A hospital fee, minus the hospital

Quote from SigX : every week? where you get that from??? maybe 2x per week... but you got to remember the dinner is usually 3 hours long.... its really not worth it and most docs dont go. but that has already been explained above. they are NOT popular.

As I mentioned, I have a friend who goes to these things a lot.

But she's a nurse, not a rich doc, which is why I asked if docs go.

Have you taken a survey to find out how many go?

Quote : bribed? this is nothing more than yet another baseless attack....

A free meal to influence your recommendation is essentially a bribe.

Quote : in the same thread??? thanks for changing the focus.... have you given your opinoni on the OP yet? are you happy hospitals are getting this money?

I'm never happy when the government is paying more than they need to.

Quote : of course, all businesses want to get the word out.

And court favor with the gatekeepers, who are influencing their customers to spend money on their products.

Quote from 124nic8 : As I mentioned, I have a friend who goes to these things a lot. But she's a nurse, not a rich doc, which is why I asked if docs go. Have you taken a survey to find out how many go?

have you taken a survey? you are the one assuming docs go weekly. remember this quote:

Quote : Maybe compared to what they used to be, but a $100 meal per week is nothing to sneeze at.

Its pretty commical when you act like docs do this weekly yet get snippy when I suggest they dont. please feel free to post your link supporting your claim.

Quote : A free meal to influence your recommendation is essentially a bribe.

bribe assume the doc will prescribe, but there is zero expectation of this.

Quote : And court favor with the gatekeepers, who are influencing their customers to spend money on their products.

court favor is not a bribe.

Quote from SigX : have you taken a survey? you are the one assuming docs go weekly. remember this quote: Its pretty commical when you act like docs do this weekly yet get snippy when I suggest they dont. please feel free to post your link supporting your claim.

They are available weekly, are they not? I never claimed any particular doc, nor even most, go to them weekly. But they could, and that is my point.

Neither of us knows how many nor how often. Just that there is that potential. Seems you're claiming it's only a conflict of interest if too many go too often.

Quote : bribe assume the doc will prescribe, but there is zero expectation of this.

That's only a valid assumption if there is a penalty for not prescribing. There may be no "expectation" but increasing prescriptions is the reason Pharma does it, so it is not unreasonable to assume it is effective, or they wouldn't do it.

Quote : court favor is not a bribe.

OK, sure.

Quote from Tony_Danza : How are incentives for using an EMR system a failure? I'm not really familiar with PQRI, but my wife wouldn't even consider working at a practice without an established EMR.

with EMRs comes some positives and negatives. the point is that the gov is offereing money to docs to adopt EMRs. there are several problems.... most dont talk to each other so the info does not follow the patient, even if they want it too. Even if using the same info, the hospital does not have to allow you access (the biggest problem). Cloning (copying endless amounts of useless information). then there is the loss of efficiency (many of the systems slow people down). finally, the way the gov decides if you get any money.... they change the rules every week (and recently were going to cancel the program during phase 1 with 2 left). its just another government farkup.

Quote from 124nic8 : They are available weekly, are they not? I never claimed any particular doc, nor even most, go to them weekly. But they could, and that is my point.

no they are not available every week. that is complete BS. the most I have seen would be every 2-3 months, at max.

Quote : Neither of us knows how many nor how often. Just that there is that potential. Seems you're claiming it's only a conflict of interest if too many go too often.

no, i never said there was no conflict of interest. i said its not a bribe.... which its not.

Quote : That's only a valid assumption if there is a penalty for not prescribing. There may be no "expectation" but increasing prescriptions is the reason Pharma does it, so it is not unreasonable to assume it is effective, or they wouldn't do it.

of course its effective.... many docs dont read the journals every single day.... just cause scripts go up DOES NOT prove that its innapropriate or "wrong" that they went up. some new medications are crap and others are true steps in the right direction and having a drug rep bring that to your attention (so you can read the journals and review the evidence for yourself later) is not always a bad thing. your assumption that all doctor-rep interactions are negative for the patient is complete bullshit.

Quote : OK, sure.

so if i prescribe a lot of drug X and the rep invites me to dinner (and I go) and my prescriptions have not changed (cause i already used said drug) I just received a bribe in your opinion??? thats some twisted shit. i suppose you think all doctor should turn off the TV or radio when a drug is being advertised?

Quote from SigX : no they are not available every week. that is complete BS. the most I have seen would be every 2-3 months, at max.

Would that not depend on your area? It seems they are available more often in large cities.

Quote : no, i never said there was no conflict of interest. i said its not a bribe.... which its not.

We'll just disagree. Clearly Pharma has an expectation that it will get you to do something you'd otherwise not do.

Quote : of course its effective.... many docs dont read the journals every single day.... just cause scripts go up DOES NOT prove that its innapropriate or "wrong" that they went up. some new medications are crap and others are true steps in the right direction and having a drug rep bring that to your attention (so you can read the journals and review the evidence for yourself later) is not always a bad thing. your assumption that all doctor-rep interactions are negative for the patient is complete bullshit.

