Monday, May 08, 2006

Do I LOOK Like a drug whore?

"Hey, Peg! There's breakfast in the lounge!" one of the nurses called. "Better get it before it's gone!"

I knew. I could smell it. Coffee, sausages, something baked, something savory. My un-fed salivary glands were working overtime. A cup of green tea just hadn't cut it, and my puny yogurt was looking punier by the minute. Pharmarama (not their real name) was supplying food today. A real breakfast. Cooked and all. The lovely Pharmarama representative Elizabeth (not hers either) was waiting in the lounge to fill our ears as we filled our bellies.

I was sorely tempted. But as I considered, a memory rose up and shook a scolding finger at me. A year or two ago, a friend had asked if I was going to the Medical Meeting in San Diego. A weekend in the sun, all expenses paid by Big Daddy Drug company. Thousands of dollars' worth of rooms, food, and entertainment. Oh yes, and a little "medical education" thrown in to make it legal.

I looked at her, drew myself up to my full 5'3", hoisted a self-righteous, "
of course not" look onto my face and demanded, "Do I look like a drug whore?" (Thankfully, she didn't answer)

We doctors get a lot of exposure to pharmaceutical representatives. They bring us samples. They bring us food. They give us pens, pads, clocks, calculators, tote bags, etc. They send us to San Diego. They provide us with "educational opportunities" in the form of dinner lectures, meetings, articles, impromptu informal conversations over free breakfasts.

What do they get in return for all these gifts they so generously hand out? Our ears. Our minds. Our business. They get to tell us about their drug and how great it is, how it beats out the competition hands down. They flash graphs at us while we spread cream cheese on our bagel. They leave us articles we never read. They give us trinkets with names of drugs on them in hopes of subliminally influencing us in our prescribing practices. We hand out their samples, which may or may not be the most appropriate drug for the situation (I have seen some wildly inappropriate uses) and may or may not increase our use of said drug.

Most docs I know claim that they aren't affected by this deluge of biased "information". They say they prescribe what they think is right, based on their own research or experience. This may be true, but I ask you; if Pharmarama didn't get something from their efforts, something they could put in the bank, why would they continue to do what they do? They wouldn't. And they spend hundreds of thousands of dollars on us. This is a gazillion dollar industry we're talking about. They wouldn't continue to make these "investments" if it wasn't worth it to them.

It's a matter of constant ethical debate in the medical profession. Should we accept gifts from the drug reps? Should we even spend time with them? Does the money they spend on us come out of our patients' pockets? Can we be neutral? Does fraternizing with them make us "drug whores", like we tease each other?

I have nothing against the pharmaceutical reps as people. One of my colleagues is married to one, and one of my friends is dating several. Most of them are very nice and charming folks. Of course, this is part of their job description, but still...they're polite and I feel obligated to be polite back. In residency and for several years afterwards, I was one of the docs who always listened to the spiel. I felt guilty if I didn't. I was raised right, and I knew it wasn't right to eat and run, or to accept a gift without saying thanks.

A few years ago, I decided to "just say no" to drug reps. Rather than draw some arbitrary line between "okay" and "not okay" (e.g. a sticky pad is "okay" but a trip to San Diego is "not okay"), I drew the line at my own feet, so to speak. Everything was "not okay". This was made easier by the fact that my clinic stopped accepting samples, for fear our lousy record-keeping was going to land us in regulatory jail. The frequency of rep visits did decline, but I have still had to test my own resolve on a number of occasions.

As this internal debate raged in my conscience, the mouth-watering aromas wafted down the hall each time a staff member exited the lounge with a full plate. What should I do? Should I give in to my gut and ethics be damned? Or should I retire to my office, close the door and dig gamely into my yogurt like some monk with a hair shirt? What if I just ate a little bit, and only smiled at Elizabeth without listening to the spiel? Would that make me a "little bit of a drug whore"? Or is that, like "being a little bit pregnant", a wishful impossibility?

What do you think?

37 comments:

Doc NOS said...

Well, you asked. So I think the entire issue is overblown. Doctors spend too much time worrying about these small issues. When Ken Lay took Arnold out to lunch, Ken paid. These pens, drugs, reps, memory sticks, and mouse pads are small stuff. What's wrong is that pharm companies can't help our bottom lines. Anyway, I'm OK with them changing my rx habits between drugs I consider equal.

