A physician friend of mine – who shall remain nameless lest he/she incur the wrath of the Pharma beasties – forwarded me the following note they received via email, offering a generous rewards program in return for answering questionnaires designed to gather information that would help pharmaceutical companies maximize their ability to impact physicians' prescription writing inclinations, or, as the note less ominously puts it “to observe and improve the quality of the information you receive from the pharmaceutical industry”. The message came from a marketing/data mining company that uses sophisticated methodologies to maximize marketing, branding, and product launches in the health services industries. My physician friend tells me they receive several such emails every week.
Here’s the note, with any identifying or proprietary information redacted so that I don’t get sued for publishing it:
Dear Dr. XXXXX XXXXXXXWouldn’t you like to earn international vacation packages and high-end luxury items just by answering surveys? Well, if you would, you’d better become a doctor. Because, you know, doctors need all of the financial assistance they can get since they are so underpaid in relation to those in other professions, like schoolteachers (who really make me want to retch, the hedonistic bastards).
We would like to invite you to join our regular study on the medical information delivered by pharmaceutical companies. The objectives of this study are to observe and improve the quality of the contacts and information that you receive from the pharmaceutical industry through:
o individual interactions (in person and online)
o events (in person and online)
o direct mail (postal and email)
o clinical trials and product samples
As we work to help improve minor modifications to better align with your activity. These will allow life science researchers to measure your perception and satisfaction with the aim of adapting and improving the quality of information you continue to receive.
To thank you for your time and participation, we offer generous incentives which allow you to earn and accumulate points for each questionnaire you complete. The more questionnaires you fill-in, the more points you earn. We also offer loyalty program which rewards you 25% more points, if you participate for 12 consecutive months. At any time, you can use your points to redeem:
o Flight tickets to destinations in the Caribbean, Europe, Central & South America, Asia, Australia and South Pacific, Africa and Middle East, Mexico, Canada and the US
o International and domestic vacation packages including tours, sightseeing and cruises
o Admission to theaters, concerts, sports events, amusement parks and many outdoor adventures
o Merchandise including home appliances, furniture, home and garden products, jewelry, toys, baby products, apparel, tools, office supplies, outdoor products
o Health and Fitness products and equipment
o Electronics including TV, audio/video equipment, cameras and camcorders, computers, Apple iPads, iPhone, video games and consoles, GPS devices, printers/copiers
You can preview our incentive selections from our website at XXXXXXXXX.com using the trial login "XXX" and password "XXXXXXX"
To sign up, simply complete the form below with your preferred contact information. You can fax it back to me at XXX – XXX – XXXX or e-mail at XXXXXXXXX.com
Doctor name: First/last name:
Specialty: Phone and fax: Mailing address: Email address:
If you have any question about the survey or the incentives, please call me at this toll-free number XXX – XXX – XXXX. I will be more than happy assist you.
PLEASE NOTE: This e-mail and any attachments may be confidential or privileged and is solely for the intended addressee(s). Do not share or use without XXX approval. If received in error, please contact the sender and delete the email and any attachments.
I took the liberty of perusing the catalog of items available via the survey rewards program, and found that they include goodies ranging from free music downloads to high-end appliances and home furnishings to every kind of electronic gadget imaginable to European vacation packages. A single music download will cost a participating physician 278 points, front row tickets to a New York Rangers hockey game in Madison Square Garden (including food and nonalcoholic beverages) 337,489 points, and an unlocked 64 Gb Apple iPhone 6 plus 205,363 points. Oh, and a 15 night transatlantic cruise leaving from Rome and arriving in Miami, with stops in France and Spain along the way, will set some lucky questionnaire answering physician back 466,277 points (per person), which seems like a heckuva bargain given the cost of the hockey game.
Of course, it’s not the marketing company that is footing the bill for these “rewards”, but their pharmaceutical company clients. And why would pharmaceutical companies be willing to pay through the nose for information that would allow them to hone their messaging to doctors? Simply put, because the doctors know damn well where these rewards come from, and studies have documented that rewarding doctors with cash or goods has a quantifiable effect on their prescription writing practices. One such study (click here and here) found that “Even small handouts--such as free meals and payments worth $100 or less--tweaked branded scripts upward. Doctors who participated were two to three times more likely to prescribe brands than those who didn't. There was also a dose response: The bigger the value of payments and gifts, the more branded scripts… Doctors who received more than $5,000 in a year's time chalked up the highest percentages of branded scripts.” And make no mistake, pharmaceutical companies carefully track just how many prescriptions for their drugs doctors are writing, and routinely use such info to target those physicians who are “underperforming”.
