.

jb said...

Thanks for your reply. Of course the pharma companies can make a little profit selling their pills in Canada- it costs only a few cents per pill to make them, once the development costs are accounted for. For the most part, Americans cover those costs, and the rest of the world gets a nearly free ride. I don't know if the often quoted $800 million average development cost is accurate, but whatever it is, they have to sell a lot of pills to make up for the ones that never get through to market, or fizzle once they do get to market.

I don't mean to come across as a pharma shill. I do not see drug reps- my office staff and I buy our own lunches, thank you. When a high $ med is appropriate, I write for it. When a patient requests something she's seen on TV, I remind her, "It's TV." Never an argument back when I tell her that those ads have the same relation to reality as beer ads- and I don't go to the beach with bikini models.

I recognize that drug companies exist to make a profit, and even that the life saving output from these companies is only a byproduct of their desire to make a profit. I also remember when beta blockers were the newest thing on the block (Inderal!), then calcium blockers, and ACE inhibitors. When Cipro was the miracle drug- made a mint for Bayer, and they deserved it. In your field, are there no women for whom Jasmin is the best choice? Just because the motives of big pharma are impure is not a good reason to deprive our patients of the benefits of its output, in my opinion.

I was responded to the "rule" you cited in your original post when I mentioned your "policy." Sorry if I misunderstood.

ObGynThoughts said...

Hi, jb
we pretty much seem to do the same in our practices with regard to prescribing drugs. Maybe I was a little drastic in my blog at first - with the intention to make a point.
I am aware that development costs are high, but which numbers can we believe? I am also aware of the many me-to drugs that come onto the market that take very little money to develop. To go back to the oral contraceptives, there are about 8 progestins on the market that are simply precursors to norethindrone, work after being metabolized to norethindrone and are hardly better than norethidrone.
Have you ever seen a study showing that one oral contraceptive is more effective than another oral contraceptive? No, because it probably could not be shown. I am sure there are a few unpublished study hidden in some drawer or waiting to be shredded. Yet we have about 50 on the market. Most of them Me-to products that cost very little to develop and bring good profits.
I mentioned the WHO list of essential medications in another blog. This list is a great example of which meds we need and shows how many we may not need...
My main message: just be careful with pharma marketing, it is very efficient. Too many of us just blindly and naively follow its messages and spend more of insurance money - which is our patients's money - than we need.
In the end we spend our patients money and we should do it wisely.