I guess I don't care. Watching TV commercials also makes me want to: go on vacation, buy a VW, get herpes (so I can be one of those beautiful people), watch Tom Cruise get shot at, and get another tv. None of that marketing is deemed wrong, even if it is all waste.

Heather said...

There's a reason tissues are called Kleenex and petroleum jelly is called Vaseline and cotton swabs on a stick are called Q-tips. Just look at how TiVo has now become a verb - marketing works and works well.

The markteting of drugs has gotten out of control. And drug companies no longer confine their marketing to doctors but have now gone straight to the consumer. They get the consumer so convinced that they need their miracle drug that as a doctor it must be hard to say, I don't think that drug will work for you or this one will probably be more effective for your symptoms.

I wouldn't have a problem with it if I felt like my doctor had truly investigated these drugs and done a comparison and was prescribing the drug that was most appropriate for me. Unfortunately, that's not normally the case.

If I walk into my doctor's office and the pen he is using and the pad he is writing on has the name of the drug that he is prescribing for me plastered all over it, I'm going to question why exactly I'm being given this drug. Is it because it's truly the best for me or because they have a president's club that is going to Cancun next month?

Virginia said...

I'm a consumer, not a doctor, but it seems to me that the pharmacutical industry is afflicted with the same corporate greed disease that the rest of the country suffers from. I'm sure they care about cures and helping people, but they seem to care about profit to the detriment of helping people and finding cures. It isn't just doctors who have to examine their conscience over this--our legislators should ask themselves the same hard questions when drug company lobbiests come forth with largesse aimed at them.

anafaran said...

Money talks, nobody walks! The old saying, BUT, you as a doctor can do what you wish, right? You can do the research and decide if these particular "pushers" are pushing what your patients need. I, the patient, will pay the higher price for your service if I believe you're really looking after my health. But now that I read your post, Dr. Peg, I'll think twice about swiping one of those RX pens out of the overpacked coffee mugs at my doctor's office. I know now there's a premium even on those! Nothing in this world is free, except maybe the air we breathe.

Anonymous said...

What a shame that your ethics, judgement and morals are so weak that you consider drug reps a threat.

peg said...

doc nos - Thanks for your input. I like respectful disagreement. Makes me think. I respectfully disagree with you about the herpes thing, though. Also, marketing for merchandise on TV IS deemed wrong by some if it misrepresents a product or makes false claims. Know any commercials that do THAT?

Heather - Good point about direct-to-consumer advertising. It's a pain when someone comes in thinking they need something they saw on TV and then I have to explain why they don't.

Virginia - Of course pharmaceutical companies don't "care" about people. They care about profit. That's why I think calling what they do "education" is often a misnomer.

anafaran - I doubt any doc would be swayed by a company pen. But when you're given samples so that you can start your patients on a drug for free, it's easy to just use that drug, rather than prescribing a cheaper alternative.

anonymous trash talker- you talkin' to ME? I dare you to take off that anonymous cloak and say that stuff to my face! Come on! Put 'em up! WHO's the weak one here? Come on, flex those ethics! Show me what ya got!

Anonymous said...

Well,I'm going to take a diametrically opposit viewpoint from Peg. I meet with reps on a daily basis, but have "my" rules.

First -- you meet on MY schedule. I'll make time available, but not when I'm seeing patients.

Second -- I love when you bring lunch for my staff. It's a great fringe for them. So when you bring lunch, you've bought my ear for that meal. That doesn't mean I'll use your drug, but I'll consider the data. If I like it, I may try your drug. But if it doesn't help my patients, I won't continue to use it.

Three -- never lie to me or overplay the data. You'll get banned from my office, and possibly reported to the FDA

Fourth -- if you have a "me - too" drug you better be 50% better or 50% cheaper or I won't change from my current drug.

Please remember that my livelihood is my reputation taking care of patients. If a new drug helps that, I'll use it. If a new drug doesn't improve my ability to make patients better then no amount of freebies, meals, etc. will make a difference

Peg's friend from PWS

Anonymous said...

Peg-

I see drug reps daily. Many of my patients (mostly seniors on multiple medications) rely on our ability to float them through the rough spots with samples.

I too have rules. If there is a patient waiting, I'll sign for samples- no ear until I'm caught up. sorry.

Don't ask me "will you write xxx?"
Don't ask me "how was your weekend?" (unless you really are my friend, and some of the reps are my friends)

I take the information with a grain (tablespoon?) of salt. When they say their drug is better because of this study or that effect, I use that as a prompt for me to research that drug class or that study.

