Yeah, docs getting money from pharma companies is

Yeah, docs getting money from pharma companies is so much more limited these last 10+ years than it was before. There is a database to track what each doctor receives from pharma so you can look it up as a patient. There are all sorts of rules in place for a dinner program, which is/was a very common practice at the territory level and one of the main ways doctors got paid. In 2004 you could take a doctor out to dinner for no reason. It wasn't but a year or two later before it had to be a speaking engagement with attendees. Had to be run through the organization and the limits and rules were tight. It honestly started to feel like a waste of time.

That being said, the "gurus" in each region were definitely being asked to speak about drugs and taking a payday to do so. But they were also held to an approved speaker deck of presentation materials and outside of offering their unique thoughts during Q&A it was always frustrating that these "thought leaders" were taking a nice paycheck home for delivering the same information the reps were delivering in the field. They just did it over either steak, salmon, or chicken with house wine or beer included.

There's a LOT of nuance that goes into what a doctor prescribes, including if they're being paid. Just because they're paid doesn't mean it's not still the best drug. It doesn't mean that they could even prescribe another, as insurance companies are like fucking mob bosses about what they allow doctors to do. Or put another way, what they will cover.

I remember a primary care doctor telling me he was no longer allowed to perform the two common (and complimentary) tests for heart health in his office on the same day anymore. They'd literally still cover/pay for both, but they wanted to make the patient come back for a second visit. No way around it for the doctors.

Bottom line, while pharma takes the brunt of the furor it's insurance companies that deserve a significant chunk of that frustration.

But back to the prescribers. They will often take the path of least resistance. If it's covered on their major plan they start there for every patient because they're less likely to find out the patient's insurance won't cover it or that the patient shows up to the pharmacy and finds out the cost of their script is $450. They blame the doc when it's really more of an insurance issue.

Insurance companies get rebates from the pharma companies by moving certain quantities of their drugs, so it's in their best interest to keep prices down by forcing doctors to prescribe what makes them the most money.

I've probably told it here before, but the head of trauma urology at a major hospital system once told a crowd of doctors that his hospital had multiple days of meetings to try to figure out if they should continue the older TUNA procedure that has more side effects but gets you more money out of the insurance carrier, or perform the newer and safer TURP that paid a quarter of the reimbursement. They finally settled on doing the TURP since it was best for the patient, but it wasn't an easy decision when for profit assholes are staring at what could be a cash cow instead of settling for an ATM with a withdrawal limit.

It's a bell curve. Most are good, solid doctors. A small amount are great and a small amount are terrible. But they also are stuck in a system that is dysfunctional at just about every level. I found that most tried quite hard to do what was right even though it was a more difficult path to take.

And to the folks talking about having a billionaire try an end around toward approval, it's both never going to happen and a terrible idea.

You've all probably heard the phrase "you never call another person's baby a Craig". Despite our thoughts on the organization, they are in full control and would be happy to delay a company who Amarex's their way through the process with concerns over spelling errors or missing punctuation.

It would be company seppuku to signal to the fda that we don't plan on playing their games. It's a bad system but it's too big and too entrenched as an entity to do anything about it while we're all still kicking.

Besides, we're already not owned by big pharma and already working on doing trials. Sure, it would be great if we knew where our money was coming from but we'll get there. Why try to skirt the system when we can latch onto it like a puppy and hump our way to approval the old fashioned way. By earning it.