This entire week, National Public Radio--that known haven of insane Marxist-Socialists--has aired a series of reports illustrating in lurid detail the extent to which physicians are manipulated by pharmaceutical companies into becoming unwitting accomplices in their efforts to generate profits. When you see how the game is played (or more accurately, how doctors are played in the game) you can't help but a) cringe, and b) wonder about the amount to which your own doctor is manipulated. I am a doctor and these stories (along with other books and articles I've been reading) are making me question just how much my own prescription practices have been influenced by these tactics, and that's in spite of the fact that I have assiduously avoided drug reps since I was a fourth-year medical student. How many times have I heard lectures from senior physicians--even those from within the academic medical centers where I was trained--where some large corporation's money had influenced the speaker, who may have been unknowingly acting as a shill? How many times have I taken these lectures at face value, assuming they were given by disinterested academics who took only the best evidence into account when preparing their slides? The more I learn about these practices, the more I realize I have no idea. Just follow the link, listen to the stories, and have some scotch at the ready. It ain't pretty.
Today's installment on All Things Considered brought a new twist to the game. I have long known that the cozy little dinners at nice restaurants sponsored by drug companies were not likely to be places where one could get unbiased information. Today's story, however, explains that sometimes the drug reps target not the audience, but the speaker in order to generate revenues. The recipe: find a practicing physician with a large patient base and prescribes a large volume of drugs. (Companies have access to the prescriptions made by doctors because of arrangements they have with pharmacies. It's perfectly legal and any doctor's prescription habits, down to the last valium tablet, can be tracked.) Approach the physician and explain that he or she is a "thought leader" and welcome them to come give these dinner talks. Provide them with slides about your wonderful drug. Watch them speak. Follow that doctor's prescription patterns--not the ones who come for the cabernet and prime rib, but Dr. Thought Leader Himself/Herself--and watch the money roll in as your company's drug sales shoot through the roof for the month or two after the gig.
Mind you, this is all above board: there's no quid pro quo as part of these speaking gigs. There doesn't have to be one. Beyond the speaking fee (which is typically around one grand: very nice money to be sure) there is no explicit arrangement as to the content of the talks. Indeed, the overwhelming majority of docs would be seriously indignant if there were any implication that they should explicitly endorse drug X at someone's instruction before a talk. No, the key to the scam (let's call it what it is) is that such docs are manipulated through a psychological trick that allows them to succumb to influence precisely because they think they're above influence. "[Doctors] come to the table with the belief that because they have gone through this rigorous academic training that they are somehow impervious," says Dr. David Switzer, a doc who blogs about the interactions between drug reps and physicians. "I don't think that we're as good at that as we think that we are."
According to one former drug rep quoted in the story, a $1500 investment in the speaker's fee plus, undoubtedly, a whole ton of flattery to a high-prescribing doctor could result in a bump of $100,000 to $200,000 for the drug in question--all from just the speaker. One can't draw too many conclusions from just one example, but the yarn is enough to make me believe that various drug companies would make it part of their marketing arsenal. Indeed, if it's legal and other companies are out there doing it, they'd be fools not to.
One of the only humorous moments of the story was when one of the drug reps had to explain what to do with some of the less stellar "thought leaders." Recall, the game is to try to target the doctor who prescribes a lot. Such a doc might not be charismatic, might be unattractive, might not even be a very good doctor, but all of that is beside the point. If they are all of the above, that's clearly a bonus and you want to have the added benefit of that speaker's influence on the audience. But if those qualities are not in play and all you are trying to do is to get the doc to push your drug, you want to limit the damage, and you book the gig at a fast-food style restaurant to ensure low attendance. (Doc Rubin, no doubt, would do no better than top billing at a parking lot outside the local coffee & donut shop!)
If you are a political junkie, you may also have seen how NPR got Big Media to pay attention to it briefly, for firing Juan Williams, their longtime news analyst. Williams, who lived the weird double-life as a commentator for both NPR and Fox News, has slowly and inexorably been moving toward this moment for some years probably. I have been unimpressed by Williams's thoughts on NPR for a very long time (not unlike its other major political commentator, the even more vapid Cokie Roberts), but his stellar performance on Fox was a piece of work, and NPR couldn't abide by it, leading to a he-said-she-said (literally) trading of accusations documented at NPR.
In case you hadn't followed all this, the brouhaha started when Bill O'Reilly opined in a guest spot on The View that "Muslims killed us on 9/11," causing the usual media flap (to say nothing of hosts Joy Behar and Whoopi Goldberg's emphatic reaction of walking off the set, bless their hearts). Part of said flap was Fox News guy Brian Kilmeade defending O'Reilly's nonsense by asserting that "not all Muslims are terrorists, but all terrorists are Muslims," causing all teachers of Symbolic Logic to have one simultaneous nationwide seizure. Williams got into the act as something resembling the Dumb House Liberal, a role he apparently plays on Fox, by noting with an aw-shucks statement conceding that Bill-O was right: "I mean, look, Bill, I'm not a bigot. You know the kind of books I've written about the civil rights movement in this country. But when I get on the plane, I got to tell you, if I see people who are in Muslim garb and I think, you know, they are identifying themselves first and foremost as Muslims, I get worried. I get nervous." NPR, saying that the remarks were "inconsistent with our editorial standards and practices," fired him.
Whether or not NPR meted out an unjust punishment is, I suppose, up for debate. But what isn't really up for debate is that Juan Williams said something completely idiotic and, yes, of course, bigoted. The defense that Williams was just speaking his mind and should be praised for his honesty holds about as much water as Carl Paladino's insistence that forwarding ha-ha e-mails of a jungle-bunnyish Barack Obama doing a tribal dance wasn't racist, which is to say not at all. Let's try this one out:
You know, when I get on the plane, I got to tell you, if I see people who are black and wearing baggy pants and bandanas, and I think, you know, they are identifying themselves first and foremost as black people, I get worried. I get nervous.
How's that sound? Umm...bigoted, maybe? So Mr. Williams lost his job at NPR. This appears to have been a boon to both Fox and Williams, though, who seems to have gotten a raise in the wake of the whole matter. Boo Hoo Hoo.