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Does your doc have your best interests in mind?

November 17th, 2016 at 07:05 am

Joan of Arch recently asked me in another post how was the MS dinner lecture I attended last night.

I thought I might talk about it in a separate post here since 1. I think it's enlightening and 2. Many of you wouldn't know about it unless you had a certain chronic disease where this practice I'm going to discuss is prevalent.

When I had my first MS symptoms, the only treatment was prednisone, a steroid that totally dampens your immune system. MS is a disease where your body's immune system works in overdrive, attacking the protective covering (myelin) that surrounds the nerve cells.

But that was 30 years ago, and today there are probably a dozen different MS drugs to choose from. Some target specific symptoms and so they would be used only if you exhibit those symptoms, while others are used for different types of MS in general terms and have been shown to reduce the number of brain lesions that show up on an MRI or the number of relapses. This is important since with each relapse there's a chance your symptoms may not completely go away or may only partially resolve. So the fewer relapses, the better.

So I'm aware of 5 or 6 different MS drug companies (Avonex, Betaseron, Copaxone, Rebif, Tysabri, Gilenya, Amphra, Aubagio, Tecidera, etc) who have a place on their website where you can search for different lunch or dinner lectures (in addition to webinars) in or around your zipcode area. In other words, there are many of these talks going on all around the country at any given time. They are held at different restaurants or sometimes a hotel restaurant, like the Marriott I went to last night.

It's easy to register for a course online. (And when you show up they rarely ask you to sign in anywhere so theoretically you could just walk in off the street and enjoy a nice meal.)

There are usually about 30 people present. The pharma companies are pretty generous and allow each MS person attending to bring a few family members with them. You can also be an MS caregiver, or know someone with MS. I've noticed a lot of people who go to these talks take advantage of this and bring as many as 5 family members, and I think as a result some of the drug companies now limit "guests" to 2 additional people.

The lecture is a carefully vetted talk with slide show by an area neurologist about how the drug made by the pharma co sponsoring the event works, how effective it is, adverse effects (required) and how it stacks up to the competition (sometimes). The doctor can't veer far from the script becus it all must be FDA reviewed and approved ahead of time.

(Similar to how, when I worked for mutual fund companies, I had to make sure all the sales literature I wrote was reviewed by the NASD (now known as FINRA).

The doctor is paid by the pharma co. to talk. I only ever remember one doctor saying this out loud. The rest don't mention it. I don't know how much, but it must be enough to make it worth their while. I'm guessing in the neighborhood of $1,000.

I recognize many of the same neurologists talking at different MS drug lectures: they want to make extra money. This is not unique to neurologists; doctors in many specialties do this, and of course, this is a huge conflict of interest. How can you be sure that when the doc recommends one particular drug to you, that he's not just thinking about how much more that drug company paid him to talk than the others and he feels a degree of loyalty to them as a result? But this is our great American healthcare system.

There is usually some time given to review MS in general, or like last night, the topic was MRIs, but the Q&A from audience is usually more interesting because it's not scripted. Sometimes the drug company will also have an MS "ambassador," someone who has MS and travels to these lectures (probably also paid by the drug company) to describe their own experience with MS and of course, to talk up how great the pharma co's drug is.

Why do I go? Well, usually when I'm working, I don't have time or energy, but now I have plenty of time on my hands and I consider it a form of entertainment. I get to chit chat with other MS people and share experiences, I get a really nice meal at no cost, I get to hear other neurologists from the area speak (I'm not 100% satisfied with my current neurologist) and I can keep up-to-date on what other MS drugs are out there.

Last night was the first time I ever made plans to do something with other MSers I met at one of these meetings outside the meeting, but the 3 of us just seemed to hit it off.

I know they don't do this sort of lecture for every disease that exists, but they do it for MS because many of the MS drugs are given by self injection or IV infusion and/or they have some serious side effects, including death (Tysabri). Naturally, a lot of people will end up stopping the meds so the drug companies do these dinner lectures as part of their effort to keep people on the drug.

For the same reason, most of these MS drugs today cost $0 to the patient, provided they have PRIVATE insurance. The pharma co still makes money selling the drug even if the patient herself doesn't pay a dime.

I'm really not sure how or if Medicare covers these drugs; I imagine given their high cost, you would hit the "donut hole" pretty quickly and then have all costs picked up by Medicare after that. Something I will need to research eventually, but between now and then a lot could change, so I'm not going to worry myself about it too much now.

You might be surprised that any doctor would feel the need to earn extra $$ on the side doing this sort of thing since they are so highly compensated to begin with.

I can tell you from my experience dating a doctor 7 years ago who happened to be a neurologist, that this is not necessarily the case. Sure, he made a lot of money, but as a solo practitioner by choice, he made a lot less than he could have. Running your own office is expensive. He made $200K as I recall, but since he went thru a divorce with his ex who was a stay-at-home and raised their 2 kids, the court required him to not only pay her alimony but pick up all her health costs/health insurance until she turned 65. Not cheap. And being the sole breadwinner in the family, he also had to fully fund his two kids' college expenses with no scholarships. He would often talk about his financial challenges and was just counting the days when his kids were done with school and his ex turned 65! That's when, he said, he could finally fully focus on growing his own retirement savings.

Of course, he still leased a nice shiny BMW but when I was dating him he was living in what had been the family's small summer lake house. It was very modest and not updated.

Although he didn't do any dinner lectures similar to what I've just described, he did answer various online surveys for money. I can't remember who they were from but they paid pretty well.

5 Responses to “Does your doc have your best interests in mind?”

  1. creditcardfree Says:

    Yep, big conflict of interest, which I was already aware of. There are websites that doctors report these kinds of earnings. I think one is Open Payments.

  2. LivingAlmostLarge Says:

    Yes conflict of interest. You know pharm gives dr free samples before, not so much anymore, free dinners (that was supposed to stop but hasn't), tons of freebies? Have you ever read Hard Sell? It's how it was and it really happened.

    You know that drugs sold in the US are marked up way over what they charge every other socialized country? And many are sold over the country. Classic case and point Zyrtec was sold over the counter in 2000 in Canada. DH came down and was floored it needed a prescription and was so pricey.

  3. CB in the City Says:

    I would enjoy getting a free dinner and talking to other kidney patients, but since there aren't any big drugs for the disease, it will probably never happen!

    My orthopedic surgeon does a lot of stumping for a particular type of hip surgery. I don't know if he gets paid for it, or if he is just drumming up business for himself.

  4. Joan.of.the.Arch Says:

    Thanks, Patient Saver. My sister-in-law has one of those patient ambassador type jobs. It is a lot of travel, but she enjoys the work. I think she normally only speaks to medical pros because hers is a rare enough condition that it might be hard to gather a group of affected people in one city. But I know one MD-PhD in my city studies it. SIl lives elsewhere.

  5. creditcardfree Says:

    Your post is being commented on in the forum, in case you are interested.

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