Life is Strange

[Doc50]

Were you doing some kind of protein supplements or just eating a lot of meat? Most Americans eat a crap load of protein and don't even get off the couch. But I can see those supplements doing the trick if you don't pair it with exercise.

BTW, high protein diets are burdensome on the kidneys.

In a few years we'll see a significant increase in premature renal disease associated with protein supplements.

 

[Runwildboys]

BTW, high protein diets are burdensome on the kidneys.

In a few years we'll see a significant increase in premature renal disease associated with protein supplements.

From what I've read, that's more with regard to inactive and under active people who take protein supplements.

 

[Doc50]

I don't think he would intentionally do so either. The problem, I believe, is that doctors are being fed alot of misinformation. He may actually believe what he is saying is true, but where does he get his information about the drugs in question? It's not from an impartial observer, of that I'm certain. The actual drug company in question is the one who provides him the information about the drug in the first place. Are you going to tell me now that there is no conflict of interest there?

Doc did not go to school to learn about every drug that is on the market today. They get visits from various pharmaceutical salesmen whose job it is to sale him on the belief that what they offer helps his patients. They'll run them through all their clinical trials to prove it. Do you believe they are being completely honest when they are trying to sale a doctor on prescribing a drug? Do you believe that these pharmaceutical companies are disclosing every bad result from clinical trials? Do you believe a salesman who likely works on straight commission is acting in your best interest (the patient) or his own?

Therein is the rub. I assure you, I am not trying to be rude or disrespectful to Doc in any way. I respect the effort he put in earning his title. But his title has nothing to do with modern medicine and everything do with how the human body works. On my biology, I defer to him. But what ever info he provides me on drugs being offered today is more than likely second-hand info passed to him from a guy trying to sell him on a drug that will yield the salesman a fat commission check.

The whole system, in my opinion, is flawed. But it's not Doc's fault and I appreciate his effort here to help. It's not so much that I don't trust what he is saying as it is the fact that I can't trust the place where he got his information.

Again, respectfully, misinformation.

The drug reps' job is to represent their product.
Of course they're biased, and of course they're way less educated on these matters than physicians. But we barely listen to their pitch; we just want some starter samples for our patients, so that you can try a medication free of charge.
If they brought no samples, they'd bring no value whatsoever. We get our information from the actual scientific studies; consider our liability if we didn't.

You may not know how the process by which science works.
Any research project has to be objective and legitimate in order to get published, and an old respected scientific journal is the goal. The study should be double-blind and placebo-controlled, and geographically and culturally broad in order to ferret out any variables. Early studies may be small, simply because they represent an emerging discovery or principle. Once published, the study is subject to the critique of other experts in the field, frequently prompting other studies to explore further details or provide additional clarity.

It's highly likely that other researchers will try to duplicate the findings in other objective settings, publishing then their findings which may dispute or verify the original. It doesn't matter if the scientists are employed by a Pharma company or not -- their results must stand the competitive scrutiny of their peers in order to gain any credence.

If a company decides to invest resources in a promising discovery or development, they must submit a plan of action to the FDA, including Phase I, II, and III human clinical trials (animal trials may have been ongoing for decades). These must meet rigorous criteria and be managed by independent 3rd parties who exist simply to manage research projects; they have no connection to the owners of the product, including the absence of stock ownership.

Most drugs fail in this process, which is designed to show both safety and efficacy, with benefits far outweighing risks. In evaluation of R&D expenditures of any random company over ten years, we now find the average cost per approved drug to be near $1 billion. No wonder the retail cost of new drugs is so high.
And there will not be any new drugs approved which are not "new"; the molecule or its method of delivery will need to be different and prove to be beneficial.

Remember, all prescription drugs are regarded as potentially dangerous if not used properly; that's why they're not sold over the counter.
Many are also life-saving or health-maintaining.
That's where your PCP comes in -- he doesn't sell you anything or benefit from your misery.
He's just there to guide you through this complex minefield.