Good thing that is a hyperbolic strawman then. You've already abdicated on the conflict of interest thing, so it seems there is at least that potential negative for the patient.

Quote : so if i prescribe a lot of drug X and the rep invites me to dinner (and I go) and my prescriptions have not changed (cause i already used said drug) I just received a bribe in your opinion??? thats some twisted shit.

If it doesn't change your behavior, then it was an ineffective bribe. Clearly Pharma wanted to change your behavior, but you did not cooperate. Congrats, I might add....

Quote : i suppose you think all doctor should turn off the TV or radio when a drug is being advertised?

More desperate strawmen FTL.

Quote from 124nic8 : Would that not depend on your area? It seems they are available more often in large cities.

more unfounded claims...

Quote : We'll just disagree. Clearly Pharma has an expectation that it will get you to do something you'd otherwise not do.

but is it always "shouldn't" do? can you except the fact that some new drugs should be prescribed over old ones?

Quote : Good thing that is a hyperbolic strawman then. You've already abdicated on the conflict of interest thing, so it seems there is at least that potential negative for the patient.

it could be bad for the patient only if there is an equally effective generic drug available.

Quote : If it doesn't change your behavior, then it was an ineffective bribe. Clearly Pharma wanted to change your behavior, but you did not cooperate. Congrats, I might add....

if one meal serves up this much distaste for doctors then you must really hate politicians.

Quote : More desperate strawmen FTL.

desperate to find you a dictionary.

Quote from SigX : more unfounded claims...

As I said before, my friend goes to these things regularly.

Quote : but is it always "shouldn't" do? can you except the fact that some new drugs should be prescribed over old ones?

Sure. But if they were really that good, why would it take fancy dinners to get the word out?

Quote : it could be bad for the patient only if there is an equally effective generic drug available.

Or a better one from a company that cannot afford a large marketing budget.

Last year, my sister prescribed me Flonase. This week, I found out there is a generic.

Not sure if it existed last year, or my sister just did not know about it, but it could have saved me some change.

Quote : if one meal serves up this much distaste for doctors then you must really hate politicians.

How did we get from a meal every week to only one?

I wasn't talking about you personally. You could be one of the special docs who is not influenced.

Quote : desperate to find you a dictionary.

Cause you think I said anything about drug advertising on TV?

Quote from 124nic8 : As I said before, my friend goes to these things regularly.

great, surely your understand that your friends actions as an individual do not define the masses.

Quote : Sure. But if they were really that good, why would it take fancy dinners to get the word out?

??? this is how the business world has worked for ages. so if you discovered the cure for cancer, you would not try and advertise your drug to docs??? ok.

Quote : Or a better one from a company that cannot afford a large marketing budget. Last year, my sister prescribed me Flonase. This week, I found out there is a generic. Not sure if it existed last year, or my sister just did not know about it, but it could have saved me some change.

maybe you should find a more conscientious doctor? maybe you should have asked if there was a generic (or lower cost) alternative? maybe she needs a better EMR (mine tells me how much it will cost the patient BEFORE I prescribe it)?

Quote : How did we get from a meal every week to only one?

why not? you seem to take a lot of liberty is claiming how often docs go to these, so why cant I? between the 2 of us I clearly have a lot more direct experience with these events yet you seem to be unwilling to listen....

I wasn't talking about you personally. You could be one of the special docs who is not influenced.[/QUOTE]
[QUOTE]I am not stupid enough to think that I am not influenced at all. all humans are effected by advertising. myself included. but when I prescribe I always consider the pros/cons with expense.

Quote : Cause you think I said anything about drug advertising on TV?

no, cause I think you use bribe inappropriately.

Quote from SigX : great, surely your understand that your friends actions as an individual do not define the masses.

But her knowledge does define what is available here, so it's not unsubstantiated.

Quote : ??? this is how the business world has worked for ages. so if you discovered the cure for cancer, you would not try and advertise your drug to docs??? ok.

If there were a cure for cancer, would you have to go to a fancy dinner to find out about it?

Quote : maybe you should find a more conscientious doctor? maybe you should have asked if there was a generic (or lower cost) alternative? maybe she needs a better EMR (mine tells me how much it will cost the patient BEFORE I prescribe it)?

Or maybe she was overly influenced by the Flonase manufacturer....

Quote : why not? you seem to take a lot of liberty is claiming how often docs go to these, so why cant I? between the 2 of us I clearly have a lot more direct experience with these events yet you seem to be unwilling to listen....

I made no claims about how many times any doctor or group of doctors go to fancy drug dinners. I made a claim about how many opportunities they have.

Quote : I am not stupid enough to think that I am not influenced at all. all humans are effected by advertising. myself included. but when I prescribe I always consider the pros/cons with expense.

