Migraine

This is not entirely a migraine discussion but it definately could be.

I went to my allergist today for my shot and asked if I could have a stronger antihystamine. The OTC one I have was strong enough for months but just doesn't cut it on bad days.
She asked if I'd had a different one before and I said Chlorephen-psuedo which I have taken in the past and liked. For a while though it was just too strong so I let the Rx expire.

Well, she goes back in the back and gets something called Xyzal and hands me about 5 samples and says they'd get me a Rx if I liked it.

Well, that's not exactly what I asked for

This was the same thing they did when I wanted something to replace the theophylline and handed me handfuls of singulair.
Now I don't have problems with samples - much cheaper for me than buy a bottle of a Rx, using one pill and throwing them away. By why hand me a drug my insurance probably won't even cover instead of honoring my request for my cheap old generic which didn't give me side effects?

I am starting to think that they are so much in bed that they don't have my best interests at heart. Has anyone else had this experience?

I've had experience with them wanting to prescribe the latest med out, but I stand my ground and ask for older meds that I know work and meds that don't give me crazy side effects. It works.

I don't know if doctors are in bed with the pharm. companies; maybe the rep did such a good sales job the MD is convinced it's what will work for you.

I don't believe samples are available of generic drugs, only brand name.

And no, I don't think doctors are being paid by drug companies. The drug reps are doing their jobs. This includes marketing the newest drugs available to doctors and patients alike.

The discussion between you and your doctor was about trying to replace a medication you were previously taking. Maybe she thought the sample would be more effective and wanted you to try it before you filled the new prescription. If it didn't work, then you could go back to the old medication.

A word on potential side effects if I may they are potential and don't happen to everyone all the time.

Nancy - I know, it's not like they can have samples of every drug just sitting around. I do understand that because of the drug reps handing them out for new meds, those are the meds that they have availible to hand out.

What I don't really get is why would I want to try a new med (which I just checked will be $55 a month after insurance) which may or may not work and may or may not have side effects? When i can just get a Rx for a generic that costs me $8 dollars that I know works and I know won't give me problems? Especially when i have a long history of getting horrid side effects from meds (even Zyrtec, which is now OTC).

It would be a different story if I didn't know what Rx I wanted, but since I do what's the point of shoving weird drugs at me? Why can't I have the med that I asked for? That's why it seems to me that something hokey is going on - because of the resistance I got when I wanted something other than what they wanted to give out.

I'll have to call over to my GP to get the med. I don't get this kind of attitude from him.

I'm taking a different side on this one.

No, doctors are not paid by the drug companies or the drug reps, BUT they do get nice little perks from the drug reps when they visit. They get office lunch on "rep days", in most cases...and who knows what else.

Now I'm not saying they are all like this, but it is the drug reps business to come in, give samples and try to get that doctor to learn about and prescribe the drug they are "repping" or "pushing" if you will, at that moment.

Not that I am 100% saying yes, your doctor, or any, do this, but in my honest opinion, I feel that some doctors do. I think some of them script out more of whatever drug is, because hey let's say that company X has a drug out and that drug rep comes in....that company is on the open stock market...yeah, they can influence the market to some degree by what they give out.

Maybe that's a little hokey - or going to far....but that's how I felt when I was first given topamax, after seeing all the other drugs out there.....and when OB/GYN keeps pushing Depo on me, when every time I say no thanks, I'm good with the pill.

This is just my opinion, and we are all entitled to our own.

I see do see Nancys side too though, she is right, the doctors are NOT paid by the drug companies, so they should NOT do this, but I'm not so sure they don't, in my opinion.

Good topic!
I'm interested to see what others think/feel on this subject.

Reading your post again, yes, I don't think drs. have generics as samples, at least I've never come across it.

I hate to break this to everyone, but your doctors ARE paid by drug companies. They get gifts, and lunches. But they also get checks. There is currently legislation in 5 states and DC to require doctors to disclose these payments (and it is being invesigated in NJ)

Here is an article on the Journal of American Medical Association http://jama.ama-assn.org/cgi/content/full/297/11/1216

And here is the first sentence in the introduction.

"Interactions between the pharmaceutical industry and health care professionals often involve payments: cash payments; cash-value payments, such as gift certificates; or in-kind payments, such as meals, textbooks, conference fees, or luggage."

Obviously, it is highly un-ethicial to allow these "perks" to effect what the doctor prescribes, but that doesn't mean it doesn't happen.

That's what I'm talking about!

It's not like they get a check paid to them, but they get vacations, gift cards, all sorts of things!

I asked one of my co workers her opinion on this, since we were talking about it, she was like "oh yeah! My doctor got an all expense paid trip to Florida to play golf with Arnold Palmer!" yep, from a drug rep!

So even though they don't get cash payments, they get it in other ways.

Laurelin,

Theophylline is a generic. I can't find anything on Chlorephen-psuedo, so maybe it's a generic too?

