Do doctors actually get a cut for prescribing certain drugs?

Factual Questions
1

I always hear this; “Drug companies bribe doctors to prescribe their drugs. Doctors get a commission on every drug they prescribe so they will prescribe you with unnecessary drugs, so don’t trust them.”

I don’t doubt pharmaceutical companies are big businesses who try and push their products.
I don’t doubt they send hot women to meet doctors and try and show off their products.
I don’t doubt doctors get wooed with meals and tickets to consider it.

BUT…how would a drug company know what a Dr. is prescribing? The doctor prescribes something in your name on his/her RX pad, and you get the white copy, they keep the carbon copy.

Are they supposedly showing the carbon copy to the RX company? That’s the only way I could see this being true. If so, that would be a huge breach of your privacy and I doubt they would risk their practice for this. Also, how does the RX company know which pharmacy you’re going to, if you’re getting the generic brand, etc.?

My doctor is wary to prescribe meds and when he does he will say the generic one is cheaper and the same thing.
So do they actually get a cut? If so, how does that work?

2

No, they don’t. And I haven’t seen a prescription drug pad with carbons for years…they’re usually either an electronic thing you never see (which would be a way to track what was prescribed, but not what was actually filled by the patient and earned the drug company income) or they’re on a plain notepad.

What has caused some concern, and policy changes, is doctors who are researchers, usually working for universities, who are simultaneously hired by drug companies as speakers at conventions, telling everyone how great the drug is based on their research. It’s considered unethical for him to be getting money from the company who’s product he’s researching. I can see that point, although OTOH, if I was going to learn about a product, I’d like to hear what the researcher has to say about it, and I think public speakers should be compensated. But I guess that’s what published papers are for. But anyway, the practice is largely condemned, and most (all?) research facilities have rules against it now. I know at one point it was going to be written into the Affordable Care Act that all drug companies that make even one product covered by Medicare would have to report all income it paid to doctors that weren’t their employees. I don’t know if it survived the gutting the AFA got in Congress.

Even the free samples, pens and other swag is almost gone. (Almost.) It’s nothing like the goldmine it used to be. (I used to get birth control pills for nothin’, 'cause the doctor just had that many free samples in her closet, and she liked me.) What I see more of now are instructional models and posterswhich happen to have a drug or drug company name prominently displayed in some way. I don’t know if these are given to the doctors, or if they have to buy them. Either way, the drug companies have figured out if they make good ones, they’ve got free advertising space in the treatment rooms.

Of course, I don’t think it’s illegal to own stock in, say, Pfizer, if you’re a physician. Nothing, other than professional ethics, would prevent a cardiologist from prescribing Lipitor and checking “May Not Substitute” on the prescription pad just for the profit of it. But I’m not sure the impact on stock value that even a very busy doctor could realistically make…and I bet it wouldn’t be looked on fondly by the doctor’s governing board if it were shown to be a pattern without medical need.

3

There is a lot less gifting to Doctors these days than there was in the past. Many larger groups of doctors and hospitals have policies that limit or eliminate gifts from pharmacy reps. now. These days you will hardly even see any (Prescription name brand) pens in a doctors office anymore. My place now has a $50.00 max per year gift policy.

In the past, there were often pretty lavish events- trips, meals, gifts, etc. that reps would give to Docs to get their attention to and encourage the use of the products. But even then, they didn’t get a ‘bonus’ or anything like that for prescription writing- just a lot of encouragement.

One Doc I worked with got a 3 days ski trip in Colorado. The first half of the day was educational and the second half was empty in case anyone wanted to go skiing- wink, wink, nudge, nudge. We were treated to many fine meals out, or meals or ultra-fancy desserts brought in to the office. They also often provided free meds that we could give to patients. But this was a long time ago and it was also in the early, kinda wild-west days of fertility work, so there was a lot of cash and meds being thrown about.
I suspect the pharmacies are moving to the patient side now as I did run across one kind of strange situation a year or two ago.

In getting and acne prescription for my teen, the Doc prescribed something new and gave me a ‘member card’ to fill out to get a discount. The prescription was expensive ($110.00) but with the card I could get it for only $10.00. Woot, right?

Unfortunately to get the discount, I was supposed to give the pharmaceutical company a lot of information and access- name, DOB, SS#, access to the kids’ pharmacy and dermatology medical records, etc. This really upset me- I don’t want to sell my kid’s information for $100.00 (or $1200.00 dollars if I filled the RX all year!).

If you are interested in the topic, you could look at Pro Publica- they do some tracking of this issue and have a database of Docs who get payouts for stuff. I still have a few Docs who get paid to give a speech or get and ‘honorarium’ to host an educational dinner on occasion.

Look at the black bar on the top of the page here: http://www.propublica.org/

4

What they said. Not only do doctors’ offices not get much in the way of freebies, they also get very few free samples. I think the only samples our office has right now is vitamins and “natural tears” eyedrops. Our office used to use samples for patients who were poor, to help them get through to their next payday or try out a medication to see if it’d work before having to buy a whole container of something that may not be effective for their particular problem. We miss that a lot more than not having pens or lunches.

And no, there are no carbons. Either a single paper sheet, or transmitted directly to the pharmacy of the patient’s choice.

