I think Zee's issue is the incentives given by pharmo companies to
doctors and pharmacies for encouraging prescribing meds.  I agree that
while they doubtless do increase awareness of meds, at the very least it
looks very bad.
    I am not speaking from experience; I haven't gotten my trip to Aruba
yet.  The biggest graft I've received as a dentist is the Zovirax coffee
mug I'm drinking from right now.

Steve

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

Where the money is going

When paying for prescriptions, most of us assume that a great deal of
the money goes to fund the costs of researching new and more effective
drugs. Unfortunately, this is far from the truth. Research and
development in 2002 accounted for a mere 14 percent of expenditures by
most pharmaceutical companies. Net profit, marketing, and
administration, meanwhile, was almost 54 percent of expenditures!

Uwe Reinhardt's "An Information Infrastructure for the Pharmaceutical
Market." Health Affairs, Volume 23, Number 1, 2003.

Here are some alarming statistics:

   * A majority of research and development spending goes into
research whose essential purpose is to extend patent protection on
existing drugs. From 1989 to 2000, only 24 percent of drugs approved by
the FDA offered a significant clinical advantage over products already
on the market.

(Source: Families USA, "Profiting from Pain: Where Prescription Drug
Dollars Go," July 2002; Michie Hunt, "Changing Patterns of
Pharmaceutical Innovation" (Washington: National Institute for Health
Care Management Research and Education Foundation, May 2002)

   * An estimated 85 percent of research and development funding comes
from National Institutes of Health (NIH), public tax credits, private
foundations and academia.

(Source: Office of the Minnesota Attorney General, "Follow the Money,"
2003.)

   * The pharmaceutical industry has been the most profitable industry
in the U.S. since 1992, and in 2002 it was five-and-one-half times more
profitable than the average Fortune 500 company.

(Source: Families USA, "Profiting from Pain: Where Prescription Drug
Dollars Go," July 2002)

   * In 2002, drug companies spent $78.1 million on federal lobbying
activities, and in 2003, all drug companies and their trade association
employed 675 different individual lobbyists, more than six for every
member of the Senate (100), or more than one for every member of the
House (435).

(Source: Public Citizen's Congress Watch, "The Other Drug War II" June
2002. Public Citizen. "The Other Drug War," June 2003.

http://www.washingtonpost.com/wp-dyn/content/article/2005/07/22/AR2005072202220.html
"When it comes to accepting gifts from the marketing reps of
pharmaceutical firms, the American College of Physicians-American
Society of Internal Medicine suggests that its members apply a simple
litmus test: "What would the public or [our] patients think of this
arrangement?"

Most patients never find out. If they did, they'd probably go into
shock over the goodies doctors accept, like meals, travel, gift
certificates or parties. The pharmaceutical industry estimates that it
spends about $5.7 billion a year on marketing directly to physicians,
which works out to about $6,000 to $7,000 per doctor."

http://www.slweekly.com/editorial/2005/feature_2005-06-16.cfm
"Eight of nine AHA experts who wrote the stroke guidelines had
financial ties to the drugmaker. That is not uncommon. In a 2002
review, The Journal of the American Medical Association found 60
percent of doctors defending a drug's use had relationships with the
drug's makers. Drug companies provide a significant portion of the
budget for the FDA. One-third of the experts who recently recommended
putting Vioxx and other arthritis medications recalled for increasing
the risk of heart attack back on the market worked as consultants to
makers of the drugs, according to the Center for Science in the Public
Interest."

http://www.drugpromo.info/readit.asp?qt=4&cat=2
"Drug companies spend enormous sums of money promoting their products
around the world to doctors. In 2000 over US$13.2 billion was spent in
the USA1, the 1998 figure for Italy was US$1.1 billion2, and in the
developing world 20-30% of the sales dollar goes into promotion3. There
are currently over 80,000 sales representatives in the USA4, where the
industry sponsored some 314,000 physician events in 20005.

Direct-to-consumer advertising (DTCA) of prescription drugs is allowed
in the USA and New Zealand and may soon enter Canada and the European
Union. Growth in spending on DTCA in the USA has been dramatic, with
nearly US$2.4 billion being spent in 20001.

