Drug Shills Dispensing Pills

[marmar]

from In These Times:


Drug Shills Dispensing Pills
A psychiatrist questions Big Pharma’s influence on her profession.

BY JEAN KIM


In 2009, as an eager young psychiatry professor at New York-Presbyterian Hospital, I presented to faculty on the need for a moral dimension to psychiatric diagnoses. I was laughed out of the room.

One psychiatrist, a schizophrenia specialist, said he didn’t see the point. The acting medical director said he felt I’d called him immoral. A top research psychiatrist said, incredibly, “Morality and psychiatry should be kept separate.”

So a few years later, when ProPublica launched its Dollars for Docs database to track the drug company money doctors were taking, I typed in their names. The acting medical director received $12,550 in 2010 and 2011 for speaking gigs. The researcher received more than $212,489 between 2009 and 2012 for speaking gigs and consultations. The schizophrenia specialist made more than $323,300. And the database only includes disclosures from 17 of the more than 70 drug companies in the world. According to Dollars for Docs, hundreds of thousands of doctors have raked in a total of more than $4 billion since 2009, with the top earner, psychiatrist Dr. Jon Draud, netting at least $1.2 million.

As a psychiatrist who “grew up” in the last decade, I was not surprised.

I started my residency training in New York City in 2000. Lunches and dinners provided by drug company reps were astaple of my diet. For a hungry, harried resident on a paltry salary, a free pit stop at a steaming Chinese buffet was heaven. All around me in Manhattan, investment bankers and freshly minted lawyers were living it up, and I admit that I wanted a piece of the pie as well. By mid-decade, academic psychiatry had become glamorous. A resident might schmooze with a drug rep and get invited to a trendy spot—Nobu, Olives, Tao—where we could imbibe Sex and the City-style cocktails and sample the freshest sushi. Drug reps, selected for their looks and charm, were the popular, beautiful best friends we geeky docs never had. ..................(more)

The complete piece is at: http://inthesetimes.com/article/17353/drug_shills_dispensing_pills

[Divernan]

1. Extremely valuable info at the links provided in this article.

First of all there's Pro Publica's Dollars for Docs. Find out how much kickback YOUR docs are receiving from Big Pharma.

http://projects.propublica.org/docdollars/

ProPublica launched its Dollars for Docs database to track the drug company money doctors were taking, I typed in their names. The acting medical director received $12,550 in 2010 and 2011 for speaking gigs. The researcher received more than $212,489 between 2009 and 2012 for speaking gigs and consultations. The schizophrenia specialist made more than $323,300. And the database only includes disclosures from 17 of the more than 70 drug companies in the world. According to Dollars for Docs, hundreds of thousands of doctors have raked in a total of more than $4 billion since 2009, with the top earner, psychiatrist Dr. Jon Draud, netting at least $1.2 million.

Next there is the federally mandated (by the Affordable Care Act) and maintained website for Open Payments. http://www.cms.gov/openpayments/

Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. These relationships can include money for research activities, gifts, speaking fees, meals, or travel. The Social Security Act requires CMS to collect information from applicable manufacturers and group purchasing organizations (GPOs) in order to report information about their financial relationships with physicians and hospitals. Open Payments is the federally run program that collects the information about these financial relationships and makes it available to you. To gain a deeper understanding of data published on September 30, 2014, view our factsheet.

[yellowwoodII]

6. dollars for docs

The site linked above is very important. I haven't had much experience with health care, so I have been surprised recently when my relative experienced illness. The level of care from physicians has declined. Now one may be automatically referred to "hospitalists" rather than a physician who knows the patient. Medications are liberally prescribed, sometimes with dubious reason. Don't get sick! You're on your own.