I could have probably seen 3 Medicare patients while I wrote this; after overhead and with much liability, I likely would have netted about $15 each. In case you're wondering, I do get paid for conducting the clinical trials, but I seldom know how the study drug is faring until after the entire trial is completed. (double-blind)

 

[jday]

The drug reps' job is to represent their product.
Of course they're biased, and of course they're way less educated on these matters than physicians. But we barely listen to their pitch; we just want some starter samples for our patients, so that you can try a medication free of charge.
If they brought no samples, they'd bring no value whatsoever. We get our information from the actual scientific studies; consider our liability if we didn't.

Thanks for taking the time to explain this process for me. I do, however, have some questions. It seems as though you are suggesting a pharmaceutical rep that comes unequipped with free samples is not going to get very far with convincing you to prescribe their product...did I read that correctly?

And if so, what is it you do with the sample to determine it's effectiveness? It sounds like you conduct your own personal clinical trial to verify if it works...again, did I read that correctly? And if so, who are you trying this "free sample" on? And what if this "free sample" causes an adverse reaction? Who then is responsible? You are the pharmaceutical company that provide you with the free sample?

 

[Doc50]

Thanks for taking the time to explain this process for me. I do, however, have some questions. It seems as though you are suggesting a pharmaceutical rep that comes unequipped with free samples is not going to get very far with convincing you to prescribe their product...did I read that correctly?

And if so, what is it you do with the sample to determine it's effectiveness? It sounds like you conduct your own personal clinical trial to verify if it works...again, did I read that correctly? And if so, who are you trying this "free sample" on? And what if this "free sample" causes an adverse reaction? Who then is responsible? You are the pharmaceutical company that provide you with the free sample?

Virtually any medication which is approved by the FDA and holds its patent (not yet generic) is promoted this way, at obvious expense to the drug company. Don't misunderstand, these drugs have been through decades of trials before approval. I have some drugs in my office that have had samples or starter-packs for more than 10 years. This is helpful to a new diagnosis, say hypertension or diabetes, wherein a Doc can place the first week of medication in the patient's hand, without cost or pharmacy visit. Often, trials of therapy are needed in order to arrive at the perfect fit of medication with patient, and purchasing several Rx's makes this process expensive and presents a barrier to therapy.
Successful sampling of brand name meds may lead to a prescription for that drug, or it may provide evidence that a similar generic can be effectively used a lot cheaper.

These newer drugs may cost $50-300 monthly without insurance or discount cards provided by the drug company. You have probably already discovered that certain very effective meds are not covered by some insurances, though they may cover a cheap generic that is not the same drug.

I tell some reps that I'm not going to prescribe their product, due to favorable alternatives. They hear that all the time. They suffer all kinds of indignation at the hands of Docs who are more stereotypically arrogant. Don't think for a minute that a physician is going to take any prescribing advise from someone who's never been yo medical school, never been responsible for the life of a patient.

The drug companies are simply making s business decision that Docs take advantage of for the benefit of their patients. It makes a whole lot more sense to do that instead of the direct consumer advertising you see for Rx drugs.
That just raises the cost of the drug without any benefit.

For adverse reactions? I'm responsible for any decision I make.
You think I might wanna be cautious?

Again, the drugs are tested here more rigorously than anywhere else in the world.

 

[jday]

Virtually any medication which is approved by the FDA and holds its patent (not yet generic) is promoted this way, at obvious expense to the drug company. Don't misunderstand, these drugs have been through decades of trials before approval. I have some drugs in my office that have had samples or starter-packs for more than 10 years. This is helpful to a new diagnosis, say hypertension or diabetes, wherein a Doc can place the first week of medication in the patient's hand, without cost or pharmacy visit. Often, trials of therapy are needed in order to arrive at the perfect fit of medication with patient, and purchasing several Rx's makes this process expensive and presents a barrier to therapy.
Successful sampling of brand name meds may lead to a prescription for that drug, or it may provide evidence that a similar generic can be effectively used a lot cheaper.

These newer drugs may cost $50-300 monthly without insurance or discount cards provided by the drug company. You have probably already discovered that certain very effective meds are not covered by some insurances, though they may cover a cheap generic that is not the same drug.

I tell some reps that I'm not going to prescribe their product, due to favorable alternatives. They hear that all the time. They suffer all kinds of indignation at the hands of Docs who are more stereotypically arrogant. Don't think for a minute that a physician is going to take any prescribing advise from someone who's never been yo medical school, never been responsible for the life of a patient.