Samples are NOT made available for generics. Generally, there are multiple companies producing generics. They're inexpensive, and it depends on the pharmacies' purchasing habits which company makes the generic you get. These are reasons why the generic companies don't do samples. Also, by the time generics are available, the drug has been out long enough that there isn't as much need for sampling.

You need to ask your doctor why you were given samples of any particular medication. It may be that your doctor felt that what you were given was the closest on hand to what you had requested. That's the only way you're really going to know.

How long ago was this, Eileen. Pharma companies are now much more restricted as to what they can do for doctors.

quote:

Originally posted by EileenHOST:
That's what I'm talking about!

It's not like they get a check paid to them, but they get vacations, gift cards, all sorts of things!

I asked one of my co workers her opinion on this, since we were talking about it, she was like "oh yeah! My doctor got an all expense paid trip to Florida to play golf with Arnold Palmer!" yep, from a drug rep!

So even though they don't get cash payments, they get it in other ways.

Teri - yes, chlorephen-psuedo is a generic. Not sure what the brand name was, since it's been generic forever.

I could ask the doctor only I never actually get to talk to my allergist anytmore...all the messages go through the nursing staff (e.g. I ask the nurse something, the nurse goes and asks the doctor and brings back a decision). Maybe my messages are just getting lost or mistranslated or something. The nurses are good about answering my questions more quickly but I'm beginning to think that maybe this is not the best setup.

I didn't mean to start a controversy or anything and I'm certainly not going to criminaly procecute anyone. I just don't like having the newest, most expensive pills pushed on me when there's a better way.

So, do you really think that EVERY doctor is paid by the pharm companies? I was under the impression the "crack down" was happening too.

quote:

Originally posted by Katinthecorner:
I hate to break this to everyone, but your doctors ARE paid by drug companies. They get gifts, and lunches. But they also get checks. There is currently legislation in 5 states and DC to require doctors to disclose these payments (and it is being invesigated in NJ)

Here is an article on the Journal of American Medical Association http://jama.ama-assn.org/cgi/content/full/297/11/1216

And here is the first sentence in the introduction.

"Interactions between the pharmaceutical industry and health care professionals often involve payments: cash payments; cash-value payments, such as gift certificates; or in-kind payments, such as meals, textbooks, conference fees, or luggage."

Obviously, it is highly un-ethicial to allow these "perks" to effect what the doctor prescribes, but that doesn't mean it doesn't happen.

Well, as for office lunch on "rep days" - I can't say I'm against that one particular perk, nor is restricted to the medical profession. My office (architectural practice) typically has at least one "vendor lunch" per week, where anyone who signs up (or even just shows up) can get free lunch and listen to the vendor rep talk about his/her product during lunch. We get all sorts of free stuff from it - but on the level of pens, rulers, that sort of thing.

I don't necessarily find anything wrong with that. It's possible there are people in our office that would push an inappropriate product on a client that we saw at one of these vendor lunches, but it just seems so unlikely to me, especially because we have so many of them (40-50 per year). These lunches are separate from the continuing education lunches (also weekly) that are held at our office.

As for the other stuff (like vacations), well, that I have a problem with. I can see how the line starts to get blurred though. A lot of our vendors ask for our business cards to do drawings for gift cards to Starbucks or something.

I see the unethical aspect of it coming into the issue when the doctor allows his judgment to be influenced by how much free stuff he's getting from a particular drug rep. I don't necessarily mind that he's getting the free stuff.

This reminds me of some of what Paula Kamen writes about in her book, All In My Head. It's a great book (though some of the information is inaccurate) - I wrote a brief review in our Must Reads folder a few weeks ago if anyone's interested.

Laurelin,

The nurses might be able to answer why you're being given the samples you are. Just remember that nothing generic is sampled. :-)

quote:

Originally posted by Laurelin:
Teri - yes, chlorephen-psuedo is a generic. Not sure what the brand name was, since it's been generic forever.

I could ask the doctor only I never actually get to talk to my allergist anytmore...all the messages go through the nursing staff (e.g. I ask the nurse something, the nurse goes and asks the doctor and brings back a decision). Maybe my messages are just getting lost or mistranslated or something. The nurses are good about answering my questions more quickly but I'm beginning to think that maybe this is not the best setup.

I didn't mean to start a controversy or anything and I'm certainly not going to criminaly procecute anyone. I just don't like having the newest, most expensive pills pushed on me when there's a better way.

The golf outing was in 2007, and yes, they are cracking down on this now.

I don't think every doctor is doing this, but I think that it is probably hard to not want to take advantage of these "perks" if you will, if they are offered.

I mean I would love a free vacation if someone, whoever it is wanted to give it to me. - but would I feel bad about taking it in the long run - probably so.

I know the drug rep/lunch thing still happends at my primary care's office - because I've heard them talk about it before. And this was recent. It's every friday - drug rep lunch day and the drug rep buys.
No, that's not as bad as a free vacation, and I mean, we have collection agents that come into our office and bring us in bagels and donughts and things like that, so I guess it's the same thing, although we don't expect it and would rather he DIDN'T bring those things in, for the good of our waist line!