[Dustlawyer]

15. Medical malpractice tort reform has also contributed to the slide in quality health care.

Trial lawyers have been the ones to police doctors and hospitals with the knowledge that if they are negligent in practicing medicine, their patients will not be the only ones who suffer. In Texas that is no longer the case. There is a $250,000 cap on pain and suffering now, so if a drunk doctor amputates the wrong leg (victim is now without both legs), if the victim was a kid, house wife/husband, or retiree they would have trouble finding an attorney to take the case. Without an ability to recover loss of future earnings since there are none to prove, they can only recover the medical cost and $250k. The expert can cost as much as half of the recovery, the attorney has to post a bond in case the claim is found to be frivolous. In many cases it is not worth the risk for the attorney who has to put his/her time and money in the case, and only gets paid and the expenses back if there is a recovery. Even a home run in this instance has the victim pocketing a small amount for a lifetime of pain and suffering.
Because of this medical providers know there is little to fear if they really screw up. The state medical boards don't really police their own. Their malpractice insurance rates never really declined, which was one stated reason for the tort reform in the first place. Study's have shown that 6% of doctors commit 90% of the malpractice. Those 6% are safe now!
The other stated reason was the big lie that the media and public have accepted as Gospel, that we Trial Lawyers file frivolous suits all of the time! In a national poll of Judges, 98% said that they do not have a problem with frivolous suits in their court. The reason is that we don't get paid and the case expenses that we pay for do not get reimbursed if there is no recovery. It is hard enough to get a legitimate case paid, much less a "frivolous" one. Many of the examples of frivolous cases filed have turned out to be made up and never even happened. Others, like the McDonalds coffee case are distorted to make them seem like "Jackpot Justice!" Google Stella Liebeck and McDonald's coffee case to learn the truth that the media never bothered to report. Don't be fooled the next time that you hear calls for tort reform against the "Ambulence Chasers!"
Tort Reform, Big Pharma buying off doctors, and commercials telling you to "talk to your doctor about_____" are just a few of the things wrong with our health care system. Thanks for posting, I am going to check my doctors now!

[VA_Jill]

17. Not the answer

The answer is, BE PREPARED. Do your research. Know your body. Know your medicines and carry a list of them with you at all times--you would be appalled at how many patients don't even know the NAMES of their medicines, let alone what they are for! Ask questions and expect answers. If at all possible, have an advocate, someone who has a list of your medicines, your next of kin and who to call, etc. and can ask and answer questions if you can't, and carry that person's number with you at all times. It's up to you to take care of yourself. It always was.

[Divernan]

2. One local pediatrician has been pushing Human Growth Hormone for decades

Extremely expensive treatments which go on for many years, starting when the kids are pre-school. Parents cautioned, "little Andrew is short for his age - better give him HGR - will be an advantage if he gets into sports . . . . girls like taller boys . . . " Fast forward to his teenage years and Little Andrew and his brother (who also "needed" HGR) are both 6 feet 4 inches tall, with legs like giraffes. Amazingly (!?!) his parents are 5'4" and 5'10" respectively. What's wrong with this picture? And it's not just this family. When I go swimming at the local Y, there are many teenage girls and boys (high school students/lifeguards/swim teams) who are at least 6 ft. tall, and with the same "giraffe leg" syndrome.

http://consumer.healthday.com/encyclopedia/substance-abuse-38/illicit-drugs-news-217/human-growth-hormone-647257.html

What are the dangers associated with human growth hormone?

There are few studies on the long-term -- or even short-term -- side effects of taking human growth hormone for non-medical reasons. But there's reason to suspect trouble. People who naturally produce too much of the hormone or have received medical treatment for growth failure often develop abnormal hearts, bones, and nerves, and are particularly likely to suffer from osteoporosis, heart failure, and other diseases. Sports medicine researchers at the University of Massachusetts, among other experts, suspect that long-term use of supplemental HGH could have similar consequences.

http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/childhood-use-of-growth-hormone-may-boost-stroke-risk-690719.html

WEDNESDAY, Aug. 13, 2014 (HealthDay News) -- Children who are prescribed human growth hormone may be at greater risk of a stroke in early adulthood than their peers are, a new study suggests. "People view technology in medicine as a way to fix things, but the bad news is that when we try to fix things sometimes there is a price," said Ichord, who wrote an editorial accompanying the study.
(The research was published online Aug. 13 in the journal Neurology.)

