Sunday, July 18, 2010

Massachusetts Medical Pharmaceutical "Gift Ban" ---------------- An argument for the the return of the medical informational dinner------------------

Massachusetts is the only state that prohibits pharmaceutical-company-sponsored neutral-site educational lectures (with dinner) for physicians.

Quick, bullet point summary of the article below
  • Doctors are clearheaded enough to eat a meal and then still think through to the best medication choice.
  • Do politicians hold themselves to this same standard? Are politicians willing to give up their lobbyist-paid occasions?
  • These medications have passed FDA-scrutiny, a very high bar.
  • Lectures are sponsored by competitors within a given pharmaceutical class, so doctors are likely to hear many different perspectives.
  • Lectures won't be the sole place that doctors get information, with sophisticated knowledge-database availabilities currently.
  • In fact the lectures barely even mention the product and are well-balanced, given by the "thought leaders" who don't want to seem beholden to a pharmaceutical company.
  • It is a competitive world and Massachusetts needs to keep attracting the best doctors. Many doctors don't appreciate losing the collegial atmosphere of sponsored functions.
  • Your work and effort is needed to repeal this "gift ban". Please e-mail as below.

It is insulting to think that doctors who are ostensibly smart enough to save one's life are (at the same time) in fact so stupid, or (perhaps worse) merely gullible enough, to be swept away (or even swayed) by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures. Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served dinner. It is the dinner-aspect that rankles the politicians, who are under the presumption that a served meal (or the associated thankfulness for same) will override doctors' better sensibilities at the time of later writing prescriptions.

These prescriptions will be written after evaluating patients, in consideration of best medical practice, desirous of success, yet under the eternal threat of malpractice or failure. Somehow though at the time of prescription-writing a long-ago-digested meal's meaning and memory will predominate over the preponderance of acute medical and clinical data, diagnosis, and thought.

Are our medical professionals so much more corruptible than our politicians? How is it that politicians are somehow able to sit through thousands of dollars worth of lobbyist-, or other political-contribution dinners without having their opinions or actions influenced (insert laugh track here) -- yet physicians are unable to maintain their balance and bearing, after the occasional dinner? At these dinners there is generally a group of a dozen or more physicians, whereas at lobbyists' convocations for politicians, the politician may be in fact the only person being fêted. In which situation is there a higher likelihood of monetary-influenced opinion-changing?

Where is the ban on politicians' attending lobbyist-sponsored dinners? Will politicians be clamoring for this anytime soon?

The pharmaceuticals associated with these dinners have already passed scrutiny by the FDA in order to reach market. This is a very high bar, a high standard to meet, and generally tens of millions of dollars have been invested in the pharmaceutical substance to bring it to market. It is sensible and necessary for future innovation and for current incorporation of information to have the prescribing population become aware of newer medications (and of utilization changes of older medications).

Politicians also ignore the fact that pharmaceutical companies don't exist in a vacuum (or as a monopoly... perhaps this is self-referential, the way they think of government, and the way government acts). Pharmaceutical companies, on the other hand, compete with each other. For every dinner that I went to in years past for promotion of (for instance) Viagra, I would also invariably attend dinners for competitors Cialis and Levitra. I would leave these lectures better informed about the ED-problem, the nature of PDE5 inhibitors, the possibility of side effects, but not "in the bag" for one brand or the other.

I have no doubt that physicians are adept enough, smart enough, and well enough balanced to make appropriate medical decisions based on the information out there (these days even more accessible , with so many instantly available medical-knowledge tools). These "live" (pharmaceutical-sponsored) educational sessions serve a useful adjunct function for dissemination of information, bringing physicians together and allowing physicians directly to question skilled and knowledgeable lecturers -- in my experience, with questions more about disease-states than about specific medications.

Physicians are quite busy and are also hard workers and high earners. Their working time is valuable and their free time is in a sense equally or more valuable. In order to bring doctors actionable and timely information, pharmaceutical companies knowingly and sensibly offer this non-monetary stipend of a sociable and social outing, a dinner. This is a nontransferable momentary benefit that is literally consumed at the spot.

I remember leaving these dinner lectures "full", but generally more nearly full of newly acquired subject-matter knowledge than abdominally full. The lectures themselves would barely mention a given sponsoring product, but even if they did, I would trust, and do trust , doctors during business hours to make their best decisions in accordance with the realities of a situation.

Even for the speaker, giving these lectures does not represent a "conflict of interest." The pharmaceutical company is simply happy to have the FDA-approved data presented to the audience. After that, the more thoughtful and neutral the speaker is with regard to the medication, the more credibility is maintained. Does the legislature want to keep suppressing the opportunity to hear truly balanced presentations?

Bringing back these sociable collegial events will help Massachusetts compete for "the best and brightest" physicians. Certainly we create a fair number here in our training institutions, but retention may be another matter.

