As a sidenote, I asked my doctor about the new drug being advertised practically everyday on TV that is supposed to be better than its predecessor (sp?) Prevacid for heartburn. My doctor said the new drug is no different but the patent ran out for Prevacid so they are pushing this one.

NEXIUM is the NEW anti-gerd drug. My doctor said to keep taking prevacid (cheapier on insurance than Prilosec) until I need it. Nexium is stronger and eventually the other drugs don't work anymore, interesting...eh...June

Given a very recent study published in Gastroenterology last month that the "stronger" acid inhibitors may cause stomach cancer after 5 years of use, I'd be very cautious about using any of these drugs on a regular or long term basis. There is, of course no evidence that these drugs prevent esophageal irritation any better than simple lifestyle measure including sitting up for at least 3 hours after eating, avoiding alcohol, and especially raising the head of one's bed on 6 inch blocks. If you carry excessive weight around your waist, weight loss also helps. Antacids like Gaviscon that can be used on as needed basis are also far less likely to have serious side effects than these relatively new and untested drugs.

My husband is a doctor, and my brother-in-law is a pharmaceutical rep, so I can see this issue from both sides. First of all, doctors will not prescribe unneeded medicines for patients, just to "pay back" a drug rep. They MAY prescribe a particular company's drug over another company's, if they are more familiar with that brand name. The best way for a doctor to hear about a new drug is from the drug company, and to get the doctors to even listen to the spiel, companies will offer "perks". Without this type of meeting some doctors will just not know about new alternatives.

There may be 4 companies who all make the same drug under different brand names, and of course they are in competition. They need to reach their target market to get their brand noticed.

However, no matter what kind of "perks" a doctor gets, no one is forcing him or her to write prescriptions for a certain drug, and he or she will use what seems to work best for his or her patients. Attending a meeting and/or accepting gifts doesn't mean the doctor will actually develop brand loyalty.

There are always exceptions to the rule, of course. However, if you are concerned that your doctor is taking "freebies" and in turn prescribing medicine that you do not need, the question should not be whether he has attended a drug company gathering. The question should be whether you trust your doctor to provide the best care for you. If not, you need to find a new doctor.

I agree with Debbeeanne: it's not like these doctors are going to start prescribing certain medicines because they get a caseload of free fountain pens. I used to work in an outpatient psychiatric facility with six on staff physicians and they all talked in-depth with the drug reps about the drugs (and 99 percent of the time right in front of my face, in the lobby) so it wasn't like they said, "OK, I'll start prescribing this if you give me a free wall clock."

Doctors are paid by drug companies to attend seminars put on by the drug company. They are paid by drug companies for enrolling patients in clinical studies and yes, they are given perks including paid vacations for writing prescriptions. If you read the article in the Post that I referenced at the beginning of this thread you will find evidence of all of these things. There are some honest doctors who both admit that these things go on and who are finally refusing to go along any longer.

More than 100,000 hospitalized patients die every year in the US because of prescription drugs according to a JAMA article two years ago.

Trusting your doctor without doing your own research can be very dangerous to your health.

BTW new drugs should NEVER be the first line of treatment unless the illness is serious and the expected benefit is very large when compared with older drugs. New drugs have not been tested in the general population and often have unintended side effects.That's how drugs like fenfluramine and rezulin got taken off the market - after they had killed or injured large numbers of people. If your doctor is prescribing the newest drug be careful. It could cost you more than just money.

Leigh, you don't have your email available, so I just want to apologise here. Several weeks ago I was mean to you in a couple of threads that got a little heated (and were subsequently deleted.) I quit smoking that week...between Hell week and menopause I have the IQ of a turnip, was extremely hostile and cranky for a while there.

Anyhow, I agree with most of what you say here. My husband is a radiologist, so he doesn't have anything to do with drug companies any more. We get the fancy trips, but they are for pretty informative seminars. Though why radiologists need to be put up at the Ritz Carlton in Paris, or a fancy Carribean resort, for a week to spend 20 hours in seminars about new breast imaging technology is beyond me. But I get to go so I don't complain. :)

I read that article in the New York Times. Its not just wall clocks, pens, and trips. Mick knows a doctor who won a brand new Porsche from a drug company.