Yes, I'm a drug rep whore. I eat the food, and am glad that my staff gets the benefit.

Worse, I love to speak for the big pharma companies. Talk about motivation to really learn about the product! Of course, I won't speak for a product that I think isn't worth something. I used to say "I'll do disease talks, not drug talks". Now, with the pharma rules, for many dinners I am constrained by their slide decks. Regardless, I won't talk about something without merit.

My colleagues will still come hear me speak, because they trust my integrity. Sure, I'd rather just be the spokes person for the American Heart Association than the Crestor speaker de jour... but if I can get the message across about NCEP guidelines and treating to goal, than it is a success.

And, getting down off my soapbox... to be truly really soul searchingly honest, on occassion, I have thought about using one drug over another cuz they brought lunch. I'll tell the patient that too- eg you've got a cough with your ACE? You need an ARB. There are a zillion of them, and none generic (this week). I have to pick one that's on your formularly and that I have samples of... which should I chose? I know, the people who brought lunch, wanna cookie?... but then, even moments later, I realize they were talking about an ARB, but I can't for the life of me remember which one.... alas. Short term memory deficit negates even the best lunches.

-Queen Lisa
(can't remember the Blogger password either!)

marybishop said...

If the pharmacology companies stopped feeding you sausages and stopped buying up airtime on tv and radio and ink in publications, wouldn't the price of drugs go down?

Off topic, but if drug companies are going to be allowed to advertise on TV, then they should have these ads regulated so the "complications" aren't spoken in sotto voce in a rushed and barely audible manner...while the drug's benefits are loudly sung out with perfect diction.

All beach scenes, animal petting scenes and young lovers should be banned too. ;-)

Ron Southern said...

I think you're on to something. Always good to find a good writer!

Ron Southern said...

I suspect that most doctors are like most people; their morals have been decidedly whittled away in the past 20 or 30 years. Everybody has always disapproved of the sugar cereal deluge on morning shows for children, but nobody ever did a damn thing about it. What kind of slipshod morals were those? I'm corrupt, too, unfortunately, but I don't claim to be Joan of Arc while I'm at it!

Charity Doc said...

I gobble up all of Pharmarama's free food, fancy restaurant dinners, free pens, etc...And I have no shame in it. The majority of my patients through the ED are indigents. They can't afford the brand name drugs anyway so I have no ethical dilemma to worry about. While I'm eating their food, I'll continue to use their free pens and write for cheaper generic drugs that my patients can afford. Our hospital has a campus wide non-Pharmarama friendly policy. They aren't allowed to leave any samples, but it doesn't stop them from soliciting us though. Am I affected by their ploy? Maybe, but I also see it as an opportunity to learn about the latest new gorrillamycin or tyrannosaurus rexastatin. I take it all with a grain of salt as the Levaquin lady claims it to be better than the rest while the Factive guy claims to be the king of the hill and far more superior than Levaquin. My patients cannot afford a standard course of any of these so I find it pointless to prescribe them unless they are admitted and in which case, which ever one is on the hospital formulary will do.

Peg Spencer said...

"Peg's PWS Friend" - Thanks for commenting! You sound like you have a very sane approach to the whole thing. I'm so glad to see differing viewpoints and strategies here.

Queen Lisa - you hussy, you! I'm just razzing you cuz I know you. Thanks to you, too, for explaining your approach. And, as long as you're being "soul-searchingly honest", I guess I better fess up. I ate the breakfast.

MaryBishop - Your question is an important one, I think. Some interesting statistics: In t001 there were 88,000 pharmaceutical reps employed by the drug industry. That was one for every 6 physicians in the country, counting interns and residents! In that same year, consumers paid about 30% markup for sales promotion.

Those data come from a fascinating book by former editor of the New England Journal of Medicine Marcia Angell, MD, called The Truth About the Drug Companies

ronald - Thanks for visiting, and for your compliment! Sad to say, I'm not Joan of Arc either. I took a snotty, righteous tone on purpose in this essay, hoping to provoke some differing opinions, but the truth is I did eat the breakfast, and I have "slipped" from my rigid so-called morals more than once.

Charitydoc - You have learned how to use the system without being suckered into it. OTOH, have you thought about what it costs the drug companies (and therefore other paying pts) to provide you and your pts with those samples?

anafaran said...

