experimenting with foods

[tex]

but I just fear that one day this may lead to our being almost forced to take a treatment we'd prefer not to for fear of some sort of punitive action from the insurance company, particularly if it's an all powerful government system.

I think it's already here. I've read occasional posts, (I don't recall where, offhand), by people who had adverse drug reactions, (or sudden lack of efficacy from their medication), and when they checked, they discovered that their pharmacy had changed brands, or changed to a generic, in response to orders from the customer's insurance company, without even bothering to inform the customer. I understand that they have the right to do that, unless their doctor specifically marks the prescription to disallow any changes by the pharmacy. I suspect that might be an everyday problem with government-run health care systems.

While I was talking with my neuro doc, (after the session), he asked me if I was ready for a goverment-run system. I told him that I was hoping that it would never come about, so then he told me about the government health care system in India, (where he is from). He told me all sorts of things about it, that didn't sound very appealing, but the last line was, "You wouldn't take your dog to a government hospital in India".

Tex

P. S. Our doctors, the pharmacies, and Big Pharma, have to share information about us - otherwise, they wouldn't be able to properly divide up all the kickbacks. Yes, I'm sure that Asacol pays much better than Entocort EC, because Prometheus Labs, (the current owner of Entocort EC), is a very stingy company. Most companies offer patient assistance, for hardship cases - those patients are out of luck with Prometheus. Or, it could be that Prometheus is not really stingy, but AstraZeneca is robbing them blind for the patent rights. AstraZeneca used to offer patient assistance, before they sold the product rights to Prometheus. Anyway, I suspect that's the main reason why most GI docs don't want to keep a patient on Entocort EC any longer than they have to. The cost to the patient is roughly the same, with either product, I believe. Asacol, however, is a much older product, so it had to cost much less to develop and get to market, than Entocort EC. That's why I'm pretty sure that it pays much better than Entocort. I would assume that it's illegal, for doctors to get direct payments, for a prescription, but there are other ways to provide compensation, of course.

[Lucy]

Wayne,

I can't see how it would benefit a physician personally to switch a patient from one drug to another, unless they are forced to use a formulary by an institution (like a hospital or big insurance clinic) or insurance company that only buys certain drugs. All the physicians I go to are independent, and just order what they think is best at the time, then change to something else if that doesn't work. Of course, WE know better with this condition!! Ha!

Sometimes a patient can't afford a medication off formulary, so a doc will go along with their request for something formulary for that reason, if it's considered an acceptible treatment.

Don't get me started on the experience I've had (more than once -- same spiel) with one of those big mail out companies that contracts with the insurance companies that contract with some big employers around the country -- it's part of my mom's "benefit" package from my dad.

Thing is that these companies will tell you that they had the right to call your doc and get the script changed to generic, even though you tell them the patient doesn't do well on the generic. Irks me that they lie and tell you it's the doc's fault because they "gave them permission" when they didn't! If pressed, they will tell you it's in the contract, but it's a trick in the contract.

What you have to do is get a NEW script with the instructions to dispense as written (brand) EACH 90 days when you get your medications -- not once a year-- or though they get it right the first time, down the road, they just switch it, thinking the patient won't notice or they'll think the doc switched it.

They are lying about having called the doc, I had someone watching for this at the neuro's office -- she was the only one to answer that phone and ok all the refills, calling for the doc. Had a BIG note on the chart -- NO GENERIC, and besides she would't have forgotten the discussion we had, particularly since the lady knew us.
Now Mom isn't on that medication, so I don't mind, but still don't go the mail order route cause it makes me so angry. We just use a local pharmacy chain that does participate in the plan. Doesn't help a whole lot, but they try to make you think it does. I'm not sure what will happen there if a doc wants her on brand or we request it. We do alot of business for our medical supplies for the family with them, but by George, I'll go completely independent if I catch them doing that like the mail out place! That's what we all need to do -- fire the bums, and let them know WHY we are leaving!