Artificial growth hormone is used to treat children and teens when their pituitary gland fails to produce enough natural growth hormone. It is also given to speed up growth and increase height when a child is short, either because of genetic abnormalities, chronic kidney disease, or below-normal signs of growth at birth. Increasingly, growth hormone is being used because parents believe their child might benefit from being taller, according to Coste.

While the U.S. Food and Drug Administration approved growth hormone in 1985, Coste noted there is still little known about the potential impact of the hormone on long-term health.

Researchers still have no idea what the effect of taking growth hormone in childhood might have over longer periods of time. "It's an additional elephant in the room, what happens to these individuals when they experience aging," said Ichord. "Who knows what the same population might be like in their 40s, 50s or 60s?"

Ichord said physicians treating children need to evaluate potential lifelong implications of treatment. "We in pediatrics need to be humble about things we do to children when they are young and be prepared to look at the long-term outcomes of treatments we prescribe," she noted.

[VA_Jill]

3. "Small for age"

was a fad when my kids were little. I got hit with it when my daughter was about 3 and the pediatrician informed me that she was in the 10th percentile in height and the 20th in weight. I pulled myself up to my full height of 5'3, looked down at her (she was 5'1) and said, "Dr. B., I am the tallest woman in my entire family and my husband is 5 foot 8. If you are looking for basketball players, you are barking up the WRONG family tree!" Nothing more was ever said about it. Now that they are grown, my sons are 5'8 and 5'10 and my daughter is 5'1 1/2 (that half inch is *very* important to her!). My second son married a woman who is 5'10, and their 14 year old is pushing 6 feet and still growing. My daughter's boys (two different dads, both around 6 feet tall) are both off the charts in terms of height for their age. So you just can't tell, can you?

[Divernan]

9. Neither of these 6'4 boys ever chose to play any sport.

Those disproportionate, giraffe-like legs left them very awkward and ungainly. I just hope they don't suffer medical problems later in life from those years of injections.

[VA_Jill]

14. My daughter

(who remained untreated, of course) played soccer from age 5 all the way through high school. She is somewhat sturdily built and was absolutely fearless. She eventually developed into a defender, and her lack of height proved a positive advantage as she could get between the feet of an opposing player and steal the ball and also cause the other player to go down while she either kicked it to a teammate or made off with it herself. She rarely ended up on the ground herself, which gave her the nickname of "Weeble"... as in "Weebles wobble but they don't fall down!"

[dawg]

4. We live in a very "heightist" society - especially when it comes to men and boys.

I'm sure there are lots of women who would consider me undateable due to my height. (Which is silly. The real reason I'm undateble is the extent to which my ex has scrambled my gray matter.)

[kag]

7. Funny. My son is 6'1'' and hates it!

He's been "tall" since middle school. (His dad is 6', I'm 5'9'' but I have a "little" brother who is 6'6''.) He's always hated it. Whenever anyone asks how tall he is, he bends his knees to appear shorter.

Even when we tell him that "girls like tall guys" or try to convince him of some evolutionary advantage, he still just Does. Not. Like. Being. Tall. Go figure.

[PumpkinAle]

5. The medical profession

has sold out.

My F-I-L used to be an anathema to his colleagues because he refused to be bought by the pharmaceutical companies and he cared deeply about his patients - he was a beautiful, dedicated, wonderful man who put care in health-care first.