I can understand that. But if there is new technology out there and a possibly better treatment available, I think I would want my doctor to know about it. Granted, yes, there are dangerous drugs out there that have since been taken off the market. But maybe there should have been more clinical trials before this drug was approved. Sometimes, though, all the research and extra literature provided does nothing but scare the patient out of taking a needed medication, which can lead to an even more serious situation. The patient plays a large part in the dynamics of this situation as well. They see the newest, latest drug on TV and actually demand that their doctor gives it to them, and if he or she won't, they will find someone who will.

If the "new treatment or technology" is truly valuable the doctor will find out about it in the many peer-reviewed medical journals available. Drug companies do not present unbiased information to doctors. They provide marketing ads to convince a doctor to prescribe the drug/treatment. This material is written and presented with an eye to convincing the doctor to using the new drug/treatment, not with an eye to providing accurate information. Pfizer knew that rezulin caused liver damage and AHP knew that fenfluramine and dexfenfluramine caused heart valve damage and PPH. They didn't provide that information to doctors though.

Doctors are supposed to be advocates for their patients. They are supposed to be looking out for their patients' best interests. Whose best interests are being served when new dangerous drugs are prescribed by doctors because the patient will go somewhere else if s/he can't get them from the first doctor? The doctor's are because he's protected his turf and kept the patient on his rolls. The drug company's are because it's making money on the new drug. The patient's best interests are hardly being protected when s/he learns too late that the drug caused serious permanent liver and heart damage. A good doctor will explain why this new drug/treatment is not the right one for that particular patient and refuse to compromise his/her ethical principles. A poor one will blame the patient for asking for the drug and ignore his/her own role as the enabler.

I would never take a new drug that's been on the market for less than 5 years and I make that same recommendation to family and friends. Thank God, my mother refused rezulin at my recommendation when it was offered to her and pushed as a much better drug for her diabetes than the glyburide she'd been taking without any problem since diagnosis 8 years ago.

Well, if my daughter had cancer and there was a new drug that came out that gave her a chance of living, you can bet I wouldn't wait 5 years till others had tested it.

And in an ideal world, doctors would all keep up to date on their journals, etc, to learn about the drug studies. But many doctors are so busy with work and paperwork, and trying to have some kind of family life, that they just don't get to read all the literature available.

That is why they schedule time away from the office, be it for continuing medical education or to learn about new treatment options.

I am tired of people thinking that doctors don't care about patients and the possible effects of drugs, treatments. The fact is that doctors are scared to death every time they make a diagnosis because they are expected to be God and never ever miss anything or not know the answer.

I doubt that many doctors go through 12 plus years of post high school education to finally begin making a living at 30 years old and not care about patients and the treatments they are receiving. Again, there are the unscrupulous few, but don't condemn everyone who takes a freebie from a drug rep.

God bless you, Debbeeanne!

My FIL basically left his practice because of situations like these, where it just got to be too difficult to practice medicine anymore without all the red tape and other crap. I don't remember him EVER talking about drug reps, etc. and he was ALWAYS reading whenever I saw him. He's retired now and STILL reads. There are VCR tapes all over the house about arthroscopic surgery (ewww) and other things so that he was as informed as he could be when he saw a patient.

If you honestly distrust all/most doctors that much, you should either find another one or become one yourself.

>>I am tired of people thinking that doctors don't care about patients and the possible effects of drugs, treatments. The fact is that doctors are scared to death every time they make a diagnosis because they are expected to be God and never ever miss anything or not know the answer. Amen to that. Mick doesn't have direct patient contact, usually, he spends most of his time reading films. I see the amount of stress and care he goes through, none the less, and its not just that he's worried about being sued (although that's certainly a factor.) He knows many of the docs treating the patients and will call them up to see the outcome of unusual or worrisome cases. He frequently goes in to the hospital in the middle of the night to consult; and this is not something he is required to do. He will often read 50+ cases a day, 5-7 days per week, and a single misdiagnosis can have serious consequences. If he can't sleep he watches imaging videos, or logs onto the hospital system and reviews the day's cases.

I do think that people should research (especially easy now with the internet) and educate themselves whenever possible; doctors are not all knowing gods! And they are trained to prescribe drugs, and most people go to a doctor with the expectation they will get some kind of prescription...in fact many people will switch doctors if they're not prescribed the new drug they've been seeing TV ads for.

