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 Post subject: continued...
PostPosted: Fri Dec 02, 2011 6:13 am 
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steve8819 wrote:
Ya some of the drug companies paying to the doctors...But it is good issue raised by u...





YES ....I also take the generic subutex by roxanne, have never had a problem with it and it costs me $10.00 for 60 tablets on my insurance. My doctor switched me right over when I asked him with no problem....maybe I'm just an old lady and looked like the type that wouldn't shoot up?? I wouldn't , of course.


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PostPosted: Fri Dec 02, 2011 7:17 am 
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Just because a doctor has agreed to do a speaking circuit doesn't mean they're unethical. Even our Dr. J has received pharma money from GSK, Pfizer & AstraZeneca. As long as a doctor maintains ethical and professional boundaries, and doesn't deviate from their Hippocratic oath, it's not necessarily sinister. If a company came to you, waving $50,000 dollars to speak on behalf of their products at a few seminars. Would you turn it down?

It's a real blurred line. From what I've read, doctors often sign up for these things with good intentions. It's only down the track that they sometimes feel pressure to bend their ethics, "gloss over" some side-effects etc. At this stage, many pull out.

I've heard many doctors claim that, despite receiving gifts, that they remain balanced and objective. But pharma marketing studies have proven that it doesn't matter how aware a doctor is of the marketing tactics. They all still feel a level of loyalty to any company that has done them a favour. It's almost human nature, and goes beyond intelligence & awareness. If it didn't work... Pharma companies wouldn't be doing it.

What's interesting is that .. at least in my country. Politicians have been forced to defend their receiving gifts directly from pharmaceutical companies as well. So it happens at "both ends".

There was some incredibly fishy behaviour going on when our TGA overturned its original decision to disallow Suboxone Film. Originally they found no benefit, and even more harmful than the tablets, and they stopped its release here. They then overturned it because of letters received from a some doctors & the Pharmacy Guild. Recently that same guild has been all over the papers for receiving kickbacks from pharma companies to endorse their products to pharmacists.

I'm beginning to think this stuff will never change.


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PostPosted: Sun Dec 04, 2011 4:14 pm 
Thanks for the helpful link!

I am glad to see that none of my doctors are on this list. If they were, I would switch doctors, end of story.


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PostPosted: Sun Dec 04, 2011 4:58 pm 
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Yes-- as some have noted, I am on 'the list'-- although I haven't done any speaking for the past year or so.

When a medication comes out, there are several ways for doctors to learn about the medication. The most common way? Watching advertisements on televisioin, or hearing about ads from patients. Is THAT how you want your doctor to learn??

The best way, of course, would be for your doctor to learn about new medications by reading the literature. As part of my volunteer teaching at the Medical College of Wisconsin, I have access to journals to get that information. But learning about medications in that way is very inefficient; such studies will report on efficacy-- i.e. whether a medication works--- but they rarely if ever include comparative information, and they do not generally cover the practical use of the medication.

When I spoke fo Shire, I was able to tell doctors how to save money by splitting doses- i.e. take a 70 mg capsule, empty it in water, and drink half, saving the second half for another day. There is no other source for that information.

You all know what I have to say about Suboxone; during my very short time speaking for them, I was able to explain to doctors that it is pharmacologically identical to buprenorphine, and they could save money on the generic.

When speaking for medications, doctors are given very strict instructions about what they can and cannot say. This information does NOT favor the drug companies, I can assure you; speakers are forbidden from saying that one drug is better than another, and can only go off the FDA-approved slides in response to direct questions, and only to answer that question. Equal time MUST be provided to talk about the risks, as compared to benefits.

Things I could say, that docs hear nowhere else? What time of day do you give it? What are the typical side effects you see? How long do you have to wait after stopping drug x before starting this one?

As for payment, a speaking engagement usually means travelling to a remote location, to meet with doctors who have limited access to university libraries. To give a talk, I would close my office for the day. In return, I was paid for the typical billings for a day's work in the office. Of course, even while out speaking, the bills must be paid-- rent, utilities, malpractice, secreterial staff, etc.

For the past two years, the rules are such that pharmaceutical companies can give nothing of value to docs, except for payment for services like speaking or consulting. I became a speaker for Forest recently; I had to go to Dallas to hear the warnings from attorneys about the fines associated with saying anything 'promotional'. The trip lasted 30 hours, and every moment was accounted for; I did not leave the hotel, as I had meetings (and travel) the entire time. To take a flight to Dallas, sit in meetings for a number of hours, get a lousy night's sleep in an average hotel, eat an average meal (the rules state that the meals cannot be valued at more than an average restaurant dining experience in that geographical area-- usually it is a food line and chicken), and fly back the next day, I was paid $500. I missed a day in the office to do it is not a way to boost income!

As for 'firing the docs who take money from pharmacy companies', those companies tend to hire people who know their stuff. The thing I like MOST about speaking is having the opportunity to hear directly from the people who conducted the studies, and grill them on the results. If you could see what goes on at the training sessions you would be impressed; the potential speakers are not going to put their good names on bad science, and so they are a very tough audience for the scientists who did the FDA research.

If your doc is a speaker for a drug, he/she is likely to know more about that medication than any other doc. And I doubt very seriously that any doc prescribes more of a drug because of being a speaker. I've spoken for seroquel, pristiq, and an anti-opioid-constipation drug that I can't even remember the name of-- never prescribed it even once. I was chosen as a speaker because I have a PhD, so I understand statistics and clinical studies. I also have a radio show and have done significant teaching, so I'm good in front of a crowd.

BTW, I contacted the propublica web site people and explained that my board problems predated my years as a psychiatrist; I asked that they add that my board problem from addiction occured over ten years ago, and that I did all that I was supposed to do. Their answer? Tough. I was treated for addiction, so I'm a bad doctor. Period. THOSE are the people you are taking doctor recommendations from.


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PostPosted: Tue Dec 06, 2011 4:56 pm 
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my dr is on the list for speaking 3000.00 from gsk whatever that is.l I am off subs he is also my phsyciatrist and I still see him for my seroquel.
I have been off subs since april and my dr was very supportive of my decision
I am very happy with my Dr, I went many years from shrink to shrink on many different phsyc meds and my current dr is the only one who was able to prescribe me medication that actually made my life better so I have no problem knowing my doc made 3k speaking about gsk whatever that is


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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