Dr. Peg, you sure have ignited something here. Keep up the verve in your writing. I'm eating it up as I head over to my doc this morning for my snoring problems. I believe it has detrimentally affected my marriage. After perusing these posts and blogs I'll have a lot more ammunition when he hands me something the babe from the pharm company dropped off last week. But if he does give me something that comes with a pen, I might let him know I have a weird weakness for Rx pens.
I make a motion that Dr. Anonymous curb the acerbic remarks while blogging on Dr. Peg's site. The laundry list of your personal judgements on Dr. Peg's character are diminishing to her and serves only to illuminate your own deficiences of character not to mention writing style. There's many other ways to say "shame on you" and what productive thing came of it? Did you intend to place yourself on a pedestal and set Dr. Peg down off hers, not that she has ever given the slightest hint this is who she is? The last reflections I've had of Dr. Peg are that she's a compassionate and tender hearted human being who enjoys her career as a doctor and emits joy in sharing her myriad doctoring experiences, painful, insightful and otherwise. Who do you think you are anyway, God?
Dr. Peg is providing a valuable, free and enjoyable service to all of us who trouble themselves to access her site. She has sparked some interesting dialogue including some of the comments you contributed later, so you must be aware of her solid character and straight shooting style. She boldly identified herself and has placed herself on the www. battlefield of bloggers. Thus far, I have yet to see any Achilles Heel. Not to say there's not one, we all have one. I think I spot yours.
Consider a more heimish posture next time you feel like sounding off. Your comments have already violated my otherwise placid morning and I'm just a mere patient/blogger.
Fix yourself a nice hot cuppa Zen tea. There's many different brands from which to choose but they're really probably all the same thing. They will give your mean spirited streak a nice lavage. Try to lighten up too, will ya?
Toss in a joke when you write such a long blog, like "how many doctors does it take to remove the heart of a Neo-Nazi?" Answer, "none because they've got none to begin with". I don't know, that doesn't even make me smile, though I wouldn't even consider operating on a neo-nazi so there, pthhtttt, I wouldn't make a good doctor, ethics fed-exed to the nearest dumpster for that patient. See, I'm not good at jokes, so we both have something to work on. I learned in Art 101 if you feel compelled to critique someone, and as art students we were compelled by the prof, interject a complement. It usually goes this way: the positive comment precedes the negative one and we go around the room this way, each person gets praised and bashed all at once. It works well, because we all know we learn from each other if we want to improve. Everyone has room for improvement even the ones that are the next Berninis, Van Goghs, or Frank Lloyd Wrights.
In short, constructive criticism; one good, one not so good. Or try this. You can say almost anything you want as long as you say it with a smile. It's hard to convey a smile on a blogsite, isn't it? It's impossible actually, especially when the remarks are punishing ones?
Hey, have a nice day. God loves even you!

Peg Spencer said...

anafaran - You're so sweet to be my champion!

I need to correct you on one misperception, though.

"Anonymous" is a choice anyone can make when they post a comment. The "anonymous" who insulted me is not the same as the "anonymi" who posted their views very civilly afterwards. I know that for a fact cuz I know those two and they wouldn't do that.

Thanks for the nice words and for sticking up for civility in blogging!

Peg

Shazam! said...

I eat the leftovers after the pharm reps have gone. If I'm single coverage in the ED, I never let them come to the patient care area. I'm not listening to them anyway, and last time it happened (the PA said they could come over), I just ended up being rude...not deliberately, I just had other things on my mind.

I agree that food is a fringe for teh ancillary staff, but all I can control is whether they come up to the patient care area. My rule is no.

anafaran said...

I feel like a fool Dr. Peg. After I posted I read the other bloggers' comments and realized the character executioner anonymous blogger might be someone you know, but nevertheless, I found the comment warranting dissection and analysis. But, if you're going to make a fool of yourself, my thinking is to do it with gusto and conviction.

peg said...

anafaran - I don't know who the flamer is; I know the other 2. Don't worry about it. You're welcome to say whatever you wish. And I certainly have NO problem hearing from people who disagree with me, as long as they're civil and don't just throw insults.

shazam - Hey, thanks for visiting and commenting! Seems reasonable to me to keep marketers out of patient care areas.

Charity Doc said...

