Sensible doctors do not believe drug company marketing.
I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin.
On Friday, I had a drug company representative attempt to tell me ( he was hanging around my coffee area ) about the joys of Targin, a fixed-dose combination of oxycodone and naloxone. I gently shook him off, and directed him to my secretary.
Drug company representatives are usually decent human beings with lives and families. However they are poorly educated, poorly informed salesmen and women with sales targets to meet and product managers to keep happy. Even worse, they and the drug company have no accountability if a patient dies because of their recommendations. If avoidable death supervenes or if there are non-lethal complications or even just therapeutic failure, I am accountable.
Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope.
Many of my colleagues do likewise. I trust that you do the same in your respective vocations. Regrettably, there is a bell curve. I am sure that the drug companies find enough gullible prescribers out in the wild for their purposes.
Have you read Bad Pharma by Ben Goldacre? One of the more interesting findings discussed in the book is that doctors were convinced they were personally not affected by drug company PR/goodies (3 day conferences in Bahamas, etc) but they were all worried that their colleagues were.
It's a standard reaction, like how most people believe that they aren't affected by TV/newspaper advertising but they worry about how it affects other people.
The problem is that there's absolutely no incentive for doctors to act ethically. You don't win any points for ignoring drug company marketing.
Vendor marketing exists in all fields, technology included. The difference is that when I'm spending money on a vendor as a tech manager it's coming out of my budget. I have an incentive to make sure that the spending is intelligent and the solution is effective.
Where is the incentive for doctors to do that? They're spending other people's money on other people's problems.
As a tech manager, you're not using your personal funds, either, you're using your employer's money.
Further, if a doctor's prescription doesn't work, or is too expensive, the patients can get a second opinion, and the doctor can lose the person as a patient. An employer may not even have that option with a tech manager.
The insurance company can investigate the efficacy of prescriptions and stop paying for ones that don't work. The article says some of them have done exactly that with Oxycontin.
At the other end, if the pain killer isn't working, a patient can go to a different doctor who will prescribe something else.
Just a different perspective: maybe give other doctors more of the benefit of the doubt? I have a family friend who's I guess what you'd call "on the bell curve" and he described to me the process. Basically he says that the representatives are paying for the doctor's time/attention with fancy dinners and whatnot. Doctors are busy people and can't read about every drug and study that's being released. He, just like you, takes in the information skeptically and ask for what studies have been performed etc. etc. Like you say, the representatives aren't scientists so often they won't know the answer and they will take notes and have their company send the doctor a custom made document answering everything he wanted to know (as you know, the marketing budgets are insane).
It's sorta similar to the function congressional lobbying is supposed to fulfill. Ie. It'd be ideal if the congressmen/doctors did all the research themselves but that's not possible so you basically have a whole research team at your disposal (who's agenda is very obvious...)
Out of curiousity: how do you find out about new stuff then? I know there's a lot of messy incentives, but if a company wants to at least show that they have a new drug, how could they get you to read about it?
"Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope."
> how could they get you to read about it?
I'd assume by performing a sensible clinical trial that proves its efficacy beyond a reasonable doubt.
Advertising is how you're sold things whether or not you need them. It is not how you learn about what's best for your patient. There are other avenues of information that aren't tainted by the motivation to sell a product despite the consequences.
"a fixed-dose combination of oxycodone and naloxone"
That sounds similar to Suboxone, just with OxyCodone instead of Buprenorphine (i think they also make bup. minus the naloxone under the brand name Subutex). The naloxone mixture never quite made sense to me. Isn't that counter-productive? Is naloxone (aka "Narcan") not an opioid-antagonist at low doses or something?
I see. I didn't know that, that's interesting. Question you may be able to answer: The naloxone/Narcan sticks that EMTs and some police have, they also pass them out at needle exchanges, etc. is that why are those applied in the nasal passage?
I'm a layman, but if i'm guessing right the term for this might be 'bioavailability' of the drug, is that correct? for example drug A may be absorbed faster and more easily through the digestive system over snorting. And then of course IV is the quickest way for just about anything, yea?
You used the correct term - bioavailability describes the fraction of a drug dosage that can enters the bloodstream.
Your example however makes an incorrect assumption. Bioavailability from snorting a powdered drug is higher than oral ingestion. When snorted, the drug passes through the thin lining of the nose and enters the bloodstream directly. When ingested orally, the drug has to make it through the chaos of the stomach and small intestine, get through the hepatic pathway (stomach and intestinal lining to liver to general bloodstream) before it reaches the rest of the body.
Depends on what you mean by "Sensible doctors". Clearly, doctors are influenced by marketing, otherwise pharmaceutical companies would not have spent and continue to spend, multiple millions of dollars targeting doctors.
Want to see if you doctor has been taking money from pharma for meals/consulting/speaking/etc? Look them up in ProPublica's Dollars for Docs: https://projects.propublica.org/docdollars/
Naltrexone != Naloxone. ULDN is incredibly dose sensitive. According to studies, 2 micrograms of naltrexone is effective, yet at 4mcg it begins to lose its efficacy.
My mother works for a doctor, she's gotten some drug company swag and passed it on. I have (had?) a pen somewhere with a floating viagra pill, and a notebook in the form of a Cialis box.
"The Journal‘s reporting suggests that Theranos had been falsifying lab records to make it look like its own proprietary gear was as reliable as the industry standard.
Documents from health care inspectors also seem to show that this kind of stuff was happening.
School is only incidentally about education.
For instance, never underestimate the power of networking at a elite private school.
A few random stories, all true:
A client of mine is global <role_deleted_to_protect_anonymity> director of a multi-billion dollar Scandinavian corporation largely because a school friend knew a few board members.
A friend obtained deep access to a person, considered to be among the five most powerful people in his country, due to his school network.
Another friend was contacted by a school friend and helped him to land a job in an elite investment bank despite the lack of any relevant experience.
"A long-awaited Senate Intelligence Committee encryption bill would force companies to provide “technical assistance” to government investigators seeking locked data, according to a discussion draft obtained by The Hill."
Dyson is the Bose of vacuum cleaners, excelling in hyping their products to the gullible.
By doing that, they perform a number of valuable functions. They return profits to shareholders; they keep their staff employed ;they part the proverbial fool from his money.
I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin.
On Friday, I had a drug company representative attempt to tell me ( he was hanging around my coffee area ) about the joys of Targin, a fixed-dose combination of oxycodone and naloxone. I gently shook him off, and directed him to my secretary.
Drug company representatives are usually decent human beings with lives and families. However they are poorly educated, poorly informed salesmen and women with sales targets to meet and product managers to keep happy. Even worse, they and the drug company have no accountability if a patient dies because of their recommendations. If avoidable death supervenes or if there are non-lethal complications or even just therapeutic failure, I am accountable.
Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope.
Many of my colleagues do likewise. I trust that you do the same in your respective vocations. Regrettably, there is a bell curve. I am sure that the drug companies find enough gullible prescribers out in the wild for their purposes.