5

They still get some excellent “free” lunches at the clinic where Mrs. Duality works.

6

A free lunch is the easiest way to get somebody to sit still for a few minutes while you talk to them.
Doctors and pharmacists are busy people, they don’t have time to hear why your product is 3% better than the competing product.

7

Oh, yes, free lunches and beautiful women in short skirts with briefcases still happen. But it’s nothing like the ski trips and tropical vacations of the late 80’s/early 90’s. Back then, it was almost worth the work and expense of med school just so you could earn the pharm rep courting! :smiley:

8

Sure, there’s a lunch now and then, but it’s not of the “feed the whole office” level typically any longer. More like “feed the attendings, fellows, and residents, and maybe enough left over for the staff and med students.” It is pretty much the only way to get us to pay attention to anything like that, otherwise we’ll herd the pretty women in fashionable suits out the door and tell them the doctor is too busy, and maybe you can leave a pamphlet?

Oh, and our docs recommend generics all the time.

9

Just an anecdote from another industry, where nobody gives a shit at this practice: academia.

I was just made to buy a ludicrously inappropriate, elementary text for an upper-level course.

Turns out the chairman of the department wrote it.

10

Unlikely she got any money for it.

Authors of published textbooks don’t usually give royalties per book sold, but on a contract.

Sometimes profs will put together materials and have them bound with their name, but doesn’t mean any profits go to them. I had a lab book I put together through a publisher with my name on it using materials from publisher database plus my own experiments, but I never got a penny- money went to bookstore and publisher.

Most places have explicit rules against profs benefiting from selling their own books to their students.

11

Interesting about actual $ profit. Then just making us pay so they could feel important.

Your right about when using “your” professors book is perfectly fine. It could be the best one out there. In fact, a professor I had in the '80’s released a volume of collected essays which we used in his class, and the Xeroxing and schlepping and filing was a pain back then. But I don’t know if I could’ve come up with $100+ for it.

12

I’m not sure what you mean here. I put the content together so it was most applicable to the class and we didnt use only half a book. Feeling important had nothing to do with it. I made nothing at all on it and my name was listed as the author.

Textbook prices are very high and its the academic professionals who are usually fighting for help in keeping costs down. Often publishers aren’t honest with us about pricing or other issues related to texts.

13

This piece might interesting to you. http://www.aaup.org/report/professors-assigning-their-own-texts-students

Sorry for the hijack!

14

Oh, and you know, so they know intimately what is in the text without having to pore over it again in detail themselves. So they know it says what they are trying to teach you rather than what some other professor at some other school teaching a different course is trying to teach his or her students. So it doesn’t contain a lot of stuff that they consider to be erroneous or misleading. Stuff like that.

15

Why did you jump down my throat with snark? Better you should (as they say in Yiddish) read it over first.

16

Ah, I see…

The first sentence. The “they” I used referred to the one case I first mentioned about the irrelevant textbook. An opinion I still hold, after lo these five minutes. In fact, an opinion at the time of writing I held for the half-second before and while writing the second paragraph, which was to agree with IvoryTowerDenizen and to make clear I understand what is acceptable and desirable in academia (et ego in arcadia). my final sentence was a broad rueful world-weary experienced man-of-the-world profound comment that textbooks are expensive and students, in this case me then, are generally low on funds.

At least IvoryTowerDenizen had the graciousness to say he was confused.

Jesus, why must people in Bulletin Boards bolt to conclusions? I know the almost real-time chatter now with live posters fosters a pretense of quick, conversational-like thinking. But when that is combined with childish social behavior–if not intellectual behavior-- now abused because of the anonymity of the Internet persona, it quickly reveals the fragility of that pretense.

It’s bad enough when people slam on the horn a microsecond after the light turns green.

17

Read your first sentence again. Maybe you have a point about this this particular case (but I would like to hear the professor’s side of it before jumping to that conclusion before taking the word of a single student who almost certainly knows nothing about the issues that need to considered in textbook selection), but you were making a very broad generalization about the corrupt nature of academia as a whole based on this one example. Yes, snark was very justified.

18

Beep! Beep! :slight_smile:

I’m a she by the by.

FWIW- your initial post did come off disparaging- comments like “Like in academia where no one gives a shit about things like that”. It’s just not true. The vast majority of us give a shit and very very few prof are making a dime off their written work, even if it’s being used in the classroom. I’m sure you didn’t mean it that way, but it felt disparaging of my profession. It was also wrong- the motives for choosing textbooks rarely include ego. Writing a textbook is extremely hard work. Usually if a prof goes through the trouble to write is it’s because they really feel they have something to offer, not to make any real money. Can’t speak for your prof of course, but in my experience ego has little to do with textbook writing.

19

Also-
I’d check your university policies too- many have rules about any monies prof collect being donated to scholarship funds etc or having committees approve prof-authored textbooks for adoption to ensure it’s the best choice.

20

Years ago my wife and I got invited to a a very swish conference/party for doctors (father-in-law = doctor) put on by a drug company. My impression was these things were absolutely standard, but like I said, it was years ago. The pretense was that it was educational, but the impression (to me) was of an expensive, paid-for vacation.