Joesph Goebbels, Edward Bernays and Big Pharma’s “disease branding”

http://fatboysez.blogspot.com/2010/10/we-are-human-beings-not-consumers.html
from the link: “If you want to understand the way prescription drugs are marketed today, have a look at the 1928 book, “Propaganda,” by Edward Bernays, the father of public relations in America”
http://edition.cnn.com/2010/OPINION/10/11/elliott.branding.disease/

WOW! My mom uses Dr. Timothy Staack from Racine and he is listed here. I wonder now if he is on the up and up.

I have consulted the lists but only payments within USA are listed. What about payments in other parts of the world? Do the companies have an obligation to disclose?

The search engine is crap; I typed in one doctor’s name and a city by that name comes up, which was in reference to a totally different physician. How can anyone trust the information?

this is insane and not true.

Thanks for the list.  The more we can understand about how our health care dollar is being spent, who is receiving the money and how much,  the better we will be able to determine where cost savings can be effectively made.  All medical professionals should disclose they are receiving monies or other consideration for any association they have with the pharmaceutical companies and other commercial groups.  I applaud open disclosure from all pharmaceutical companies in this instance and am seriously concerned about the motives of those who do not.

The underlying assumption with this information is that physicians are being unfairly “manipulated” by pharmaceutical companies, and that these sorts of payments are an intolerable conflict of interest.  The fear is that doctors will be influenced to make health care decisions based on economic influences and pressure, rather than judgement. 

At an avg. of about 15.5k per physician…I’m not convinced.

The real story out there about conflicts of interest is the fact that hospitals now directly employ 50% of all physicians. I can tell you, as a hospital based physician, that I see far more pressure being applied to doctors by hospital administrators to cut costs by discharging patients early, and not speak up too loudly about quality of care issues.  Hospitals can also manipulate physicians with other threats, including sham peer review, to do their bidding.

When a hospital is paying a doctor’s entire salary…effectively, the physician now works for the hospital, not the patient. This is the real scandal going unreported.

California Medical Board, like most other dysfunctional CA agencies, does not have accurate data on their public web site concerning disciplined physicians.

Jerry: I am in 100% agreement with your statements about hospital-owned physicians.  It is absolutely LUDICROUS for all of the misplaced outrage over pharmaceutical companies paying doctors to give educational conferences, etc. while hospitals all over this country are buying-up physicians left-and-right.  Have the leaders of the this project at propublica.org ever been to a medical dinner program, or a talk at a medical meeting/symposium, or participated in a medical focus group?  I would like to hear the authors of this list substantiate their level of concern about drug company payments to physicians.  I believe that there is a lot of misunderstanding…

Great that you are doing this. Full transparancy and disclosure of all things drug and drug company related is vital to our well-being.

Some of the top physicians in the country are speakers and I do not think they are influenced by the money they are getting. This list is made by people who have never been to any of these talks! and also you can not just drop all physicians in one pot!
The dollars of our health care cost are not spent this way but by paying CEO of big insurance companies such as United health Care CEO 99 milion dollar salary! while collecting premiums from patients, raising the cost and even cutting back physician’s fee!
the health care cost is high also because we have to deal with malpractice in a fashion that no other country has to deal with! the health care cost is much more complicated than paying physician for talks!
I want to know when we find out who is behind putting this list all of a sudden out NOW?while you had the data since 2009? who will benefit from the list!! making doctors look like all their practice is based on who pays them to talk???
Now physician have to use electronic records, have to show performance ( even if their patients are not compliant!0 , they are reimbursed less and less, have less time to spend with patients, patients are unhappy, there are ads all day long and night long about drugs on TV and attorneys at the same time! to get the doctor in trouble!
In this time of great talks about health care reform, no one really talks about the real issues!
Listen to alternative radio, Steve talks! he is a ER physician who lectures at UW, everyone would learn something from him

Why are pharmaceuticals still allowed to advertise on public tv and even radio commercials? The concept of advertising a medication seems to be a way to convince the American public that they need a medication for a condition they may not even have! A doctor should be the one suggesting medications to a patient, not the television!

Fazio - read How We Decide, by Jonah Lehrer.
(you make some good points, but you’re missing some too.)