The Massachusetts legislature holds a possibility in current session of repealing this "gift"-ban. Please do all you can in contacting your legislators to help further this process towards repeal.

Thank you very much for your consideration.


Randall S. Bock, M. D.

for those interested in taking action, here is a quick addendum to help you focus your efforts:
The conference committee members who will be determining the fate of the “gift ban” repeal have been announced. please contact any/all of the below. Let them know your opinion on this matter.

· Sen. Karen Spilka – Metro West
· Sen. Ben Downing – Western MA
· Sen. Bruce Tarr – North Shore
· Rep. Brian Dempsey – Haverhill – Supported repealing the ban
· Rep. Garrett Bradley – Plymouth – Supported repealing the ban
· Rep. Viriato Manuel deMacedo – Plymouth – Not present

Thursday, July 15, 2010

hearing aids versus reading glasses

Hearing aids cost thousands of dollars. In my early dotage ;-) currently 53 years old, I recently found imperfection in my near-vision (as we all do, over time). Probably I was laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, this year, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the grand sum of $10.00. That comes out to less than $1.50 per pair. As a result I keep one set by my bedside, one in the kitchen, one at my office, one in the car etc.; always at hand.

Not so long ago, reading glasses would have been "fitted" by an optometrist much like prescription glasses would have cost potentially hundreds of dollars each pair, but the wisdom of the market prevailed, under the implicit acknowledgment that the vast majority of cases of people needing reading glasses doesn't require prescription-fitting. Pretty much everybody gets nearsighted in the same manner, albeit differing in gradation; so it's just a matter of finding the right amount of correction in purchasing the new reading glasses. You can try one pair and then another until you are comfortable. There's the possibility that one eye's visual correction need is different from the other 's, and for those people optometrist consultation might be in order; however for nearly everybody else, off the shelf reading glass purchases are adequate, after trying different diopter-gradations of the eyeglasses.

Age-related diminishment in near-visual acuity is a result of change in the shape of the eyeball, essentially the drying out of the intraocular gel. This is nearly uniform although some of us get it earlier than others. Because the problem is pretty much the same for everybody, although differing slightly in degree, the solution is nearly the same for everybody. As a result , there is a great economy of scale, and eyeglasse-fitting for hundreds of millions if not billions of people just a matter of choosing a correction-level and finding a nice style, really no harder than buying a pair of gloves and probably easier than buying a pair of shoes.

Along the same lines of losing our near vision gradually, pretty much much we all lose our hearing, or more harshly said "go deaf" in the same manner as each other (with aging that is).

If we can fit gloves, reading glasses, or shoes so easily: usually for relatively little indentation into our pocketbooks, why then do hearing aids cost thousands of dollars? I recently bought a replacement Bluetooth earpiece, and it cost me all of $20. This Bluetooth coordinates with a variety of telephones and computer and other devices. It is tiny and extremely complicated. It has volume adjustments, battery-saving mode and probably a bunch of other features that I have not figured out yet.

Why is this purchasing paradigm so different from that of hearing aids'? I know that a hearing aid has to augment sound yet not overdo it in case a loud sound occurs whereupon the hearing aid 's amplification could damage the eardrum. But really how much more complicated is a $2000 hearing aid than a Bluetooth earpiece?

I think the pricing has much more to do with lack of access on the part of the consumer to a free open market for same. Everyone is funneled through the audiology offices.

There was apparently some interpretation of a federal statute by FDA making hearing aids prescription devices. This apparently was a misreading of statute and the market is now opening up. Once this occurs we should be able to obtain hearing aids for prices similar to the more complicated Bluetooth devices, and maybe get more features too. Wouldn't it be nice if one could remotely control hearing aids; add GPS or item loss-prevention; replace them for tens of dollars rather than thousands?

Remember when contact lenses cost hundreds of dollars per pair? That market has totally turned inside out. We need to open up the market for hearing aids. I'm somewhat surprised that organizations supposedly advocating for the elderly, e.g. AARP, have not been more proactive in this area. The AARP wants its members to have hearing aids, promotes the benefits of hearing aids, but does not appear to have done very much to open the market. They have tried to promote a tax credit for hearing aids, but this only transfers the cost, the high cost, of hearing aids to other taxpayers effectively.

It would seem to me that the highest benefit from the current approach acrues to audiologists. Similar situations obtained previously vis-à-vis contact lenses for ophthalmologists, orthotic shoes for podiatrists, reading and other eyeglasses for optometrists, teeth whitening fittings for dentists, antisnoring mouthpieces for ENT's or dentists.

We have to flip this model inside out so that the greatest benefits accrue to those with the problem: in this case hearing loss. I have so many patients with hearing loss who can't afford to go the hearing aid route. When they can purchase these items freely, try them on, and choose openly between brands, prices will drop. The free-market rules!