Peg,

The drug reps are not allowed to leave samples at my hospital/ED. Something the entire medical staff and administrators have adopted. But they do leave plenty of pens and food though. My view is that if they don't leave them here, they'll leave them somewhere else. Might as well be here so we can gobble them up and enjoy the spoils of being in the medical profession. Sad ain't it?

But I rather like not having to ever buy a pen again. Haven't bought one since I started med school. Am I a drug man-whore? Nah, maybe a peeping-tom. I look but don't prescribe. Like I said, the vast majority of my patients can't afford those fancy brand name drugs any way. The Levaquin, Factive, and Avelox gals have been visiting us quite frequently this past several months. It's the War of the Quinolones, I tell ya. Have never prescribed Factive or Avelox. Levaquin is not on the Medicaid formulary either so what's the point? But I did get cool pens from all 3 drug reps, though. Yea! A whole desk drawer full in fact. I lose one every day anyhow and the nurses are always raiding my desk drawer for pens and whatever else is in there. The Ketek dude has been frequenting as well. Another expensive drug with a catchy anagram for a name that my patients can't afford. Generic Erythromycin, Doxycycline, Bactrim, Amoxicillin, Pen-VK, Cephalexin, Macrodantin, or Ciprofloxacin it is. Last I heard, these still work quite well. There's an arsenal full of cheaper generic antibiotics one can prescribe.

connery said...

Dear Dr. Drug Whore,

My feeling is, just cuz I listen to them talk to me about Drug X, and just cuz I eat their lunch, and just cuz I write with their pen--doesn't mean they've bought my soul.

I've had much smug fun toying with them, sometimes, as I inform them that I base my drug choices on primary event prevention or preventing deaths, and I really don't give a rat's ass whether it's a comfortable pen, or whether it's on so and so's formulary, or that it's a fraction of a percentage point better at lower THIS irrelevant but fancy-sounding parameter than Drug Y. If Drug Y has more solid studies behind it, or if it saves more lives, or prevents more heart attacks--I'm gonna continue using THAT drug, despite how politely I may listen to Brand X's drug rep who served me a delicious lunch!

Just cuz you eat their pancakes or their lasagna doesn't mean they've bought your soul.

I, personally, prescribe whatever I want.

But, you're right when you raise this point. And, one of the responders asked it also--the billions the pharmaceutical companies spend on buying us lunches and dinners and pens and useless plastic crap certainly raises the wholesale AND retail prices of these drugs for the consumer.

And, I wonder about that sometimes, too. If you cut these companies' promotional budgets, wouldn't the prices come down?

Sometimes, I learn a lot from the drug reps. I soak up the information, or hear of a drug or familiarize myself of something new, or a new study that I haven't had a chance to read or hear about elsewhere yet in detail.

If it interests me, or if I think it sounds good, or if I trust the source or the way it's delivered to me, I will read up independently about it, or ask them to mail me the studies or something.

So, I find myself using them for information as much as they use me to try to influence my choices. They very rarely, if ever, do.

If they have a good, solid, trustworthy, mortality-decreasing, or event-reducing product, then I'll use it.

Once in awhile, I'll try a new BP drug that seems equivalent or better if it's well-studied, just to see how it works in my patient population. I've recently been very pleasantly surprised with one drug, and then went to one of Dr. Queen Lisa's lecture talks (or a similar one) and learned a lot of study data on efficacy and lack of side effects compared to other drugs from a trustworthy and reputable (albeit paid) physician. So, the info benefitted me and my patients. And I had a delicious dinner, and an entertaining evening while learning new info at the same time.

But, usually, my top choices are my top choices for a reason, and a delicious lunch or dinner or a pretty smile* or a nicely colored pen won't sway me.

*Usually. ;-) (I'm kidding here. I would never jeopardize my integrity or my patients' care over a meal or a pen. C'mon! Or, even a pretty smile.)

--Dr. Connery

P.S.: Anafaran, I LOVE that you defended our dearly beloved leader, Dr. Peg. Please don't whup me; I was affectionately joking when I addressed her as a "Drug Whore." Dr. Peg, as you have suspected from reading here, is a unique breed of (not only doctor, but) person, with scruples and integrity and wit and strong human decency and empathy for her fellow members of humankind. I didn't read the "flaming blast" but I read your long heroic defense of her, and I salute you. And beg you not to fry me for my joking "Drug Whore" crack. I doubt Dr. Peg is either on drugs or a whore, from what I've read here. Nothing could be further from the truth, in my opinion.