The drug companies are simply making s business decision that Docs take advantage of for the benefit of their patients. It makes a whole lot more sense to do that instead of the direct consumer advertising you see for Rx drugs.
That just raises the cost of the drug without any benefit.

For adverse reactions? I'm responsible for any decision I make.
You think I might wanna be cautious?

Again, the drugs are tested here more rigorously than anywhere else in the world.

Thanks again for the information. As I am sure you knew going into this, I still have reservations about submitting to the every-day-pill. But it was nice to get your perspective on this. Truth be told, I was unaware of the regulations that now prohibit kick backs or bonuses for prescribing certain medicines; when did those rules come about? Because I know at one time that was a fairly normal practice and I did wonder at the time how in the world that would be legal.

 

[Doc50]

Thanks again for the information. As I am sure you knew going into this, I still have reservations about submitting to the every-day-pill. But it was nice to get your perspective on this. Truth be told, I was unaware of the regulations that now prohibit kick backs or bonuses for prescribing certain medicines; when did those rules come about? Because I know at one time that was a fairly normal practice and I did wonder at the time how in the world that would be legal.

30 years ago, drug companies really wined and dined physicians, with golf outings, expense-paid meetings at resorts, etc ; the kind of things commonly seen throughout all corporate environs, but not near as bad as the lobbyist/congressman kiss-up.

The Kennedy-Kassebaum (HIPAA) legislation was signed by Clinton in '96, and implemented sweeping changes over the next few years, including elimination of any perks which might influence the prescribing habits of a physician.
There was never any cash, except that paid to Docs to represent the virtues of a product, done in various medical or public forums, and at least based on sound research. But some Docs did a lot of those, with substantial revenue. So all of that went away; we can't even get a pen or a pad of post-it notes from a drug rep now.

Not that any of it should have ever had any influence to prescribing.

 

[Runwildboys]

Virtually any medication which is approved by the FDA and holds its patent (not yet generic) is promoted this way, at obvious expense to the drug company. Don't misunderstand, these drugs have been through decades of trials before approval. I have some drugs in my office that have had samples or starter-packs for more than 10 years. This is helpful to a new diagnosis, say hypertension or diabetes, wherein a Doc can place the first week of medication in the patient's hand, without cost or pharmacy visit. Often, trials of therapy are needed in order to arrive at the perfect fit of medication with patient, and purchasing several Rx's makes this process expensive and presents a barrier to therapy.
Successful sampling of brand name meds may lead to a prescription for that drug, or it may provide evidence that a similar generic can be effectively used a lot cheaper.

These newer drugs may cost $50-300 monthly without insurance or discount cards provided by the drug company. You have probably already discovered that certain very effective meds are not covered by some insurances, though they may cover a cheap generic that is not the same drug.

I tell some reps that I'm not going to prescribe their product, due to favorable alternatives. They hear that all the time. They suffer all kinds of indignation at the hands of Docs who are more stereotypically arrogant. Don't think for a minute that a physician is going to take any prescribing advise from someone who's never been yo medical school, never been responsible for the life of a patient.

The drug companies are simply making s business decision that Docs take advantage of for the benefit of their patients. It makes a whole lot more sense to do that instead of the direct consumer advertising you see for Rx drugs.
That just raises the cost of the drug without any benefit.

For adverse reactions? I'm responsible for any decision I make.
You think I might wanna be cautious?

Again, the drugs are tested here more rigorously than anywhere else in the world.

Regarding the highlighted; Don't they become less effective after a few years, and wouldn't that taint the results?

 

[Doc50]

Regarding the highlighted; Don't they become less effective after a few years, and wouldn't that taint the results?

No, not the same pills -- the same KIND of pills, replenished about every 2-3 months over several years.

Those old pills you may have around the house are likely good for at least 5 years, capsules for 3 years, liquids for 1 year, and suspensions like antibiotics for i month.

 

[Runwildboys]

No, not the same pills -- the same KIND of pills, replenished about every 2-3 months over several years.

Those old pills you may have around the house are likely good for at least 5 years, capsules for 3 years, liquids for 1 year, and suspensions like antibiotics for i month.

Okay, I guess I shouldn't have taken you literally. My bad.