Debbeeanne I have a question for you. do doctors get any money for the prescriptions they write. I always wondered. I totally agree w/ you and Carina. I was using a new Dr. since mine retired and I had a reaction to a scrip he wrote me and when I went the next a.m. to tell him, he never seen me, he sent his nurse to ask me a few questions and then wrote me a different scrip because he said no one else he had treated has had a reaction to this medicine. I did not think I would get to go right in but felt he should have at least seen me between patients, I was willing to wait till whenever anyway needless to say he is not my Dr. anymore, but my point is I think you need to trust your Dr., and if you don't, get another one. The patient has the right to turn down meds if they want. so research the med and ask your Dr. questions about it. They are there to help us not see how many med they can presribe.

My concern has always been not so much that this practice will corrupt hysicians but the enormous expense wasted on these perks. The cost of prescription medicines in this country is outrageous and sending thousands of doctors and their families (many are related to me) to the Ritz Carlton in Paris does not exactly bring the price down! And even if you are not taking any of these drugs, your tax dollars are indirectly funding these trips through Medicaid and, to some extent (not much drug coverage included), Medicare. If the AMA has condemned the practice, we as consumers should not condone it.

If the docs have time to take the trips, they have time to read the literature.

See:

http://www.fleishman.com/overview/reputation/cipra/estralab.html

for an example of how the drug industry influences medical practices.

The latest figures show that drug companies spend an average of 13,000 USD per American doctor every year to market their products. This is in addition to the direct to consumer advertising of prescription drugs. Those billions could indeed be better spent on real healthcare issues. This is also taxpayer money since the drug companies get to write off these "expenses" as a"business expense."

Okla gal, Doctors ABSOLUTELY do not get a penny for writing prescriptions. It is the same thing with any tests they order, unless they do the tests in their office and read the results themselves.

I do agree that the costs of medicines is outrageous, and that competition has gotten out of hand. The extent of spending to get the doctors to come to a seminar is overdone. However, I continue to reiterate that doctors are not swayed to write prescriptions based on how much the drug companies spend to market the product to them.

And drug companies spend 13,000 USD/doctor/year and get nothing for their money? Not quite, as the article below makes clear.

Interestingly, patients' reaction to doctors is a lot like constituents' reactions to politicians. Other politicians are crooked but not the one they vote for/support. Other doctors are corrupt/incompetent but not *their* doctor.

The most serious issue here is the enrolling of patients into clinical trials (usually for off-label uses) without either their knowledge or their consent. Doctors are paid by the drug companies for enrolling patients and for prescribing the drugs.

Here is a link that might be useful: http://www.healthyskepticism.org/editions/IN9903.htm

thanks Debbeanne, I had always wondered about that. I think everything gets so expensive because too many ignorant commericals about sueing someone for things that didn't hurt anyone or cause you used a drug that 5 yrs. down the road it wasn't as safe as you thought it should be. Drs. are only human and sometimes things go wrong that are out of their control.

Things that didn't hurt anyone? You might read the article referenced. Adverse reactions to prescription drugs are the 4th to 6th leading cause of death in the country. This is in cases where the drug has been used appropriately and does not include drug errors.

At last count rezulin had killed 150 people and permanently injured several hundred more to the point where their quality of life has been permanently damaged. Many require liver transplants. As for "5 yrs. down the road it wasn't as safe as you
thought it should be," people have the right to expect that drugs they take are safe and effective or to full information about the future risks of the drugs, so they can decide whether or not to take them.

Doctors who get information from drug companies instead of from reliable sources are more likely to prescribe new untested drugs on the say-so of a drug company. They are also more likely to have been paid by the drug company for prescribing the drug. The way to protect yourself from this kind of thing is to do your own research and take control of your own medical care.

Did you know that only 1% of people who are victims of medical malpractice ever sue for their injuries?