P.P.S.: Is it just me, or are these "word verification" things getting longer and more complicated this week? I got one here that's longer and more confusing than my optometrist's first 3 lines of his eye chart, for goodness' sakes!

connery said...

OK, Anafaran, I found the first "anonymous," the one who questioned someone's "ethics, judgement, and morals."

I didn't get that sense at all from reading Dr. Peg's article on this. Not at all. They must've misinterpreted it. Or had an axe to grind. Or a bad day. Or something.

I think any doc who would compromise their "ethics, judgement, and morals" to change their prescribing habits to please a rep or to thank them for lunch or for the plastic CD case with the company logo on it is a doc who I would not wish to go to.

There are folks out there who are swayed by these sales people. People have told me so.

I just roll my eyes.

We're scientists, and we have to filter the information we get through scientific skepticism, to make sure our choices are medically and scientifically wise.

Not because "so and so company" treated me to dinner last week, or gave our office 20 pens, or the rep told me a joke or flirted with me.

Those aren't thought processes I would want MY personal physician to use when deciding what to prescribe to ME.

Why would I want to do that to someone else who is entrusting me with their life?

Spiderman: "With great power comes great responsibility."

I know Dr. Spidey would prescribe what he thought was the best drug, not what drug company gave him the nicest meal.

--Peter Parker-Connery

P.S.: LOL. I just got a short and simple "word verification" thing. I guess the squeaky wheel gets the grease. Thanks, Dr. Peg. Or blogger.com. Whoever acceded to my request in my last post.

peg said...

Charity doc - Thanks for the clarification. SO basically, the drug companies are losing money on you, is what you're saying, since you don't use the expensive new "me-too" drugs because your patients can't afford them. Makes it an easy decision, I guess.

Connery - Thanks for the post about how you think and handle the reps. Your approach is what I hear most docs say, and I commend you for being able to maintain your neutrality.

Thanks also for your kind words.

I have no control over the word verification troll. In fact, half the time I get kicked back out myself and have to type in a new jumble of garbage when I thought for sure I had the last one right! I think it depends on how many bots it caught crawling over its bridge today.

"Dr. Drug Whore" (no worries - I thought it was funny)

anafaran said...

I better get myself a updated PDR just so I can understand what all you MD's are talking about. Maybe it's not such a bad idea if a patient is educated before coming into the doctor's office. But wait a minute, that might make me one of those 'know-it-all' patients that would drive doctors crazy. No, I wouldn't want to make your decision making more difficult than it already is, but that is an interesting question to me. Would a doctor prefer the patients to be more up to date on the latest the pharm companies are pushing?
That would at least take the pressure off you folks. Next time the reps come in with a new supply, you can say, no thanks, the patients aren't biting on this drug. Supply and demand will more often than not cause the little perks to fall by the wayside, but if the drugs they start producing really help patients then at least the pens will keep coming since you'll be writing more Rx's. Anyway, pens are all a doctor/writer cares about I bet.
My 3rd year med student daughter heard my cholesterol shot through the roof. She told me that the cholesterol reducing drug companies are making billions with a 'B'. I decided when I went in for my next check-up following the new lipids report just in, I would just say "No!". I told my intelligent, adorable and witty doctor that I was putting myself on a 'no animal product' diet and an exercise routine for three months to see if I could lower the levels on my own. He said in effect, more power to me. So that's what I'm doing, but I have to admit I sneaked in a juicy bratwurst at the White Sox/Royals game last weekend,(oh, yeah, and a Heineken, which made it hard to know which to let go of when the foul tips started coming into the stands). Well, do you know anyone who's perfect? Let me have their phone number, will you? They must be a baseball fan, by the way.

connery said...

Anafaran--

I AM a fan of baseball, bratworst, AND Heineken, so I can relate to not knowing which to drop to attack a foul pop comin' atcha.

You can always put the beer between your legs while you hold the 'worst, and lunge for the ball with your free hand.

Or, alternatively, hold the beer, stuff the 'worst in your mouth, and you still have a hand for the foul pop up.

I try not to use "medical jargon" here, but if I ever slip back into "docspeak" that's indecipherable, just ask what I meant. No harm, no--er--foul!

(Sorry, that last comment was a "reach.") ;-)

--Connery, Big Fan of a Beer and a Dawg on a warm summer's night

anafaran said...

