
Association between gifts from pharma group to drug prescribed by French doctors - hokkos
https://www.bmj.com/content/367/bmj.l6015
======
techaddict009
Its pretty open in India.

Drugs prescribed by a Doctor can be bought and is mostly available only from
the store he mentions in the prescription.

Big doctors have their own store.

You go anywhere else very rarely you can find the same drug.

Most of the times doctors will prescribe additional 2-3 generic seasonal
medicine which you mostly do not need just to achieve targets so that they can
claim their gifts (TVs, Foreign Trips, etc.)

This a serious issue in India which no one is batting an eye on.

~~~
Iv
In France, the prescription is valid in any pharmacy and the pharmacy seller
(who has a degree in pharmacology) can and often do propose the generic
version of the prescribed drug.

There has been some marketing to present generics as cheap knockoffs of bad
quality, leading to many people choosing to pay for the prescribed drug (which
will be reimbursed anyway) but it all comes down to the patient's behavior.

~~~
linuxftw
Generics might be cheap knockoffs. It's uncertain if the purity, formulation,
method of production, and quality control for a generic will yield the same
benefits (or any benefits) for a particular drug. There are countless stories
about how some people like some brands of generics better than others.

There was some reporting around these parts recently that generics don't
really undergo any kind of efficacy studies, they are assumed to just work,
and there's really not much oversight whatsoever.

~~~
derefr
It’s kind of weird. The FDA, and agencies in other countries modelled after
it, usually have two jobs:

• for drugs, such agencies verify that new drugs are safe/effective _in
concept_ (rather than in any particular manufacturing implementation)

• for food, the agency looks at _specific manufacturers and distributors_ of a
food, and—given a particular food they’re _claiming_ to be producing—the
agency verifies that their product meets the agency’s own definition of what
that named food “should” be (i.e. you can’t sell Cheez Whiz as “cheese”
because it doesn’t contain enough [whatever], though you _can_ sell it if you
don’t try to call it “cheese”; you can’t sell beef as “beef” if it contains
toxic levels of thyroid hormones, though you _could_ sell it as something
else, e.g. as a hypothyroidism supplement, since those levels _would_ be
expected for that product; etc.)

But, strangely, these agencies _don’t_ have any mandate to to apply the
“food”-type rules (checking manufacturers and distributors for their output
being within tolerances to a definition) to the drugs—even when those drugs
are known to be produced through a process that can leave harmful reagents in
them if not cleaned properly.

What’s up with that?

~~~
linuxftw
> What’s up with that?

I suspect it's all about who benefits. In the food industry, we've seen the
effects, the industry is consolidating and forcing smaller players out.

In the case of generic prescription drugs, those are still very large players.
There seems to be a cartel for all but the most common drugs, where
manufacturers don't bother competing for market share.

------
guerby
Data point according to:

[https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobby...](https://fr.wikipedia.org/wiki/Industrie_pharmaceutique#Lobbying)

In 2003 pharma industry was pending more than 20 000 EUR per year per doctor
in France. Not far for a full time employee per doctor.

One quarter of revenue on marketing, more than for research.

Most of this is because of government granted monopolies aka patents.

Alternatives are proposed, see Dean Baker for example

[https://www.nytimes.com/roomfordebate/2015/09/23/should-
the-...](https://www.nytimes.com/roomfordebate/2015/09/23/should-the-
government-impose-drug-price-controls/end-patent-monopolies-on-drugs)

[http://cepr.net/publications/briefings/testimony/drugs-
are-c...](http://cepr.net/publications/briefings/testimony/drugs-are-cheap-
why-do-we-let-governments-make-them-expensive)

[https://www.ncbi.nlm.nih.gov/pubmed/15346683](https://www.ncbi.nlm.nih.gov/pubmed/15346683)
(yes nothing new :)

Book :
[https://deanbaker.net/books/rigged.htm](https://deanbaker.net/books/rigged.htm)

Blog : [http://cepr.net/blogs/beat-the-press/](http://cepr.net/blogs/beat-the-
press/)

~~~
rscho
I very much doubt it's 20'000 EUR for GPs. It's likely much lower, because
what you are citing includes data for surgeons, dermatologists,
ophtalmologists, etc. who all are much higher priority targets for pharma
marketing.

------
Ididntdothis
I bet the doctors’ lobby will deny that payments will have any impact on their
behavior. The same way they deny that working 24 hour shifts and being sleep
deprived has no impact on their performance.