Here is a link that might be useful: http://www.vaccinationnews.com/Rally/AdvDrugReactJAMA.htm

Following up here, you might also consider the thalidomide children and DES daughters (and sons), both groups who were somewhat.... hmm... inconvenienced?.... by drugs with unintended late side effects - side effects doctors should have known about and would have if they had bothered to question drug companies' information. In the case of thalidomide, pregnant women learned 7-8 months later that the drug was "not as safe as [they] thought it should be.." Mothers of DES sons learned the dangers at birth and their daughters discovered them 20, 30 and 40 years later. Maybe you view these as acceptable risks. If so, you have the right to take them for yourself, but don't expect others to be equally willing to harm themselves or their children.

BTW - didn't we forget to congratulate Carina on stopping smoking? Good luck with it!

I "skimmed" over the article on methods to sell drugs...interesting, I guess. However, I find it highly unlikely that a physician will solely prescribe a medication just because the drug rep told them about it...that is ridiculous! In all the pharmacies I've worked (3 total) and the doctor's office I worked in, there was no shortage of PDR's (Physician's Desk reference). I also have a hard time believing that a drug reps uses candy and other things to basically bribe other office workers so that they can gain access to the physician. If the physician is busy, they will not see the drug rep. Drug reps do have an "agenda" so that they will not be hanging around the office for hours waiting to speak with the physician; that only makes sense. When I worked in a doctor's office, i absolutely hated the drug reps because they were just an annoying presence and basically an interruption to the physician's day. But a physician or nurse must be present to sign in samples.

"Representatives use the local pharmacies, or obtain the information from doctors directly using such schemes as SCRIPTRACK eg doctors are required to fill in paperwork providing information regarding their prescribing preferences etc in return for small prizes, lottery tickets, etc. The companies go to great lengths to obtain this information."

If I'm reading this right, I thought it was against patient confienditality for anyone by the DEA to gain access to information on patient scripts. In my experience, no one is privy to that information except the pharmacist, doctor, and the DEA (who may audit prescriptions at any time). I don't understand how this article can be credible when he gives no references, doesn't even list his name, or the companies he worked for.

It isn't against patient confidentiality rules so long as the names of the patients for whom the prescriptions are written are not disclosed. The case of the pharmacist who was caught diluting anticancer drugs made it obvious that drug companies keep track of how many prescriptions are written for their drugs. The pharmacist got caught by the drug company because he wasn't ordering enough drug from the drug company to fill the prescriptions he was getting. The drug company tipped off the FBI. Apparently doctors never noticed that their patients weren't getting the drugs - which begs the question of how effective the drugs actually were.

>>BTW - didn't we forget to congratulate Carina on stopping smoking? Good luck with it! Why, thank you drrazzle! 33 days without a smoke. agh. :)

There are more drug reps at one of the Doctors my family uses and it is beginning to make me wonder what in the world is going on that they have to be there every day. It is not my personal Dr. so I have not said anything, but if it were my Dr. I would have asked him what is going on. I don't see any need for these reps to be there all the time. What do they do besides present the drugs? And, wouldn't once a month be enough, or are there so many reps that they have to be there all the time. I am not exaggerating, they are there all the time. We stopped by today to pick up a prescription and there were two leaving and two coming in. That is just what I saw in 5 minutes.

See:
http://www.guardian.co.uk/medicine/story/0,11381,646078,00.html for some eye-opening information about drug company influnce on even the science doctors have available to them. Last year 15 (IIRC) major medical journals announced that they would no longer accept articles from researchers who were being paid by drug companies. I suspect that the result is merely to drive the connection a little further underground. Numerous studies show that doctors who are paid by drug companies are far more likely to find favorable effects/results than those who are not paid by drug companies.

A study reported in Toronto this week and available on CNN indicates that only 7% of doctors admit to being influenced in their prescribing practices by drug companies but believe that 19% of their colleagues are so influenced.

Here is a link that might be useful: http://www.guardian.co.uk/medicine/story/0,11381,646078,00.html

Carina congrats on your success. The BIG question is how did you do it? I need to do the same.

Okla...I just gritted my teeth and did it. There is no perfect time to quit. It bites, for sure. Almost 6 weeks & I am still having cravings, I have an ear infection & my sinuses are messed up. As a smoker, I just rarely got sick...one of those ironclad immune systems! My last cold (or illness of any kind) was in 1993. Quitting really seems to stress one's body.

On the positive side: My skin is definitely looking pinker & better. I don't smell, my vehicles don't smell, my house doesn't smell. I'm not coughing any more. And if everyone is to be believed, smoking is bad for me (who knew!?) so this is a much healthier thing to do!

