Yes physicians do benefit from seeing drug reps and pharma does benefit
from this, and other ways they control medical education.

Gifts and graft:
http://www.nofreelunch.org

THE BULLSHIT PARADE:

From:  <xxxx@wt.net>
To:    <justsayno@nofreelunch.org>

The worst problem with drug promotion lies not with the sales reps but
with industry-funded research. I personally witnessed the excesses for
8 years while on the faculty of a major medical school. This operates
at several levels.

First, one must understand that in academics teaching is like catching
fly balls and publishing is like hitting home runs. They didn't pay
Hank Aaron for his fielding. It isn't just the publishing and reflected
glory to the institution that drives academicians to do research. The
institution takes a cut of every grant, whether it's industry money or
an NIH grant. The percentages vary, but they are rather large; a $10MM
grant yields several million for the hospital, school, or whatever
institution the grantee works for. Those who bring in grant money have
*power*. What can they get with that power? A raise, a bigger office,
private secretary, less time actually having to teach residents or
touch a patient (when I was in academics it seemed to be a matter of
prestige to *not* carry a pager). Also, although it is difficult to
directly gain monetarily from grant money, one can usually buy a few
new computers or other toys that may find their way home.

Publishing favorable articles leads to invitations to speak at fun
places - all expenses paid - and receive nice honoraria to boot. Yes,
the drug companies fly private practitioners to nice places, but who
are they listening to? Impartial lecturers? No - they are listening to
the drug whores who will say nice things about the product. Some of the
drug whores I met during my own march in the bullshit parade were big
names in the field, including departmental chairmen. Some of the
biggest names in my specialty are, in my opinion, on the take. The
people who really get wined and dined at these meetings are the
"mouthpieces", not the attendees.

One time I was even mailed a lecture, complete with slides to present,
at a sponsored meeting at a very nice resort. When I balked and
insisted on giving my own lecture with my own slides it caused a major
storm. Another time, one of my colleagues asked another colleague to do
the statistics for his drug company data. When the results came back
unflattering he asked if perhaps a different statistical test might be
tried.

If a researcher plays the game well, publishing flattering studies and
giving lots of positive lectures, he might get a real plum: a
"consultant's contract", or a position on the "advisory board". This
can mean tens ofthousands of dollars of income per year for very little
actual work.

Therefore the real danger is in the poisonous influence the private
sector has on the generation of scientifi studies. Bad results and
balanced lectures are not rewarded. Sadly, with the drying up of public
funds for research in the past two decades, academic institutions have
had to rely more and more on private funding. When I graduated medical
school in 1979 medical journals did not require financial disclosure.
Now you see it everywhere - a sad reflection of the influence of
commercial research funding, and the closest anyone will come to
actually admitting we have a serious problem.

When a drug rep buys you lunch you know you are being fed a sales
pitch. The truly insidious aspect of all this is that published
peer-reviewed articles funded by drug companies are usually taken at
face value, and the lectures are given by drug whores (after all, they
are the ones with funding and have written all the articles - they are
the "authority" by virtue of the sheer volume they have published). The
damage done by this misinformation takes years to undo.

~~~~~~~~~~~~~~~~

I wish they would go with evidence based medicine. Evidence based
medicine does not show any benefit for statins for women of any age or
the men over 70  who do not already have heart disease. Evidence based
medicine did not show any benefit but in fact harm, from HRT
supplementation.

http://www.cspinet.org/integrity/press/200409231.html
"The studies cited do not demonstrate that statins benefit women of
any age or men over 70 who do not already have heart disease," said
John Abramson, a clinical instructor in primary care at the Harvard
Medical School. "Furthermore, we are concerned about the findings
from one of the five cited studies showing that statin therapy
significantly increases the risk of cancer in the elderly."

http://www.ti.ubc.ca/pages/letter48.htm
"Therefore, statins have not been shown to provide an overall health
benefit in primary prevention trials."
And this, from the epidemiology group Therapeutics Initiative out of
the University of British Columbia, British Columbia Canada, who
receive no industry funding. "Do statins have a role in primary
prevention?"

HRT
http://www.cwhn.ca/resources/menopause/hrt-glance.html
"The researchers halted the study prematurely because participants on
HRT exceeded the boundary for breast cancer risk that was established
at the beginning of the study. There was also an increased risk for
heart disease for participants on HRT compared to the placebo group."

Prozac
http://i.cnn.net/cnn/2005/images/01/03/eli.lilly.pdf
Negative information withheld. The missing Prozac notes that prove Eli
Lilly knew as early as 1988 that Prozac caused harm.

Just one way it works, but there are lots more on www.nofreelunch.org.
Physicians get samples to hand out. Once a patient has used X by
sample, they will likely use it by prescription. Drug reps compete
intensively for the space docs offices have for samples. They know it
works. Physicians, and even student docs, get all kinds of gifts, from
free staff lunches, to computer systems and educational junkets in
Pacific Islands. Pharma knows this will come back a thousand fold.

is no incentive to prescribe one more than the other , of course

vida supra

Glad you think I'm right, but I was talking only about acupuncture.  I'm
afraid my opinions of chiropractic are quite different.