Or, I go to a doctor, who is a medically trained professional, and they prescribe a medicine to me based on their experience and training, without any incentive for financial reward?
No, I don't pay the doctor, the healthcare pool does. And then, the doctor is incentivised to cure me, not keep me in a perpetual drug-purchasing lifestyle as big pharma would.
Doctors get cash and hospitality benefits from big pharma though based on how they prescribe.
If there is drug X from company Y and drug A from company B and then there is no difference in therapeutic benefits between two drugs, but company B gives doctor cash and has access to regional sales data where the doctor operates, they can modify the benefit based on sales. Then the doctor is incentivised to prescibe the A. This may be harmless, but if the doctor gets into a financial trouble or simply get overwhelmed by greed, this can quickly turn into something that harm patients.
In my country doctors don't have to disclose those relationships and they don't even have to declare this as income.
This is absolutely not true in most countries. Where I practice you can get into big trouble for this. You have do declare pharma affiliations, cannot accept sponsorship and the age of junkets through drug companies is long in the past.
I could be deregistered if I was found to be accepting anything (travel, hotels, conferences) and not declaring it
Great that your country stamped this out, but I am afraid you are the minority. Pharmaceutical industry is the most corrupt after politics and army and almost no doctor is immune to bad influence.
Straight up denial is actually harmful in getting the truth out there and fixing the problem.
You aren’t saying anything substantial here. The world renowned scientists coming up with the discoveries that allow us to live long lives should not be bucketed with the MBA goons trying to mark up insulin shots and corner the market with medical patents they acquired.
What industry do you work in where those at the top of the companies aren’t maximizing their ROI and profit seeking? That COVID shot in your arm ID from the scientists that worked feverishly to invent it, and should be celebrated like the ones that solves medical mysteries across all different disease classes. R&D is not free period.
Why not have the government subsidize medical costs, why punish the inventor who have huge R&D overhead? The corruption you talk about starts and ends with the government.
Australia. This is the rule in most developed world economies, although I have to admit complete ignorance of the US (... the largest developed world economy)
I was invited once, by another doctor, to speak (paid gig, curtin closer) at a conference being put on by a pharmaceutical company. It was on digital health and the company I think may have had an interest in anaesthetic drugs or supplies or possibly it was surgical - (I’ve just trawled my records and without spending an hour or more I don’t think I’m going to find it) either way there were lots of Anesthetists and surgeons there, mostly because for only $100 they could knock off 20 CPD points by coming and listening to something half interesting in a nice venue for a while and get a meal and catch up with each other.
I had to fill out pages of forms with the company to get paid, firmly renounce that I would be promoting any drug or product, resolve to declare my affiliation with them for a minimum of 12 months, etc etc (this was in around 2018).
The company’s logo was on the pull out banners and the projection screens obviously but there wasn’t even a hint of drug or product anywhere in the room. No tote bag, just some mints and the pad and pen.
The ethical bar has been raised so high that medical companies are now reduced to running paid conferences on adjacencies that clinicians may possibly be interested in, that align with their college’s professional development goals, and can’t even mention their products!
So why do they even do it anymore? I pondered this as I filled out my forms - I believe it is due to residual infrastructure and marketing apparatus and budgets from the days when they could offer the world. Now they’re like vestigial organs, floundering to maintain purpose but knowing that a KPI is eyeballs on logos
The kicker is, if it was anaesthetics, there are only probably 2 makers of sevofluorane in the world anyway!
In my country, general practitioners can only prescribe a limited number of drugs and specialist visits a month, so as not to overwhelm the healthcare system. It's their moral choice to deem a person sick enough for a certain course of action.
Whatever pill the doctor writes me up, I always end up asking the apothecary or looking up online the cheapest substitute. This is how the elderly here cope, they can barely pay bills, let alone choose which pills to skip. I've personally not had any problems with big pharma substitutes so far.
Technically I don't think it's unique to the US. In Denmark doctors get a fee per consultation. It's pay with tax money, but still the doctor is financially motivated to see patients. It might only apply to general practitioner though, I think hospital doctors are on a fixed salary.
One issue, that could excuse medical companies going directly to the patients would be a lack of knowledge among doctors. Doctors contently write prescriptions for medication that's no longer available and is often not as updated as a pharmacy on new medication. This means that at least some doctors aren't suggesting the best treatment, simply because they aren't aware of it.
The doctor can also put a generic name of the drug on the prescription and patient can tell the pharmacy to sell them a particular brand instead of a generic. So there is space where such direct advertising could work.
A financial incentive to treat? No, that's pretty common across healthcare systems. It's being worked on as system move away from fee-for-service, but generally, the more a physician does, the more they make.
I don't think it's fair to put Ireland in the same category as the USA here:
1. Zero ads for prescription medication anywhere
2. Medical card for everyone on low income covering everything
3. Never pay more than EUR114/month for prescriptions, no matter how much you medication you need or your income.
I've never had doctors pushing any kind of medication on me or my family.
I was curious about another HN poster from Ireland so I looked at your other comments and you're defending RTÉ so it's safe to say we won't see eye to eye.
You're a glass half full type of person, to put it in polite terms.
I could rant all day about media and health in Ireland. Specially from a migrant perspective but it's not really the place.
What is undeniable is that Ireland ranks amongst the worst in Europe and it's very much for profit. It's just Irish people don't know any better and they look at the wrong place (USA) and only at the money aspect, not the quality.
Quality wise, I'd much rather be in USA than Ireland because treatment here is terrible in many cases and there's always a sea of excuses and bureocracy.
You need to go to a doctor anyway. Not all of them are good, and imo they shouldn't have absolute say in what you take. If you suggest some medication you saw an advertisement for, they should take it into consideration instead of telling you to stfu about it. Yes, my experience with doctors has been terrible.