~~~
wpietri
They will certainly deny the impact. Which is absurd given that pharma
companies all spend that money as vigorously as they can. Do doctors believe
that pharma companies are extremely good at optimizing complex systems when it
comes to drug production, but suddenly really bad at it when it comes to how
they sell the drugs?

~~~
wpietri
And as an aside, I think the long-shifts thing is a slightly different case.
I've talked with doctors, and one pointed out that a big threat to patients is
information loss during handoffs. The more you change shifts, the more
information gets lost.

It's similar to how we developers will often keep working on a problem until
it's solved. That's especially true in incident response, where the same
people tend to keep working on an issue until it's solved, rather than saying,
"Oh, it's 5 pm, I'm going home; somebody else can figure out why the site is
down."

That's not to say doctors have the right balance now; they definitely have a
macho-culture problem where people tough it out when it isn't necessary or
beneficial. But it's definitely not as simple as I thought at first.

------
nraynaud
And French doctors have access to a periodical about drug that is anal on not
taking money from big pharma (
[https://en.wikipedia.org/wiki/Prescrire](https://en.wikipedia.org/wiki/Prescrire)
).

------
mirimir
In a previous lifetime, I had access to pharmaceutical industry data, at the
level of individual products, which reported the relationship between
detailing (visits to doctors by drug reps) and prescription behavior (for
target drugs and competitors).

Bottom line, pharmaceutical manufacturers employ drug reps because they
increase sales. For up-and-coming brands, detailing is a major promotional
component. And it's carefully managed.

------
ajudson
"During this outbreak, Muyembe has also made a decision many thought
unthinkable even a few years ago. He decided that all of the blood samples
collected during this Ebola epidemic will stay in Congo. Anyone who wants to
study this outbreak will have to come to his institute." not sure if this is a
good idea

------
pkaye
In the US, you can look up your doctor here
[https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)
Apparently drug and medical supply companies are required by law to report
anything they gift to doctors or hospitals.

------
simosx
It should be common in most European countries that have national health
systems.

edit: Source: [https://blogs.mediapart.fr/emmanuel-
kosadinos/blog/310818/no...](https://blogs.mediapart.fr/emmanuel-
kosadinos/blog/310818/novartis-greece-scandal-unveils-permanent-scandal-
pharma-industry)

~~~
jacquesm
It actually most likely isn't common. In the past it was, but there was a
serious crackdown on doctors improving their golf handicaps in luxury resorts
on the dime of big pharma and all variations on that theme. Surprised to see
this make a recurrence.

~~~
Scoundreller
Sometimes that crackdown is because the big pharma companies are happy with
their current positions, so they propose cutting all of these expenses across-
the-Board.

Then they maintain their incumbency and reduce a lot of their costs without a
huge hit to revenue.

And if you’re a new pharma company with a truly awesome product, good luck
getting anyone to prescribe it when you didn’t buy them a round of golf a
decade ago because you didn’t exist.

------
rscho
GP in France is such a shitty job that people will go to great lengths to
avoid that sector. French GPs earn ~25$ (base price) per patient, so they have
to work their ass off to have a decent lifestyle. The people here talking
about golf courses and living the life just have no idea what they're talking
about. It's VERY different from the issues of the american system and it's no
wonder this is happening.

~~~
Ntrails
> French GPs earn ~25$ (base price) per patient

My GP sees ~10 people per hour, ~7 hours a day. That sounds like it would be
worth 1750 per day. Assume 250 day working year for the ease of my mental
maths, you've got ~450k revenue?

Assuming tests/drugs etc are all extra, and that the surgery takes a sizable
chunk - it still feels a decent distance from the breadline?

~~~
baud147258
I don't know how your GP work, but last time I went to see one it was closer
to 2 or 3 patient per hour.

~~~
krageon
My GP takes 10 minutes per appointment and they sometimes take about 5 minutes
after to enter information. Seeing 4-5 people per hour enter their office is a
normal day.

Edit: To be clear, this will afford them a salary that is a multiple of mine
while still leaving room for about 3 assistants per GP (maybe more, given that
assistant work is something that your insurance or you also end up paying
for), rent for the office and equipment. They're certainly not underpaid. I
don't think they are overpaid either, as the time taken to study before you
can become one is very long and the work is probably quite unpleasant.

~~~
baud147258
I was more wondering about the quality of care.

