Howard: Probing data over a 29-month period, you and your fellow researchers found that overdose deaths are higher where opioids are most prescribed, and that they’re most prescribed where doctors are most marketed to by drug companies. How do the drug companies market to doctors?
Hadland: The most common way is to take doctors out for a meal. There’s a number of other strategies, including paying for speaker fees or honoraria, but it’s these meals that are most common. The same doctor will be taken out sometimes dozens of times.
It is legal to take doctors out for a meal, or cater for the whole office and give a dog-and-pony show, ostensibly for providing information on safe prescribing, but really to drum up sales.
In 2009 in Massachusetts, such meals were in fact banned; At PhRMA’s (and caterers’) behest, the ban was essentially repealed (amended into irrelevancy) in 2012.
And we told you so, ten years ago: Advocates like Health Care For All warned the repeal would cost money and — at the very least — not improve patient care. I had commenters on this very site tell me there’s no way doctors, with their years of rigorous training, would be swayed by a bagel sandwich. Of course, the drug companies have entire marketing departments whose research tells them exactly that, and they’ve developed their strategies accordingly. They know what works; it’s worth a lot of money to them.
But I daresay none of us imagined the immense, tragic human cost of lifting the ban. We knew it would cost money; instead it cost lives.
As is often said, regulations are written in blood. Bring back the gift ban.
Christopher says
Time was public advertisements for prescription drugs were banned too.
Charley on the MTA says
I think we need to recognize the inherent tension between drugs as health care and drugs as profit center;
that an industry with so much influence over people’s physical health — length of life! — cannot possibly serve two masters and therefore needs to be carefully regulated and overseen;
and that doctors are not super-human, but all too human.
SomervilleTom says
Indeed! Not just drugs, either.
The same tension exists between tests as health care and tests as profit center (CAT scans, MRI, stress tests, etc) and between “routine procedures” as health care and as profit center.
The term I like is “wallet biopsy” — the provider has, for each patient’s insurance provider, a checklist of pre-approved tests, procedures, and treatments that are associated with each combination of patient complaints and history. The alleged purpose of these is to “rule out” various complications and risks. They are coincidentally quite profitable.
The provider schedules whatever the insurance company will pay for, with the highest priority items being those with the highest markup. Improved health care is a side effect, rather than a business driver.
One reason they’re very profitable is that they’re readily scheduled. The provider much prefers to schedule available up-time of the MRI machine with regularly-scheduled tests than to make the same machine available for non-routine emergencies. “Available” means “unbilled” and “unbilled” means “not making money”.
We have an entire health-care delivery and payment system that is driven by the profit motive and that maximizes profits by maximizing utilization of expensive resources. It should not surprise us that the result is a system that produces a high volume of tests (or drugs) rather than improved outcomes.
johntmay says
Maybe, just maybe it’s time to rethink the patent process for drugs as well?
johntmay says
Pro Tip: When arguing with a “free market” right winger who sees a false dichotomy of socialism/capitalism, they will often cite Stalin and the rest who have slaughtered millions of innocent people….and ask you “When has Capitalism ever killed anyone?”……..remember this as one of many times it has killed someone.