The companies would not be spending billions of dollars if there was no
return and, according to the best evidence, promotion does increase
sales. For every dollar spent on magazine and television advertising
there is a return of US$2.51 and US$1.69, respectively6. Increases in
the sales of the 50 drugs most heavily advertised to consumers in 2000
were responsible for almost half (47.8%) of the US$20.8 billion
increase in retail spending on prescription drugs from 1999 to 20007."

http://my.webmd.com/content/article/1728.541655
The Journal of the American Medical Association 2000;283:373-380,
391-393.
"In an accompanying editorial, Dr. Robert M. Tenery, Jr., of the
American
Medical Association's Council on Ethical and Judicial Affairs, writes
that the
Council has attempted to police physician interactions with drug
companies. The
most egregious activities have stopped, such as awarding airline miles
for
prescriptions written, but recently the need for continuing medical
education
(CME) has driven a resurgence of drug company-sponsored junkets, he
says. CME
credit is a requirement for licensing in most states. Tenery notes that
drug
company money and influence "has permeated virtually all levels of
physician
CME in the form of complimentary meals and entertainment, consultation
fees,
and pseudo-CME courses." He concludes that physicians and the drug
industry
need to develop new industry-wide standards to prevent abuses of the
system."

Where the money goes:

Montreal Gazette.

Cozying up to drug firms disturbs some physicians
Heart doctor complained to professional order after
being invited to refer
patients to clinical trial

CHERYL CORNACCHIA
The Gazette
Tuesday, February 24, 2004

Cardiologist Colin Rose, who also teaches medicine at
McGill, says close
relationships to drug firms undermine doctors'
willingness to try
non-pharmaceutical treatments for their patients.

When a company contacted Colin Rose and offered to pay
him $6,000 to refer
patients to a drug study, they had the wrong doctor.

Rose, a cardiologist at the Montreal General Hospital,
not only said no, but
he passed the written offer to the Collège des
médecins du Québec,
suggesting it investigate the ethics of paying doctors
to refer patients.

"I'm about the last one on Earth they should have
contacted," Rose said
yesterday.

It turns out that the physicians' college doesn't
investigate those kinds of
cases, but the doctor is no less upset by the offer to
send patients to the
study, which was sponsored by Merck Frosst.

Rose, who is also an assistant professor of medicine
at McGill University,
is outspoken about what he sees as an increasingly
cozy relationship between
doctors and drug companies. He says it undermines
doctors' will to suggest
alternatives like lifestyle changes instead of
prescription drugs.

The hypercholesterolemia and coronary heart disease
study to which Rose
referred is being conducted by the Clinical Research
Consultant Group at the
Seaforth Medical Building on Côte des Neiges Rd .

The group's letter to Rose, dated Nov. 18, 2003,
detailed how he would
receive an honorarium of $6,000 if he referred at
least one patient being
treated for high cholesterol and heart disease. He
would have been required
to perform a physical exam of the patients at the
beginning and end of the
study and write the initial prescription. Nurses
employed by the group would
do the rest - seeing patients throughout the 12-week
study.

The study is evaluating the cholesterol-lowering
efficacy of a 10-milligram
dose of a drug called Ezetimibe when given with a
10-milligram or
20-milligram dose of Atorvastatin, another
cholesterol-lowering drug. Both
drugs are approved for use in Canada.

Rose later received an e-mail from Bernice Pynn, the
lead researcher of the
drug study, saying "at this time there is no
discussion of publication" of
the study results. Pynn, a biochemist, was unavailable
for comment
yesterday. However, an assistant at the clinical
research group confirmed
the multisite study is sponsored by Merck Frosst. So
far, she said, 15
patients are enrolled in Montreal.

Vincent Lamoureux, a spokesperson for Merck Frosst in
Kirkland, said doctors
are sometimes compensated for their time. However, he
said, he was
unfamiliar with the study Rose cited, even though
"there definitely seems to
be a link to some of what we do."

COMMENT:

Just so. That's pretty obvious in selling novels or magazines, so why
do people's mental circuit breakers trip out when it comes to
pharmaceuticals? A pill is a piece of physically instantiated
information, like a newspaper. It should be obvious that the more
subscribers you can find for your newspaper, say the New York Times,
the better the quality of the paper you can produce for the
subscription price. So, does subscriber advertising really tend to
*raise* the price of a subscription to the TIMES, or decrease it?