I talked to this so called gate-keeper pharmacist at the huge mail out company and he went through the EXACT same answers as my questions started to sound a little more informed (scripted undoubtedly!). This time, I had absolute proof he was spouting what he'd been told to say by higher ups, or else he WAS a higher up as it was the exact same words. Soooo...at that point, on the verge of a stroke, I told him that I knew what he was doing, and that he was doing this for his 401 K, etc.
At that point, he told me that I was "practicing medicine without a license!" He knew I had some work experience dealing with these kinds of things, so he was caught, and at the end of his script. If I'd had my wits about me, I'd have told him he was "practicing pharmacy without a conscience!" Don't you just hate it when you have a comeback when it's too late! Ha!

It seems that the only way to go these days for an honest person, at least, is to work for yourself, and be very careful who you hire,k and do business with.

I'm afraid we're getting to the point where it's like in the book, "The Italians." (Anyone every read that book?) There's a line in there that goes, "If you don't do business with the mafia, you don't do business!"

Don't even get me started on the big government so-called hospital here in town. I call it the hospital from Hell!! And just think, that hospital is subsidized with your tax dollars. What will we do when there's no one left to subsidize because we're all in the "system from Hell?" I honestly believe our system will be the worst in the world before long.

Yours, Luce

[Gayle]

Well, personally I thought I "smelled" the long fingers of our insurance pharmacy benefit manager in this matter!!! But I do not know that.

You and I probably think alike here.

Husband here had been on Lipitor and it was "suggested" in one of the quarterly reports from our Insurance carrier that he "look into changing to a generic statin".

Now I have to say that usually I rather like generics as they have had longer track record so in general, there should be more information on them -- both pro and con.

I am also concerned about the proliferation of electronic records. This has the potential for a lot of GOOD, and a HEAP of bad, -- in my opinion anyway. To much information is already "out there" in spite of all the privacy documents people must sign every time they see a Doctor.

Personally I'm not generally much into conspiracy theory, but between Insurance and Government -- WATCH OUT!!


Bed-time,
Cheers,
Gayle

[tex]

Luce,

Drug companies run promotions on certain drugs, at times, and as part of the program, physicians are eligible for certain "perks", such as attending "seminars" in the Bahamas, or various other luxury vacation spots, all expenses paid, (for example). Why do you think that when a drug company rep comes into a doctor's office, he or she doesn't have to wait in line to see the doc, the way that everyone else has to do? They go right in.

Wayne

[Lucy]

Wayne,

I can assure you they don't always go right in. Most of the drug reps I know frequently have a hard time getting in at all in some places.

The main reason the doc will see them is if the office is out of samples produced by the company they represent. Without these samples, a patient won't know whether a medication agrees with him/her until s/he has already bought the whole bottle, so having those samples saves the patient money if he ends up having to be switched to something else.

If you see a rep going in ahead of you, it may be because the doctor's office called to ask the rep to bring the samples by for a specific patient. In that case, the doc may see him for a minute in his/her office as a courtesy, but often times, after the rep leaves the waiting area, he is really waiting in the doc's office or unpacking the samples for the medicine room while the doc is still attending to patients. Sometimes he will just leave the samples and not even see the doc -- may see the office staff briefly. There just isn't time in a doc's office for chit chat.

I feel left out!!! We were NEVER offered a trip to the Bahamas, nor any doctor I know, and I know alot of them. Where do these tales get started, anyway??? It's now illegal for a pharmaceutical company to even bring pens or sticky pads to a doctor. If you see any, they've been around a while.

It IS legal to provide education, but the speakers have to reveal any interest they have in a medication they discuss while doing their presentations. The doctor I know best hasn't had a vacation in years, and does well to drive 75 miles to Galveston for lunch on a Saturday, and no drug company ever paid for it, she just can't afford to be gone for any length of time as the bills keep coming in whether she's in the office or not.

I think the people on the media putting out all this class warfare stuff have vested interests in doing so, given their politics, and I wouldn't be surprized of anything the drug companies wouldn't do to sell their products, just as any business wants to do.