It appears to me that physicians are pawns of big business just as the consumers are, and are an easy scapegoat.  This tiny bit of targeted “transparency” is to appease and mislead the “truth hounds” who are honestly pissed, but gullible enough after decades of being in the dark about big pharma and big insurance to follow this red herring of a trail and bay until the public attention is drawn away from the real issue, leaving physicians in the crosshairs.  Just another blood sacrifice to cover the enormity of the real sin.

This database is a great start. The criticisms here from other physicians about pressure from hospitals or other sources don’t negate the value of this data. We should be applauding transparency and working towards it - not blocking change because it’s not the complete picture. We’ll only arrive at the complete picture incrementally.

But as for future steps, I’m curious whether the upcoming disclosure regulations also require disclosure from the medical device industry. There certainly are a lot of surgeons out there practicing with a hand in the cookie jar.

“Drug companies have long kept the names of their speakers—and how much they pay them—secret.”

Post the pay of all your reporters, including yourself. For some reason, you are ignoring this demand.

Yes, I searched for a Dr. Diamond and got a doctor with another name in a city named Diamond, but that’s a glitch in the search engine, and it does not invalidate the entire database!

But this is just the tip of the iceberg: for example, the head of research at the Framingham Study, one of the oldest and most ‘respected’ cohort studies around, is a consultant for Merck and GSK.

Does anyone seriously believe that this fact does not taint the data coming out of that study?

Has anyone considered the benefits to patients when doctors supplement their income outside of the fee for service or salary model?. I use speaker income to supplement my practice so that I can spend more time with my patients. My patient follow up visits are all scheduled for 30 minutes (sometimes we run over!). There is no way I could spend that time if I relied solely on insurance or patient reimbursement. So in effect the speaker income allows me to give greater quality of care to my own patients as well as educate other health care providers so they can appropriately prescribe new drugs.
The strict FDA regulations governing advertizing (and thus speakers) for pharmaceutical companies greatly minimize the chances for abuse.  Speech at these functions is incredibly constrained /controlled by the legal departments of the companies. These companies do not want to be fined by the FDA so there is strict adherence to FDA approved messaging by the speaker. “Fair balance” as defined by the FDA is the mantra for most all these companies at speaker training. That means the bad aspects of the drug MUST be presented. No off label use of the drugs are allowed at pharmaceutical company sponsored talks.

Who but big pharma should bear the cost of educating physicians about new drugs.  When physicians are properly trained on the appropriate use of new drugs the patient benefits.

What a load of old rubbish. Apart from the many data that are missing, increased transparency is a good thing. However,  all this is is a a lame attempt to sensationalize and to mislead people who are unfamiliar with the legitimate workings of medical education.  Why should speakers at any and educational venues not be paid for their time and learning?  Who are those who’s pretense of superior ethical standards allows them to cast aspersions on the ethical judgment of others? .

HPSEE: If you were willing to work with fewer patients, you could devote more time to each of them.

OH… I know, then you wouldn’t be able to live at the level that you and the rest of the medical profession have become accustomed to over the past 50 years.

Doctors used not to be paid, or to expect, extremely high incomes. The rise in income for MDs over the past half-century has resulted in a lot of people going into medicine just for the money, people with no real interest or aptitude for medicine.

I’m not aiming this at you, HPSEE. You might be a wonderful doctor. And it could be you make no more than you neighbors who work on cars for a living. But most doctors make and expect salaries that are excessive.

Oh but we save lives!!!!

So do firemen and cops.

Hank

I see that my doctor has also taken $ money forom a couple of the drug companies. No surprise to me, he does research for them. Am we really that niave that we would expect that there is a connection between them?? If the medicine helps me and I still think that my doctor puts my best interest ahead of the drug companies then I don’t have any problem with it. I think that is the situation. If I felt that for any reason my best interests were being compromised I would no longer go to my doctor. He does not push the medicine on my and for the most part I really don’t use it. I think Dr. Goldstein is a very professional doctor and his primary interest is in helping his patients. I have not even needed a presciption filled from him in over 2 years. I would say he has my best interest at heart. This is how Doctors are supposed to treat their patients. He knows what is available to help, he recommends what he thinks will help and then he leaves it up to the patient to let him know if it is working. I am sure there are many Doctors who are abusing this relationship with the drug companies but I can assure you that Dr. Goldstien in not one of them.