The irony is that the regulatory burden on the the pharm industry is so
high right now, mostly due to activists like Zee, that they really are
forced into the kinds of economies of scale which only large scale
advertising CAN deliver. Zee wants a small limited edition art-journal
kind of world, while demanding the kind of monster potective regulatory
infrastructure that, were it to be imposed on the publishing industry,
only formulaic best-sellers could support. And wonders why my heart
doesn't bleed for her position.

A story, reported by a nutritionist and MD I once read. Once upon a
time, there was a wonderful new anitbiotic for TB (panacea!), which
caused blindness in lab animals (plaugue!). But such were the horrors
of TB at the time, that they decided to do limited trials on humans
anyway, since our retinas differ somewhat from the average animal (as
you can see at night with a flashlight). They ran the tests, warning
the sanitarium patients to report the slightest problems with vision.
After some time, a walk through the wards produced one fellow who was
"reading" his magazine upside down.  Turned out he couldn't see at all.
They asked why he'd said nothing. He replied that he'd seen too many of
his friends go out the back door over the years, and he was determined
to go out the front, even if if with a cane and dark glasses. He knew
if he complained, they'd stop the drug (They cut his dose, his vision
came back, and he was later able to re-start).

That research world described above, is gone. The drug never would have
gone to human trials in THIS world, and *everybody* in the hospital
would figuratively have gone out the back to the body removal lift, in
the politically correct way. Say "Tuskeegee," and remember them in your
prayers.

And TB, meanwhile, is winning. New drugs are more and more too
expensive to develop, and when we try it in Africa to cut costs, there
are political objections and more muttering about Tuskeegee. Corporate
greed is blamed for the spiggot running dry. So TB continues to rank
with the top killers of people every year in the world.  That's our
unintended consequences of limiting individual choice, and interfering
with research. That's our brave new world of best-sellers or nothing.

SBH

PS. The drug in the story, however, survived its trials and is still
used for TB, albeit with careful vision testing. All doctors know
ethambutal. Now no longer panacea or plague, but just a perfectly
pedestrian pharmaceutical. Albeit an older one.

S.

Well perhaps I chose the wrong word. SWAG? And, DTCA is so far not
allowed here. I think that's what I mean. It really takes a huge chunk.
You know that. You just think it's ok. Call it education. OrwellSpeak.

 : ))

What YOU want, is for somebody to go out and pick it for

Not at all. Taxes is the preferred way here. But even so, there are
lots of out of pocket expenses. None of the several products I've used
recently were covered under taxpayer supported heatlth care. I paid out
of pocket. The preferred delivery system for estradial cost me $110.
This spate of products will be the first I've used since statins, and
they were the first since antibiotics in the '70s. See when you aren't
subjected to pharma shill day in and publication out, you are less
susciptible to thinking you need something picked, selected and sorted
to continue living.

Of course I care. I sometimes wonder who's point of view you are
attributing to me?  Point of view can change depending on the issue.
It's not knee jerk left, always.

Some technology is too precious to be owned by one entity.

I know you don't agree with that. But we have the pretense, at least,
of living in democracies, you and I. And I have the option and right to
change my mind as I learn more about anything.

Zee

    Isn't that the way Canada works?  I understand there's some kind of
flow chart with a point system.  You know, the one all us lefties were
asking about after the election last November.
    What's H1B?

Steve

 But a young and growing family in the US cost a hell of a lot of

What do you recommend?

I think it could be a lot cleaner than it is currently here in the US.  Or
do you recommend we just wring our hands and piss and moan?

There were no such images of any Latino kid in the ad.  It showed stock
footage of Mexicans rushing the border and climbing over a fence, and made
statements about overcrowded schools, etc., and gay men french kissing.  It
was the tone that was offensive.

You go right ahead.

Florida.  Where were you?

Not sure how to interpret that sigh.

You know, you actually do a lot of politicking yourself here.

Um, no, actually.  It all sounded too simplistic.  Turns out it is.

So let's hear your list of solutions.