

Health regulatory and advocacy groups are deliberately corrupted - Pr0
http://arstechnica.com/science/2013/01/profits-over-your-dead-body/

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carbocation
During a second-year pharmacology course in medical school, our instructor was
talking about the influence of pharmaceutical reps. He asked us to raise our
hands if we would be influenced by a $1m gift. Most raised their hands. Then
he asked us to keep them up if we would be influenced by a free car. Some
hands dropped. Then a gift card for nice clothes. Still more hands dropped.
Finally, he asked if we would be influenced by a slice of pizza.

I was the only person with my hand still up.

People really like to believe that they are above being influenced. People are
wrong. It's OK, we just need to try to continue to redesign our medical system
with that in mind.

~~~
joe_the_user
Great post till the last sentence. But that sentence is doozy.

 _It's OK, we just need to try to continue to redesign our medical system with
that in mind._

"We"? " _continue_ to redesign?" - I'd never question that health care is
being constantly redesigned. But given that the present situation is product
of the previous redesignings, would not you say that the "they (big pharma,
etc)" redesigning to keep their profits and influence up has so-far outpaced,
beaten "us" redesigning? That the _continuing process_ is broken, that if "we"
is patients or doctors or whoever is most concerned with patients' well-being,
"we" have to get off our duffs and do something if we are going have even a
modest expectation of positive outcomes here?

~~~
carbocation
I think you're right. If you omit "to continue" then I hope my last sentence
becomes more valid.

------
pella
related:

# "Ben Goldacre: Here’s the foreword to my new book, Bad Pharma
(badscience.net)" ( 142 points )

[http://www.badscience.net/2012/09/heres-the-intro-to-my-
new-...](http://www.badscience.net/2012/09/heres-the-intro-to-my-new-book/)

HN -> <http://news.ycombinator.com/item?id=4569559>

#2. "Something Doesn't Add Up: John Ioannidis and medical statistics
(stanford.edu)" ( 49 points )

[http://alumni.stanford.edu/get/page/magazine/article/?articl...](http://alumni.stanford.edu/get/page/magazine/article/?article_id=53345)

HN -> <http://news.ycombinator.com/item?id=4987387>

------
bediger4000
One thing to do: set up a healthcare advocacy group as a honeypot. Try to
figure out who the plants and shills are, document their behavior. Also,
faithfully document the gifts/bribes received, and what the quid pro quo was.

Any takers?

------
logjam
Pharma gives gifts to physicians _because giving gifts works_ to sell pharma's
products.

When I was in medical school and residency, it was a standard thing that
lunches were all sponsored by pharma. These were usually nice catered meals
brought in by some pharm rep. The price was at least listening to a sponsored
(biased) speaker, or a five minute sales pitch. Sometimes an office's or
deparment's prescribing numbers for a particular drug were actually tracked
and discussed, as if we were in a sales meeting and we were or were not
meeting the pharmaceutical reps quota for sales. Dinners were even more
elaborate, commonly held at some swank restaurant, with a paid physician
(shill) brought in to present "research" about that company's drugs.

My attendings were offered tickets to desirable sporting events, or paid
travel to medical conferences that just happened to be in Tahiti. There was
that wink and nudge: _of course_ you would be using your own clinical judgment
about the effectiveness of the drug being pushed. _Of course_ the freebies had
no effect on your judgement. _Of course_ the published positive results
reported at sponsored conferences and in sponsored journals constituted _all
the data_ and _all the trials_ of that particular drug.

If you had qualms about big gifts or even meals, a pharma rep was always ready
to give you a gift of the latest _textbook_ (embossed with the name of a drug
and/or pharma company) or maybe a sponsorship to the latest conference: after
all, augmenting your education would only benefit your patients, right? What
could possibly be wrong with that?

Physicians are increasingly and rightfully refusing to accept gifts of any
kind from pharma. It was unethical then and remains unethical now. Many med
schools and residencies have now rightfully banned pharma reps from any
contact.

We need more and better regulation, not less.

Ask your doctor if he or she accepts gifts. If they do, or if you see product
advertisements of any kind in the office (to include pens, notepads, pharma-
labelled equipment, drug/product brochures), _find yourself another doctor._

~~~
cloverich
I'd also argue we need better education.

My pharm. class followed the typical academic exercise in memorizing
information which was 80% useless to modern medical practice. The heavy focus
on biochemistry and mechanisms of action were interesting but mostly
irrelevant, because they didn't help us answer questions most relevant to
_clinical_ practice; we don't typically choose drug A over B because of a
biochemical property, but because there's _evidence_ that one works better
than the other, is more cost effective, has a better response rate in a
particular population, etc.

Shifting pharm. education to focus more on those types of things - how do we
choose the right drug; how can we use _evidence_ to critically choose when a
new, more expensive drug, is actually better? Or marginally better but cost-
effective? This type of teaching is relegated to one-off class' and side-
topics. Its not center stage.

The methods of big Pharma can definitely be unethical, but I think the real
problem is our physicians are fundamentally _unprepared_ to ask the right
questions and make the best decisions.

~~~
ars
This isn't going to happen because it turns doctors into technicians: You have
this illness? Click click click - OK it says this drug is best.

Doctors like the thought that they are evaluating each case based on first
principles.

Right now there is: Dr. -> Urgent Care -> Emergency Room

We need something below Dr., for the really routine stuff. In some countries
certain drugs are not over the counter, but are prescribed by pharmacists.

(Obviously there is a very important place for proper diagnosis. I'm talking
about the really obvious stuff.)

~~~
orta
In the UK its quite common to see a nurse for routine things that you're
talking about here, personally I've not seen a doctor in years because of
this.