[Divernan]

8. The conscientious, empathetic older docs are retiring, and the difference is striking

in the level of care from the next generation. Granted they are under tremendous pressure from their employers to see a tremendous number of patients - like one every 8 minutes? But still, they swan in, barely look at your medical history, ask few questions - I mean it is entirely up to you to describe your symptoms, dates of onset, any recent changes, etc., because they have little time or interest in asking questions. So we all need to research our symptoms in advance, have everything written down beforehand so we don't forget anything in our precious 8 minutes. I rely on the Mayo Clinic website for thorough information on symptoms, including all possible causes, all possible treatments, etc. When drugs are listed re treatment, I then research the individual drugs, looking for reports of efficacy, reactions, complaints, background studies, etc.

My great family doc of many years left her practice with one medical giant to go teach for its main competitor. First Giant invoked its do not compete clause as applying to teaching as well as practice.
So I started seeing another doc in her old practice. New doc immediately prescribed an additional drug with no change in my health or symptoms beforehand. I had a reaction - dizziness/lightheadedness/low blood pressure. It apparently never occurred to new doc that it MIGHT be from this new drug. Instead, she refers me for an echocardiogram and a chemical stress test ($$$ for her UPMC colleagues). I research chemical stress test and find that as of December, 2013, the FDA put out an elevated warning for 2 drugs used in the chemical stress test that they were found to trigger heart attacks. Specifically, "FDA warns of rare but serious risk of heart attack and death with cardiac nuclear stress test drugs Lexiscan (regadenoson) and Adenoscan (adenosine)."

I also found that possible side effects of that new drug from the new doc were lightheadedness, dizziness and low blood pressure. So I did not get the chemical stress test. At this point, I tracked down my "old" doc - where she is practicing some 40 miles away, just across the boundary for the do-not-compete zone. I tell her my recent history and symptoms. She looks in my ears and tells me I have some swelling from an earlier bad cold - prescribes an antihistamine nasal spray. One spray & my symptoms clear up. So it wasn't the new prescription, but it was something that a competent doc would have found if she had bothered to look into my ears. Sheesh! And my old doc saw no reason for me to have gotten that new scrip.

[PumpkinAle]

19. Wow - thanks for sharing

hope you are able to keep in touch with your old-doc.

I rely a lot of natural remedies as much as possible.

Best of luck and good health!

[LibDemAlways]

10. Has anyone else heard of concierge practices?

MDs in my corner of Southern California have started charging $1500-$2000 a year just to get in the door. The money buys access and more time in the doctor's presence. This is, of course, in addition to regular fees. I think it's unconscienable. When I was a kid, doctors still made housecalls in the middle of the night. Now it's all about the money. And Divernan is right. The care is frequently sub-par.

[VA_Jill]

16. My partner's former doctor

left the group practice he was in to start a concierge practice. It failed miserably. MISERABLY. Now he is a hospitalist. I feel sorry for both the hospital that accepted him in that capacity and the patients who get stuck with him. He is a terrible doc, IMNSHO, one of the kind that makes you wonder how he got INTO medical school, let alone OUT!

[niyad]

11. k and r

[msongs]

12. step one - end the tax deduction for food/meals, drink, and entertainment. we all have to eat but

we don't all have to eat at expensive restaurants at taxpayer expense when much less expensive options are available

[olddots]

13. this book tells it like it is

MANUFACTURING DEPRESSION. by Gary Greenberg. .

Depression is an industry created for huge profit by people who have no intentions of improving mental health .

[SomethingFishy]

18. I saw a commercial on TV from CVS pharmacy, it was a 60 second

lesson on "taking your meds". It looked like a commercial designed by Big Pharma, and at the end they raised a toast to all the people who took their pills today..

Now I understand that some people need medication, but this was kind of creepy...

Anyone else see this ad?

[Scuba]

20. So how does one suffering from mental illness find a doc who doesn't rely on drugs?

[RedCappedBandit]

22. Speak to a social worker or psychologist

for long term counseling. If you decide it's what you want/need, request a referral to a psychiatrist and supplement that counseling with an appropriate prescription.

[RedCappedBandit]

21. Some psychiatrists are a complete fucking joke

Good article