The quitnet site helps too. And patches, gum, etc are quite inexpensive these days. Good luck!

Interesting about the infections. I found the same thing when I quit more than 6 years ago. I went from perfect health to having several low grade upper respiratory tract infections a year for about two and a half years. Like you I blamed it on the stress of quitting, but also wondered if nicotine or some other substance in tobacco had some kind of antiviral effect that I lost when I quit smoking. None of these infections were serious enough to require any kind of medical attention, and I was never sick enough for it to prevent me from doing anything I wanted or needed to do, but they were annoying. I think I found them even more annoying because I had expected health benefits not deterioration. The problem went away in couple of years and I'm now back to no sign of any illnesses at all for more than 3 years, so I suspect I've recovered my previously robust immune system.

The positives of no coughing, and the end of the really nasty smells are well worth the agony. Hang in there, Carina.

I think all the infections and sick feelings are signs of nicotine withdrawal. Its similar to the headaches when cutting out caffeine.

Secapps,

I know the reason why our office always had an endless stream of drug reps was because we stocked many different medications, thus meaning several different drug reps. In our case, we gave these samples to low-income patients who otherwise couldn't afford to pay for the Rx or only were allowed a specified amount of drug at a time.

BTW, Congrats, Carina!

Thanks all for the congrats! There is a smokers' rights site based in New Zealand that I found...some fairly interesting information about the health benefits of smoking (there are some.) It is kind of a backlash against the anti smoking hysteria, but some very interesting stuff. I could go on & on about nanny governments & you really do not want me on my Libertarian ranting, so I'll shut up now!

I will also take this opportunity to say adios...I paid for these forums, but I know many haven't. I'm going on vacation in a couple of days...just want to say I've enjoyed everyone's input here.

Carina

Hi Everyone

From the New Zealand perspective, this is an anti-smoking country with restrictions on where you can and can't smoke, the cost of tobacco and funded programmes to help people to give up smoking backed by the government. Just saying this so that the smokers rights site based in NZ doesn't give the impression to the rest of the world that this country is a smokers haven.

Joan - New Zealand

Joan...government restrictions on smoking is probably the reason WHY there is such a site based there! :)

Leigh K, a question for you. I am not asking to provoke you but it seems that you constantly post antagonist respones to every section. This is a menopause forum. Some of us, (perhaps the unlucky ones) have genetic predisposition to poor health. I was a body builder work out vegetable eating machine, at 28 huge inner ear and jaw tumor (never did drugs, smoked or anything) chemo and four surgeries later (including hysterectomy have left me very unhealth. I am now 36, 2 years ago became so ill I couldnt walk. Auto-immune sle (3 aunts have perished from this) and hypogammaglobulenemia. Therefore, gamma globulin infusions. I have been to more doctors than I could count to the infinity number (slight exageration 'joke'). I have found that doctors are practictioners and try. I will consult a pharmacist regarding meds way before a doctor. Doctors know what the particular drug is useful for but, as I am allergic to sooo much. I fall into the 1% side effect profile. Pharmacist know the composition and such. I have personally taught many phycians about new side effects and after controversy and putting the pdr in front of them they say wow. But on the whole doctors try to do what is best for their patient. I am even sometimes glad they receive free samples from drug companies because they pass those on to us less fortunate long term ill patients that have to pay for meds directly out of our pocket. Now my question to you is. Have you ever had a serious illness for which you had no control, trust me I have now been through 9 surgeries. 2 in 2 months. I have a 13 year old son and an 11 year old. There constant worry is mommy are you going to die on us. Heart wrenching. I come to this forum for advice on what has worked for other people. As far as meds go, because unlike you. Some of us has to take them to have a better quality of life. You remind me of my mother that never had a soar throat telling me to get out of bed and run when the pain is so bad my leggs arent even working. I would do anything to not to have to take another pill but I would a least like to find some form of hrt to make my younger life a little more peaceful.... AND I don't feel guilty about that. Give me good advise instead of bashing please. We all know meds are harmful, doctors are not perfect but companies hire sellsmen to do what it takes. Its everywhere. Banking, escrow and Realtors are worse (Ive been involved in all three).