Wyeth Pharmaceutical Detailing - Future Of Our Healthcare System

Healthcare Providers Paid To Promote Big Pharmacy Companies

Here's a statistic that should make you sit up and start worrying about your healthcare: One in four physicians in the U.S. is being paid by a pharmaceutical company to help promote its drugs to other doctors.

It's called pharmaceutical "detailing" - the term to describe sales visits in which drug reps go to doctor's offices to promote the benefits of a specific drug. Often the pharmaceutical rep is accompanied by an MD who has been paid - some would say, bought - by the drug company to add legitimacy and credibility to the sales pitch.

These so-called "drug lunches" are not new. For years, drug makers have used them as a way to introduce and promote their products. And physicians, strapped for time, value the opportunity to hear about the latest products - and get a free lunch in the comfort of their own office. I too experienced them when I was practicing internal medicine. Now, some in the medical profession are beginning to question the practice thanks in part to a courageous essay in the New York Times by a doctor who took the drug money until he realized it came with a price - his own integrity.

Daniel Carlat, an assistant clinical professor of psychiatry at Tufts University School of Medicine, was hired by Wyeth to "give talks to other doctors" about encouraging the use of Effexor XR, an anti-depressant manufactured by Wyeth. According to Dr. Carlat he was to be paid $500 for one hour "lunch and learn" talks at doctors' offices, or $750 if he had to drive more than an hour.

First, he and his wife were flown to New York for a Wyeth "faculty development" program, pampered for two nights at a luxury Midtown hotel and handed a check for $750 to go out and enjoy the town.

Soon Dr Carlat was hitting the road, and spreading the word about Effexor. Within a year he had earned $30,000 from Wyeth - a significant addition to the $140,000 he makes in his private practice.

As the Wyeth reps became more comfortable with him, they began to see him more as a sales colleague. He received faxes before talks preparing him for particular doctors with astonishing details about the doctor's personality and prescribing habits.

Dr. Carlat writes: "The process is called 'prescription data mining' in which pharmacy information companies buy data from local pharmacies and sell it to drug companies. This information is then passed on to drug reps that use it to tailor their drug-detailing strategies." Dr. Carlat's story is far from unique. The drug companies' reach is far greater.

The American Medical Association (AMA) is in on this racket: It licenses its file of U.S. physicians, allowing the data mining companies to match up D.E.A. numbers to specific doctors to the drug companies. The A.M.A. makes millions from this practice. However, you will never read or hear about this practice in the media.

Eventually Dr Carlat grew uncomfortable with his role as he realized the honest research on Effexor showed it increased the incidence of hypertension and was in conflict with the rosy presentation he was being paid to give. He felt dishonest that he was putting the most positive spin on the drug and not talking about the limitation of the data when presenting to the "lunch and learn" doctors..

He writes: "I was blithely minimizing the hypertension risks . . .why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn't I asking this obvious question out loud during my talks?"

There was yet another problem: Effexor patients were suffering severe withdrawal symptoms when they stopped using it.

Dr. Carlat developed reservations about recommending Effexor as a ''first line'' drug and mentioned that at a Lunch and Learn. Several days later a Wyeth manager called to say he'd heard he wasn't as enthusiastic about the product he was paid to promote.

Dr Carlat had had enough. "I decided my career as an industry-sponsored speaker was over. The manager's message couldn't be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much 'medical education' I provided."

Now he publishes "The Carlat Psychiatric Report" that is not financed by the pharmaceutical industry and that honestly and critically assesses drug research and marketing claims. He still sees patients and still prescribes Effexor, but "not as frequently".

Dr. Carlat deserves credit for describing his experience and asking whether his role as a company speaker led to faulty medical decision making. Did his advice lead doctors to make inappropriate drug choices? Did their patients suffer needlessly?

His experience is the tip of the iceberg. It is estimated that some 200,000 doctors in the U.S. are cuurently on the payroll of drug companies. How many of them have the integrity to look themselves in the mirror and ask the same questions as Dr Carlat?

I commend Dr. Carlat and hope the example he sets for the rest of us in the trenches, working to serve our patients is a strong and smart example to be taken to heart. It will save not only the patients, but also the whole medical system.

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