It’s well known that pharmaceutical companies regularly pay the doctors who prescribe their products cash money, in the form of "consulting fees” and “honoraria”. More often than not, these consulting fees and honoraria are paid to doctors who simply talk to other doctors about a prescription drug, quite often over a free meal at a fine restaurant, or for giving a presentation on the drug at a symposium. Some doctors rack up tens of thousands of dollars per year in these fees, as has been made public via the Open Payments website, which was mandated by the US government in the Affordable Care Act.
While the Open Payments website itself is not all that user-friendly, the organization Pro Publica has built their own patient friendly portal to access the database, called “Dollars for Doctors” (click here). This website makes it extremely easy for patients to enter their doctors’ names and locations and come up with a list of all of the pharmaceutical company payments their doctors received from August 2013 to December 2014. Believe me, some of the numbers will shock you. One physician, a family medicine doctor in California, received nearly $44 million for “promotional speaking/other” during the 18 months in question. Yowza, for that money he must be quite the electrifying speaker, able to talk to the green off of an iguana. Using the site, I found that my first MS neurologist netted $72,580 during that time period, while my current neuro received a grand total of $17, which is one of the reasons he’s my current neuro.
It’s because this information is so accessible that pharmaceutical companies are finding new and more creative ways to funnel money and rewards to doctors, ways which bypass the laws and never see the light of day, such as handsomely rewarding doctors for answering questionnaires. Pharma has also increasingly taken to paying for physicians Continuing Medical Education (CME) courses, a practice that has seen a 25% jump since 2011 (the mandate that dictates public disclosure of physician payments went into effect in 2010).
All of this begs the question, how on earth is it tolerated, never mind legal, for pharmaceutical companies to pay the physicians who dispense their products? To my knowledge, this is the only industry in which such widespread and lucrative “consulting fees” and “honoraria” are considered everyday business. In most other lines of work such payments are called “bribes” and “kickbacks”. In the latter part of my career I worked for one of the major international music and entertainment conglomerates, and if we were caught paying a disc jockey to play one of our records (a practice known as “payola”) people would go to jail. Somehow, though, these practices are business as usual in the medical profession.
Pharmaceutical companies and the doctors who have their hands out frequently claim that these efforts ensure that physicians stay well-informed on the latest and greatest drug info, but are we really to believe that doctors would remain hopelessly ignorant if such palm greasing and wallet filling shenanigans were prohibited? What, would physicians suddenly forget how to read medical journals and the informational materials provided to them for free by the pharmaceutical companies? Has the Hippocratic oath been altered to state “First, do no harm. Second, information about pharmaceutical products not accompanied by copious amounts of dough shall be ignored”?
These issues are especially important to patients suffering from chronic diseases like Multiple Sclerosis who must rely on hideously expensive drugs, many of which carry with them a frightening list of potential side effects, to try to keep their disease at bay. We must trust that our physicians are choosing drugs and giving advice based on their keen medical insights and years of experience, and not because drug company monies have influenced their decision-making processes. The doctor-patient relationship for those suffering from chronic and potentially debilitating illnesses is a long-term affair, not a one night fling. As with all such relationships, trust is the beating heart of these partnerships, as life altering decisions hang in the balance. The fact that even the hint of financial self-interest on the part of the doctor might play a role in this complicated equation is, quite frankly, obscene.
I’ll now get off of my electronic soapbox, but I would encourage each and every one of you residing here in The States to quickly look up their doctors on the Dollars for Doctors website (click here), to see just how much financial benefit your physician has reaped through these dubious practices. This is not to say that every physician receiving large amounts of money from the pharmaceutical companies is corrupt, or has fallen under the spell of Big Pharma. But knowledge is power, and if your doctor has taken what appears to be more than their fair share, I’d say a frank conversation is warranted. No need to be confrontational, but certainly a cogent explanation would be welcome. Remember, for those of us suffering from long-term illnesses, the doctor-patient relationship must be a partnership, not a dictatorship. Ultimately, keeping yourself well-informed on all facets of the management of your disease may in fact be the very best medicine…
Hey, just for kicks, why don't those of you who do look up your doctors on the Dollars for Doctors website tell us how much pharmaceutical money your doctor received using the comments section of this post. Might allow us to contrast and compare… And vent and rant and rave…