It’s a lot better today than it was but it was never about pens. The big money was always in the “researchers” and “thought leaders”. And why is it that the ortho guys are never brought up? The were never monitored as they were whisked around the world by the orthopedic sales reps.
Big Pharma’s positioned itself brilliantly to take over American Public Medicine. Like every other business, they either position themselves for the future – or die.
The view now shared by many of the Americans is that doctors are the chokepoint in getting their medicine out to the retail market. Prescribing pharmacists – who work at the pharmacy they prescribe for – are part of their plan. The image in Retail Medicine is that of free and independent choice of the customer.
Read up on the great revolution of Telemedicine – now your screaming baby gets amoxicillin within minutes! Retail plays by the odds, so a 1% chance of meningitis is now the customer’s problem — nobody else can be blamed for ‘missing meningitis’ other than the mom. 95% satisfaction rates are fine in the retail world.
The “intermediate prescribers” are fat and sassy – for the next few years. I see many “prescription” medications going OTC – you have a sore throat, you pay for the antibiotic you can afford. And nobody will suggest that you lay off the antibiotic – no, that’s not gonna happen. We’ll quickly hear the screams of the NP’s when general nurses start prescribing; of the PA’s when the EMT’s start prescribing – and so on.
The rest of the world is appalled by the hubris of the American people about healthcare. We will play dice with our own lives, and the lives of our children. We do not trust those “rich greedy doctors,” but instead trust the big companies with brand names – and we have raced in the direction of trusting the brand for many years. It’s a Ford, it’s a Cadillac – and it’s a Glaxo, or a CVS.
The profits on the 95% successes are formidable – enough to brush off the 5% bad outcomes with a small settlement. $50,000 for an infant meningitis death – small change.
Don’t blame Big Pharma – corporations go to where the profit lies. People want ten-dollar medicine, and they will surely get it. This is how it works in Bolivia, in rural Chile, in Botswana – why not here too?
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Doug:
Someone please refresh my memory as I seem to have missed out on the WHISKING AROUND part of the program. As you know, I am an orthopedic surgeon in practice now for 21 years. While I did occasionally have a rep pay for me to attend a conference (not unlike EVERY physician, including you I’m sure at some point), I myself paid for ANYTHING that would even remotely resemble “WHISKING”.
There really isn’t anything wrong with that in my opinion, since it actually does help to advance our profession. Where the big problem lies, and as you have alluded to, is paying these “thought leaders” for “intellectual” purposes (i.e. use my implant X amount of times and I will pay you y amount of dollars).
These guys who accept this sort of payola, can call it whatever they wish but they are the big problem.
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But I have had patients ask me how much of a “cut” I get on the EKG’s and the medications I order. Don’t worry about reality, Dr. B – the image of the greedy doctor’s already been sold to the public. I’ve never been whisked, and the world of getting “goodies” from the drug companies is as stale as Wednesday Golf and Brand-Name-Only and Haley’s MO – but the spinmasters will shake that puppet in the face of horrified consumers, and try to get “more control over greedy doctors.”
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Amen Steve. Without the promise of a good meal, why would I give up two hours of my evening? Whatever real excesses were committed by Big Pharma have been greatly amplified to take advantage of the “rich doctor” hobgoblin. Worse still, those wrongs have been dwarfed by those from academicians, organized medicine, and government, wrapped in their fake moral superiority.
I have far greater respect for the average drug rep than I do for any AMA delegate or medical ethicist.
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Big Pharma’s positioned itself brilliantly to take over American Public Medicine. Like every other business, they either position themselves for the future – or die.
The view now shared by many of the Americans is that doctors are the chokepoint in getting their medicine out to the retail market. Prescribing pharmacists – who work at the pharmacy they prescribe for – are part of their plan. The image in Retail Medicine is that of free and independent choice of the customer.
Read up on the great revolution of Telemedicine – now your screaming baby gets amoxicillin within minutes! Retail plays by the odds, so a 1% chance of meningitis is now the customer’s problem — nobody else can be blamed for ‘missing meningitis’ other than the mom. 95% satisfaction rates are fine in the retail world.
The “intermediate prescribers” are fat and sassy – for the next few years. I see many “prescription” medications going OTC – you have a sore throat, you pay for the antibiotic you can afford. And nobody will suggest that you lay off the antibiotic – no, that’s not gonna happen. We’ll quickly hear the screams of the NP’s when general nurses start prescribing; of the PA’s when the EMT’s start prescribing – and so on.
The rest of the world is appalled by the hubris of the American people about healthcare. We will play dice with our own lives, and the lives of our children. We do not trust those “rich greedy doctors,” but instead trust the big companies with brand names – and we have raced in the direction of trusting the brand for many years. It’s a Ford, it’s a Cadillac – and it’s a Glaxo, or a CVS.
The profits on the 95% successes are formidable – enough to brush off the 5% bad outcomes with a small settlement. $50,000 for an infant meningitis death – small change.
Don’t blame Big Pharma – corporations go to where the profit lies. People want ten-dollar medicine, and they will surely get it. This is how it works in Bolivia, in rural Chile, in Botswana – why not here too?
Doug:
Someone please refresh my memory as I seem to have missed out on the WHISKING AROUND part of the program. As you know, I am an orthopedic surgeon in practice now for 21 years. While I did occasionally have a rep pay for me to attend a conference (not unlike EVERY physician, including you I’m sure at some point), I myself paid for ANYTHING that would even remotely resemble “WHISKING”.
There really isn’t anything wrong with that in my opinion, since it actually does help to advance our profession. Where the big problem lies, and as you have alluded to, is paying these “thought leaders” for “intellectual” purposes (i.e. use my implant X amount of times and I will pay you y amount of dollars).
These guys who accept this sort of payola, can call it whatever they wish but they are the big problem.
But I have had patients ask me how much of a “cut” I get on the EKG’s and the medications I order. Don’t worry about reality, Dr. B – the image of the greedy doctor’s already been sold to the public. I’ve never been whisked, and the world of getting “goodies” from the drug companies is as stale as Wednesday Golf and Brand-Name-Only and Haley’s MO – but the spinmasters will shake that puppet in the face of horrified consumers, and try to get “more control over greedy doctors.”
Amen Steve. Without the promise of a good meal, why would I give up two hours of my evening? Whatever real excesses were committed by Big Pharma have been greatly amplified to take advantage of the “rich doctor” hobgoblin. Worse still, those wrongs have been dwarfed by those from academicians, organized medicine, and government, wrapped in their fake moral superiority.
I have far greater respect for the average drug rep than I do for any AMA delegate or medical ethicist.