Even a doctor who genuinely has his patient’s best interests at heart is still in danger of being influenced in subtle ways by any relationship that he may have with pharmaceutical companies, even if the only effect of that influence is that he will tend to think of a drug (or a surgical intervention) before a less invasive solution (like a change of diet).

It is important to realize that there is no such thing as a drug without side effects, minor and major, short term and long term.

Just deciding to use a drug at all for any condition is a risky business, and other avenues should be explored first. Even if that other avenue is doing NOTHING.

It’s an old saying among MDs that about half their patients would get better on their own anyway if they didn’t come to see their doctor.

The recent Avandia debacle is an example: the drug was prescribed to diabetics to lower their blood sugar, the rationale being that lowering their blood sugar would reduce their chances of having heart attacks.

Except their is no ‘evidence’ at this point that lowering the blood sugar of diabetics actually reduces their chances of having heart attacks.

But we now know that thousands of patients INCREASED their chances of having heart attacks by taking Avandia.

NO treatment would have been better than Avandia, and GSK knew it.

Our doctors SHOULD have known it. The doctor’s job is to vet drugs, not just blithely prescribe them.

Well, Hank, it isn’t as clear cut as you think it is.

There isn’t any way for an individual doctor to deduce the increased risk of a heart attack from literature or personal experience.  The reason it is now known that “thousands of patients increased their chances of having heart attacks” by taking Avandia is because of post marketing surveillance.  The increased risk is not entirely agreed upon even now.  So get off your high horse.

Doing nothing for a patient with diabetes is preferable to treating it.

Dude…you’re nuts.

Okay, Dantes, point made and accepted and I apologize for overstating my case.

Obviously you need to control blood sugar if you’re diabetic, and I admit that neither bigpharma nor your doctor can really know what a drug will do to people until a lot of people have taken it.

Still, GSK suppressed data about this drug.

And no matter how you cut it, many doctors are all too willing to prescribe drugs, even drugs they KNOW won’t work, as, for example, when doctors give people antibiotics even though the overwhelming probability is that the cold the person has is caused by a virus.

Sometimes patients will even *demand* an antibiotic, and some doctors give in to that demand.

But *good* medicine would consist of explaining to the patient that the antibiotics won’t work in this case, that antibiotics have serious side-effects, and reassuring the patient that they *will* get better if they only give their body a chance to work its own antiviral magic.

Hank

Hank

About time!

In the Real Estate industry (and others) you can end up in jail and/or fined for getting something of value in return for business. How is it that my Realtor or title company are held to a higher standard than my doctor?? This is a CLEAR conflict of interest and should be made illegal. This is a global consumer SCAM of major proportions and needs to be stopped immediately.

My name is on here and I was not paid a dime.  They are saying that I got $650 in “meals” and what this amounts to is them bringing cookies and snacks for my employees and an ocasional lunch—this makes it sound like I was bribed!.

HANK, Firemen and cops don’t go to school for a decade or longer, don’t owe massive student loans, and don’t run their own buisnessness.  HPSEE’s comments are about the only reasonable comments I have read.

Okay, how many of you people have actually sat in on one of these presentations given by doctors?  If you haven’t, do you really KNOW if they are beneficial to patients as well as to the doctors that attend?  These presentations do the following and much more:
1.  Educate doctors on new data for drugs which helps them understand whether they should or shouldn’t prescribe them
2.  Introduce new drugs on the market and what the pros and cons of the drug can be, such as drug-drug interactions and side effects
3.  They give doctors a chance to share clinical knowledge with each other on how to better treat their patients
4.  They supply the latest and most up to date information on medications and thus help doctors to better determine the “risks vs benefits” of medications.

These meeting aren’t just a bunch of doctors sitting around smoking cigars and shooting the breeze with each other.

Oh, and by the way, it is an insult to all the hard working doctors out there that truly care about their patients and want to give them good quality treatment to say they just prescribe certain drugs because they are “bribed” by some pharmaceutical company.