Trouble is, a fancy dinner has more influence than mere advertising. That's why they do it.

Quote : no, cause I think you use bribe inappropriately.

What does that have to do with your hyperbolic strawman about you not watching TV ads?

Quote from 124nic8 : But her knowledge does define what is available here, so it's not unsubstantiated.

link please. that is the standard in the podium, not hearsay.

Quote : If there were a cure for cancer, would you have to go to a fancy dinner to find out about it?

what people have to do is irrelevant. what people are willing to do is the question.

Quote : Or maybe she was overly influenced by the Flonase manufacturer....

not mutually exclusive from what I said. please re-read:

maybe you should find a more conscientious doctor? maybe you should have asked if there was a generic (or lower cost) alternative?

Quote : I made no claims about how many times any doctor or group of doctors go to fancy drug dinners. I made a claim about how many opportunities they have.

false/ original statement:

Quote : Maybe compared to what they used to be, but a $100 meal per week is nothing to sneeze at

implication is that people are actually doing this which is extremely unlikely. any drug rep will tell you that getting doctors to these is extremely hard. we are forced to hear you blabber on about your one friend but you refuse to listen to my DIRECT knowledge on the subject having known hundreds of doctors.

Quote : Trouble is, a fancy dinner has more influence than mere advertising. That's why they do it.

link please.

Quote : What does that have to do with your hyperbolic strawman about you not watching TV ads?

so your saying that free public tv shows is not bribing people?

Lol, SigX I think nic is just trying to get under your skin. He's just playing Devil's advocate for everything.

Nic, to say "perhaps you're one of those special doctors who is not influenced"....oh come on. Are you really that out of touch with medicine. You know damn well 90% of us physicians couldn't give a flying fark what the rep says. Most of us will prescribe what the patient needs and pick the med we think would work best for the patient. It's not like we're trying to drug patients unnecessarily (unlike some previous douchebag accusations). If a patient needs a statin or beta blocker we go with the one that best meets that patients needs (price vs complications vs efficacy vs compliance).

The time that the drug rep influence works the most is when we dispense samples. The reps come to the office, give their spiel, and drop off samples. If I start somebody on some new med, I usually use (well used to use, I don't do office work anymore) the samples. If the drug works for the patient I continue them on it and try not to do the medical merry-go-round. In that case yes the doc is influenced and I see this happen frequently. But we're smart enough to know not to prescribe a $200 med when a $20 one will do the trick - no patient is going to take the $200 drug and noncompliance will be an issue. What the reps were trying to do was to keep us from prescribing the other guys stuff, not write Celexa for everything that walks through the door. You think they let country bumpkins into med school (OK, well they let me....)

Let go of the dinner thing. It's pretty rare to see those nowadays (and I live in LA - you can't get more metropolitan than that). Like I said the last time I went to one was in 2007 and I was single all the way until I met my wife at the end of 2008. I could have been having $100 meals every night...yeah right. Not going to sit through a 4 hour powerpoint lecture for some silly dinner. Remember you said a long time ago any 1/2 decent doc should be able to make enough to play golf every afternoon and I went off on you (I was seeing all the unwashed masses of 90241 and making less than your nurse friend per hour I'm certain). You think we're going to sit 4 hours for a $100 meal...$25/hr....why the hell aren't we out on the back 9 (whatever the hell that is, I've never played golf in my life).

Senor Danza...I don't use an EMR currently as all my notes are still written in the patient's chart at my hospital but I used to use EMR when I had an office. CMS has learned that EMR now is rewarding physicians too much since prior to EMR we were always downcoding (underbilling) for fear of getting audited. Now the EMR program does the billing and it's CMS's own damn fault they have to pay physicians more (since its automatically charging higher codes cuz us physicians are documenting too damn much). Sadly the motivation for CMS to push EMR was for costs, not to reduce medical errors (which is currently higher with EMR - can you see grandpa doc over there copy pasting his notes for a prostate exam on a 67 year old woman). So EMR is currently costing CMS more and causing more medical errors. And some of them are so horrid,spitting out pages and pages of useless paper with no meaningfull information on them - again stupid programs coded by morons. It was a rush to get out crappy products because they knew docs would have to buy them nomatter how shitty. Imagine how crappy Prius and Volt and Lead would be if the gov mandated that we all had to buy them - there would be no rush to innovate.

I would love to see a national standard on EMR and have it delivered for FREE by the government (hell, they're making us involuntary federal workers, they should give us federal forms just like at the Post Office). I would love if I could see a CT done at some other hospital 3 years ago for every Medi/Medi patient I have. Unfortunately Congress has like 6 physicians and 3 of them have their head so far up their ass and removed from medicine they don't know what it's like to see patients anymore. All they would need to do is hire 2 docs of every specialty and have them put in requirements for a comprehensive program, have some IT guys code it, and then bam spread it across America. Too expensive? I don't know, seems we can print $1 trillion dollar coins now