Archive for September, 2009

I had no fucking idea

Posted in Uncategorized on September 12, 2009 by docrighteous

Prof. Susurro nails it

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If you can get past the gratuitous slap at sex workers. . .

Posted in Uncategorized on September 8, 2009 by docrighteous

. . . then Dan Carlat has a pretty good post up over at his place.

Depending upon your personal situation, it may be “good”, and on your line of work. Me? I’m a psychologist in a large group practice which includes a psychiatrist whom I rather like but whose über-conservative politics drive me crazy. Oh. And did I mention? He gives paid talks for a drug company, disguised as CMEs. So Carlat’s blog post reminds me of something I prefer not to think about but which makes me sick when I do. To wit: This is, IMHO, tots unethical behavior. What can I, should I do about it? Fuck if I know.

I’m happier when Dr. Carlat refers to these guys as “hired guns” rather than the “whores” in the title, as follows:

…Schering-Plough is already poised to make aggressive use of hired guns to get psychiatrists to prescribe its new antipsychotic.

In his post, Dr. Carlat references his NYT Magazine article on his own experiences as a hired gun, which I wish were required reading at my office. I am having fantasies, as I write this, of printing off several dozen copies and putting one in every mailbox.

I asked our good doc about it casually one day and he admitted that his activities were “supported” by the drug company, that he wasn’t teaching about a disorder or even a class of medications but about one brand-name medication in particular, and that he used materials supplied by the drug company. He says he “enjoys getting out” into the countryside. Hmm. I think I see a pattern here. Do these companies target nonspecialists in rural areas in an attempt to control that market by brainwashing generalists out of the mainstream who lack the experience/training/exposure to know any better?

Here’s what Carlat says the new guys flogging Schering-Plough’s new antipsychotic will be getting paid:

–$1,600 for a 45 minute power point presentation or informal “peer discussion group.”
–$1,000 for a 45 minute web-based live presentation (you get $600 less because you don’t have to leave the comfort of your office)
–Total maximum (called “contract total aggregate”) amount that you may receive over the course of the year is $170,000.

Dang. That’s good money if you can get it. I have taught part-time at the local Cow College and I figured, by dividing all the hours I spent prepping, grading, meeting with students, and actually teaching into my salary that on an hour-for-hour basis I could make more working closing at a local burger joint. Seriously: They were hiring, and I saw the hourly wage posted on the sign. Closers make more than adjunct professors. And we have to make our own PowerPoints!

The injustice of it all.

My doc friend, on the other hand. . . well. Those are some serious bucks.

Certainly serious enough bucks to cloud his judgment, if not those of his “students”. Be interesting to know how much of the stuff he flogs gets prescribed at our practice. I know one thing: I find excuses to send my clients to other docs. I am afraid that whether it was the best drug for my client or not, he might prescribe it. And with the best of intentions! I think he honestly sees himself as an ethical physician who genuinely cares about his patients.

So whaddya think? I am tots not in a strong position here, above and beyond the psychiatrist/psychologist power differential. Should I ‘front him at a staff meeting? In private? Talk to the other docs and build up a consensus that we shouldn’t do this at this practice? Ignore it? Just start whittling away at it bit by bit, expressing a concern or two in an offhand way whenever it comes up?

Doc