Hey Connery,
Your cool! And as long as you didn't say, "no, harm, no, fowl" or my least favorite expression: "Kill two birds with one stone!" or "One in hand is worth two in the bush"(implying two little captured small animals).
I'll still consider you next time I get a hold of some baseball tickets. What's your favorite team?

anafaran said...

To myself: That didn't make any sense at all, knuckleballhead!Go have another cup of caffeine.

connery said...

Thank you, Anafaran.

I am a big fan of the Albuquerque Isotopes. ;-)

Didn't they used to be called the Dukes, back when they were the Triple A team of the Dodgers? Now, they belong to the Florida Marlins, I believe, although they probably have a better team than their major league "parent."

I am a Mets' fan. My whole life. Not just 'cuz they're off to a great start and in 1st place. That happens about as often as Halley's Comet, but I love the team anyway.

Even if they're not on, give me a "Game of the Week" involving any team, and a beer and a companion to watch it with, and I'll be happy.

(This line of conversation has absolutley NOTHING to do with the Pegspot article topic; don't know if I've violated any blog rules, but I apologize. It's all Anafaran's fault--she started talkin' about baseball, and I just picked up her bat and started swinging right afterwards. Reminds me--another Peg-oid topic. Yesterday, the major leaguers used pink bats to raise money and awareness for women with breast cancer. It's about time those guys did something for the public's benefit.)

difficult patient said...

Stick with your ethics . . . Besides, when it comes to prescriptions, usually less is more (in my humble patient opinion).

anafaran said...

Connery, Dr. Peg is a very forgiving blogsite hostess as you well know. I think she'll call us safe at the plate on the tangential bunt into the topic of baseball. It is the season afterall. If I come across any Mets tickets, I'll let you know. How about you spring for the beer and brat? Hooray for pink bats by the way!

Giovanni said...

"Durg Whore"...what a concept! I like the struggle you've gone through. I appreciate your stand.

Giovanni

dr peg said...

anafaran and connery - I'd do a special post on baseball, except I know little about it and care even less! *ducking* Sorry, but in my opinion it's boring to watch. (unless you have a LOT of brats and beers) Not only that, I'm pissed at the sport because my daughter's high school had TWO baseball fields and NO soccer field, and she is an ace soccer player. They had to practice on a piece of the football field. But I digress even farther than you did.

difficult patient and giovanni - Thanks so much for visiting and commenting. I agree with the "less is more" concept in medicine in general.

wolfbaby said...

Im a patient not a doc so I don't know if this matters but my doc gives me the samples cause she knows I cant afford the real deal and unfortunatly there is not another drug like this one to help my problem. You gotta follow your heart. Thats all that matters... but those samples, they help me alot.

dr peg said...

wolfbaby - Thanks for your comments and your perspective. You have a good point about the samples. You're lucky that you can get all your meds for free.

weezilgirl said...

i have to tell you this....i was married to a surgeon for 16 years and he didn't accept samples or gifts from drug reps. we never took a trip, used a pen or a memo pad or drank from a drug sponsored coffee cup. i respected that very much about him....unfortunately, there were other problems. :-)

dr peg said...

weezilgirl - Thanks so much for reading and for your comment. I admire your ex for his fortitude.

Anonymous said...

This is what a pharm rep really thinks: Because she now has a handicapped child, she thinks she should not have to pay for any medical study in which her child is involved. She also thinks she was wise for banking cord blood and that those who do not just weren't as clever as she was. I think she is callous. If a child was not involved, I would think she deserved her new life spending all her ill-gotten gains taking care of the kid.

Tam Thompson said...

As a patient/consumer and a volunteer Firefighter/EMT, I appreciate your integrity, Dr. Spencer, and I think you're doing the right thing by drawing the line "at your feet."

I became aware of this issue about 25 years ago when a friend in pharmacy school told me what went on.

Here's the other part of the equation...patients notice. At the orthopedics, I notice when there's a Celebrex clock on the wall, along with logo'd pens, pads, etc--and then when I'm handed a script for guess what, I wonder if my doc is really doing right by me or pandering to his sugar daddy.

And I'll bet other patients notice theses things, too.

I believe medical schools should have the guts to address this head-on so that residents will know what goes on, and are aware of the ethical issues involved.

Thanks for publicizing this!

The Authors of "50 Ways" Interview on KCHF TV

50 Ways to Leave Your 40s TV interview with Phoenix' Pat McMahon