Are there really that many naive people, and doctors in denial, out there???
JSM—-your only benefit was to receive meals and snacks for your employees!!! Why do you think they did that?  To educate you about their drugs???  No——to improperly influence you and your staff. 
All the talk about education:  Give me a break.  In most other professions the practitioners have to get continuing education and pay for it themselves. In the medical profession it is provided——do you think it is merely to educate the caregivers?  The money is to influence doctors——consciously, subcounsciously, and directly.  Do you see the numbers on these lists???  do you think the companies, most of them public companies answering to the almighty dividend and share price, are spending that much money and not expecting a return on their investment.  This is an obvious example of “quid pro quo” business today——and it was far, far worse for a long time until some restrictions were put in place a few years ago. 
Note a very important fact about the information in this list——it does not include over 60% of the drug companies operating in the US.  Where is Roche, the kingpin of scandals????  Roche, the vitamin global price-fixer, the Tamiflu disclosure that Roche hyped the “bird flu” and H1N1 epidemic to increase sales, and the FDA requires a notice on the bottle that basically says “You’re as well off not taking Tamiflu as you would be by taking it” after a study showed that there was no difference between the Tamiflu group and a control “placebo” group, and Roche’s current diabetic monitor and strip scandal in which, unforgivably, after the FDA has issued warnings that its products can cause fatalities when used as directed, continues to sell and market the product.  ROCHE and others do NOT publish their gifts to doctors.  ROCHE, the same company frequently nailed for improper marketing and payment schemes, has continued to refuse to make any information available to the public.  The reasons are obvious to most of us——they have a lot to hide, and their doctors who receive the payments are very scared of being named. 
The “appearance” of impropriety???  Stop kidding yourselves——-money is paid to obtain a result, and that result is sales.  We all know that, if a doctor who is getting money from a certain pharma company stops ordering as much, or stops ordering completely, the doctor will get a hint—-subtle or direct——that if his conduct continues he wilI not be eating at Morton’s or traveling to Vegas for that convention.  I don’t want a doctor deciding whether to prescribe medication, or which medicine to prescribe, because he saw a great concert last night, had a wonderful “educational” trip to the Bahamas last week, or bankrolled his child’s college education by speaking about the drug he is going to prescribe for me.

Dr. Cheney you are revealing the amazing fact about doctors: that it is possible to be extremely smart and also extremely naive at the same time.

What kind of ‘education’ do you think you are going to get from somebody who has a product to sell?

Are the presenters at those conferences, for example, going to alert you to the fact that some non-pharmaceutical treatment for the same problem even exists?

Are they going to highlight the faults of their drug and not mention the faults of their competitors? Even if they know very well that a competitor makes a more effective drug? Or that a lifestyle change might have the same result?

Every time you interact with a drug rep or attend a Pharma sponsored event, you are being brainwashed, not just into thinking that that particular company’s product is the best around, but on a more fundamental level you are being told, in a thousand indirect ways, that drugs are THE way to deal with illness.

Recently, when I asked my cardiologist to check my homocysteine, he told me that he didn’t want to waste money checking for a marker that cannot currently be altered by a prescription drug.

In other words, he was not interested in my actual *health*, in finding out what my homocysteine level was, which might be an important piece of information about my overall medical status.

No, his answer was, in essence: ‘If there’s no drug for it, I don’t even what to know it exists.’

This is a very smart man who has been practicing medicine for several decades.

But decades of drug rep visits, drug ‘education’ conferences, drug ads in the big medical journals, and spending all his time in the company of people who think the same way he does, and are subject to the same public relations propaganda that he is subject to, has blinded him to any line of investigation that can not yield a result that he can write a prescription for.

This is not practicing medicine. It is serving as an outlet (and, I might add, a very highly paid obligatory middle man), for Merck, GSK and all their lesser confederates.

I’m amazed at the general condemnation of drug companies on this thread, and also amazed at the condemnation of physicians who bother to listen to pharmaceutical reps.

For all you naysayers out there, go ahead and start listing the number of new drugs which have been introduced into the market by the U.S.Government.

I can’t think of any. 

While many may believe that drugs are not needed for illness…well, that’s true in some cases…some illnesses are self limited, but that becomes apparent only in retrospect. To argue that all drugs are always unnecessary is ludicrous.

Of course pharmaceutical salesman push their products…so do CT scan companies, MRI companies, IV infusion companies, hospitals, and doctors…all try to convince their customer their product is the best. The FDA (like it or not) signs off on the drugs, even the claims made by pharmaceutical reps.

If you want to go back to the days of eye of newt prescribed by witches, be my guest…you can find somebody out there peddling some nostrum that purports to be a drug, but isn’t or might be…whatever.

Me…I will listen to anyone I think might have a better idea to care for my patient…but it doesn’t mean I will use it, even if they buy my staff a pizza.