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Have you read Bad Pharma by Ben Goldacre? One of the more interesting findings discussed in the book is that doctors were convinced they were personally not affected by drug company PR/goodies (3 day conferences in Bahamas, etc) but they were all worried that their colleagues were.

It's an excellent book and I highly recommend it.

It's a standard reaction, like how most people believe that they aren't affected by TV/newspaper advertising but they worry about how it affects other people.

I am well aware I am affected by advertising, but I am responsible for its effect on me.

The problem is that there's absolutely no incentive for doctors to act ethically. You don't win any points for ignoring drug company marketing.

Vendor marketing exists in all fields, technology included. The difference is that when I'm spending money on a vendor as a tech manager it's coming out of my budget. I have an incentive to make sure that the spending is intelligent and the solution is effective.

Where is the incentive for doctors to do that? They're spending other people's money on other people's problems.

That comparison doesn't work.

As a tech manager, you're not using your personal funds, either, you're using your employer's money.

Further, if a doctor's prescription doesn't work, or is too expensive, the patients can get a second opinion, and the doctor can lose the person as a patient. An employer may not even have that option with a tech manager.

> As a tech manager, you're not using your personal funds, either, you're using your employer's money.

Right, but I am spending the money of my company. They control my salary and advancement, and I also have a fixed pool to draw from.

Doctors are spending money for insurance companies.

How is it different?

The insurance company can investigate the efficacy of prescriptions and stop paying for ones that don't work. The article says some of them have done exactly that with Oxycontin.

At the other end, if the pain killer isn't working, a patient can go to a different doctor who will prescribe something else.

Just a different perspective: maybe give other doctors more of the benefit of the doubt? I have a family friend who's I guess what you'd call "on the bell curve" and he described to me the process. Basically he says that the representatives are paying for the doctor's time/attention with fancy dinners and whatnot. Doctors are busy people and can't read about every drug and study that's being released. He, just like you, takes in the information skeptically and ask for what studies have been performed etc. etc. Like you say, the representatives aren't scientists so often they won't know the answer and they will take notes and have their company send the doctor a custom made document answering everything he wanted to know (as you know, the marketing budgets are insane).

It's sorta similar to the function congressional lobbying is supposed to fulfill. Ie. It'd be ideal if the congressmen/doctors did all the research themselves but that's not possible so you basically have a whole research team at your disposal (who's agenda is very obvious...)

Out of curiousity: how do you find out about new stuff then? I know there's a lot of messy incentives, but if a company wants to at least show that they have a new drug, how could they get you to read about it?

> how do you find out about new stuff then?

"Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope."

> how could they get you to read about it?

I'd assume by performing a sensible clinical trial that proves its efficacy beyond a reasonable doubt.

Advertising is how you're sold things whether or not you need them. It is not how you learn about what's best for your patient. There are other avenues of information that aren't tainted by the motivation to sell a product despite the consequences.

"a fixed-dose combination of oxycodone and naloxone"

That sounds similar to Suboxone, just with OxyCodone instead of Buprenorphine (i think they also make bup. minus the naloxone under the brand name Subutex). The naloxone mixture never quite made sense to me. Isn't that counter-productive? Is naloxone (aka "Narcan") not an opioid-antagonist at low doses or something?

The naloxone is not well absorbed when taken orally. It's in the Suboxone to deter injection.

This marketing says it's in the Targin to reduce constipation:

http://multivu.prnewswire.com/mnr/targin/36704/

I see. I didn't know that, that's interesting. Question you may be able to answer: The naloxone/Narcan sticks that EMTs and some police have, they also pass them out at needle exchanges, etc. is that why are those applied in the nasal passage?

I'm a layman, but if i'm guessing right the term for this might be 'bioavailability' of the drug, is that correct? for example drug A may be absorbed faster and more easily through the digestive system over snorting. And then of course IV is the quickest way for just about anything, yea?

You used the correct term - bioavailability describes the fraction of a drug dosage that can enters the bloodstream.

Your example however makes an incorrect assumption. Bioavailability from snorting a powdered drug is higher than oral ingestion. When snorted, the drug passes through the thin lining of the nose and enters the bloodstream directly. When ingested orally, the drug has to make it through the chaos of the stomach and small intestine, get through the hepatic pathway (stomach and intestinal lining to liver to general bloodstream) before it reaches the rest of the body.

Depends on what you mean by "Sensible doctors". Clearly, doctors are influenced by marketing, otherwise pharmaceutical companies would not have spent and continue to spend, multiple millions of dollars targeting doctors.

It's not about conversion rate, it's about LTV.

Even if they only influence 1 doctor in a hundred, but that doctor brings enough revenue, it's worth it.

Want to see if you doctor has been taking money from pharma for meals/consulting/speaking/etc? Look them up in ProPublica's Dollars for Docs: https://projects.propublica.org/docdollars/

> he was hanging around my coffee area

What? Are they allowed to just enter hospitals as neither doctor, patient, nor visitor, and hang around promoting their companies' drugs? If so, why??

Have you read about ULDN? I know some addicts who've had a lot of success keeping tolerance down with this method.

Naltrexone != Naloxone. ULDN is incredibly dose sensitive. According to studies, 2 micrograms of naltrexone is effective, yet at 4mcg it begins to lose its efficacy.

One of my questions when interviewing a new physician is to ask their opinion on "detail people".

My mother works for a doctor, she's gotten some drug company swag and passed it on. I have (had?) a pen somewhere with a floating viagra pill, and a notebook in the form of a Cialis box.

Hardcover, I assume