That being said, I have attended many drug sponsored and public sponsored medical lectures, and found them both to be informative, some more than others. Continuing education is very expensive, and many hours of it are required, so since many doctors just don't have the money to do all of their hours "for fees," they have to attend some of these that are sponsored or else provided by a public institution, plus, sometimes they offer courses that the doctor thinks s/he need for the information. I know the doc I know the best tries to get things she can get close to home to avoid having to pay lodging, and especially if she can get them on a weekend or after work to avoid missing any office days. She is fortunate in that this is such a large medical community, so lots of excellent choices in things to attend.

Welp, I think my BP has gone back down to below normal, so best be back to my night job.

Yours, Luce

[tex]

Luce,

I'm well aware that not every doctor's office is "under the influence", but many of them obviously are, (just read the articles at the links below). You're lucky to have been working and dealing with such ethical individuals.

http://www.scu.edu/ethics/publications/ ... ibing.html

http://blogs.courant.com/george_gomboss ... ts-to.html

http://blogs.consumerreports.org/health ... land-.html

I'm not sure when the first article was written - I believe last year. The other two were written very recently - within the past few months. There are plenty more references available, it you do some googling.

I rest my case. I have to get to work.

Wayne

[Polly]

My two cents:

I have never seen an offer for a tropical vacation or anything like that. It used to be that we would get drug companies to sponsor conferences/meetings and they would pay for snacks, handouts, etc., but this doesn't happen as much any more. Mostly I've just seen the pens, notebooks, and stuffed animals on the exhibition table.

The main reason docs meet with the drug reps is to get sample meds. that can be given to "grey-area" patients - those 50 million working-poor Americans who are uninsured and lack the money to pay for meds. It's a huge problem. Fortunately, we do have health programs in most states to help pregnant women and children, but adults are not so lucky. Can you imagine how frustrated I feel when I can fully treat a baby but know that the parents will not have access to quality followup and treatment for their own health problems - high blood pressure, diabetes, asthma, etc.?

Love,

Polly

[Gayle]

To a great extent it often seems that folks don’t appreciate that their Doctors are, in actuality, running a small business. As with any business, there must be revenue generated in order to 1.) pay the workers, (which of course today includes an insurance billing specialist) 2.) run the plant, and 3.) maintain the facility, 4.,5.,6.,) etc. -- all before the Drs. earns their income.

In most Drs. offices today TIME IS MONEY. It is rare for a Dr. to be willing, or able, to spend time with someone like a drug rep. during office hours, as that Drug Rep. is not a revenue generator for the business. If a Rep. needs to talk with the Dr. specifically, they often sit until the end of hours for their turn.

Yes, you may see Reps. coming into the office and “going back” before you are called, but that is not necessarily to see a Dr.

And, in a little directional change here …

As to benefits medical personal may derive from the drug companies, --- the Big Pharma’s as well as Medical Product companies do a lot of the sponsorship of Continuing Education Programs. All licensed medical personal are REQUIRED by law to attend a stipulated number of hours of continuing education per licensure period. These programs have gotten VERY expensive and by sponsoring these programs, they do help defray costs. And of course in return, they set up an exhibit, give out their logo’ed note pads, pens, etc., etc, and of course -- chat about the various nuances of their products to anyone who cares to listen – this during the program break periods.

Once in a while a segment of a program may be devoted to information/education regarding relevant data and facts about new medication or products that may be in the pipe-line. Where better should this kind of thing be discussed than with a large gathering of professionals that may someday find these items on the market and relevant for their particular use?

The claims of exotic vacations and huge paybacks are vastly exaggerated in the media. Have they ever happened? For sure, --- but they are the exception and the media extrapolates from one incident to mean all. One simply can’t believe, or take a face vaue, everything in print.

Speaking just for myself here, I am sick and tired of TV advertising for all these drugs and products. (which is all done in the name of EDUCATION) I can’t look at a professional golfer today without thinking that they must have erectile dysfunction due to the heavy dose of advertising for those drugs during those events. I used to love to watch golf … that's been spoiled for me.


Guess this was way more than 2cents worth.


Gayle