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August 2016 Newsletter

Recent Project News

  • On August 3, our ethnographic study of the intimate relationships between surgeons and medical device representatives, Salespeople in the Surgical Suite was published in PLoS One. Authored by Bonnie O'Connor, Fran Pollner, and Adriane Fugh-Berman MD, the study is the first published exploration of the experiences, expectations, and reservations about relationships between device reps and surgeons to be told from the persepctive of the participants. See Fodder, below, for an in-depth summary of the piece.

  • In July, Pfizer agreed to a written code of conduct with the City of Chicago for marketing opioids. Pfizer promised not to promote opioids off-label and to disclose in its promotional materials that opioids have a risk of addiction – practices that all opioid manufacturers should already be doing. Dr. Fugh-Berman believes that Pfizer has other motivations behind this PR move. “It’s in Pfizer’s interest to highlight the addictive properties of opioids because they have a competing product under development,” she told the Boston Globe. “When a company comes out slamming a particular class of drugs, it’s generally because they have a competitor in the wings. Think of this as prelaunch marketing, which can start long before the launch.” The story was also covered in the Washington Post, Chicago Tribune, and CBS News.

Mark Your Calendars


Its official! Our sixth conference will be held June 15-16, 2017 in Washington, DC. We are looking forward to having a great conference with engaging speakers and wonderful attendees. The current agenda for the conference includes talks on drug pricing, pharma backed advocacy groups, and opioids. Please send any ideas for topics or speakers to pharmedout@gmail.com.

August's PharmedOut Fodder

Salespeople in the Surgical Suite


How does a surgeon choose which hip joint or other device is surgically implanted into your body? That may depend on which medical device representative (“device rep”) the surgeon relies on when they go into surgery.

Our new study in PLOS One explores the relationships between surgeons and device reps and how these relationships impact patient care. The authors did in-depth interviews with 14 orthopedic and ENT surgeons, three former and current medical device reps, and a former medical assistant to an orthopedic practice. This is an enthographic study - one that documents the beliefs and practices within a culture (in this case the occupational cultures of surgeons and device reps) from the perspective of people within that culture.

We found that medical device representatives not only sell surgeons the tools they use in the operating room; they have also become integral members of the OR team, standing by to assist in the use of their company’s products, if needed, during joint replacements and other surgical procedures. The device reps provide information regarding the newest products and presumed improvements in implantable devices, as well as the availability of relevant training sessions offered by their companies. Surgeons often develop close working relationships with specific device reps and rely on their expertise to enhance efficiency in the OR and, should an unexpected problem arise, to aid in trouble-shooting. It is the device reps’ job to cultivate these relationships, the avowed objective of which is optimal patient care. But is patient care helped or harmed by the promotion of the newest, relatively untested devices by unregulated surgical assistants who receive commission on every device sold? There are also issues of informed consent, as many patients don’t know that a salesperson in scrubs will attend their surgery.

Our study reveals ethical dilemmas and financial considerations in the recommendation of specific products; challenges the adequacy of continuing surgical education; calls for earlier device safety and efficacy data gathering and dissemination; and suggests that neutral entities may be able to provide the services currently provided by industry representatives. Several hospitals, including Loma Linda (Calif.) University Medical Center, have trained hospital personnel to replace sales reps as surgeon assistants – and have cut the price of implants in half.

Our study is available at: http://dx.plos.org/10.1371/journal.pone.0158510.

PharmedOut Photo of the Month


The PharmedOut team (Sharma, Dili, and Joy) at the Nutrition in Medicine conference in July. 

Check these out!


Public Citizen released a report that shows that most patient advocacy groups that opposed an overhaul of Medicare Part B that would remove incentives for physicians to prescribe more expensive drugs were funded by pharmaceutical companies. A separate analysis, Pharma’s Orders, shows that lawmakers who opposed the overhaul received 82% more in pharma campaign contributions  than lawmakers who opposed it. Ed Silverman’s articles on the subject are here and here.

Summer is a great time to catch up on CME/CPE! Physicians, Pharmacists and Physician Assistants: Check out our great industry-free continuing education modules on Rational Prescribing for Older Adults, medical cannabis, generic drugs, and more at http://doh.dc.gov/dcrx. Free to Washington DC health care providers and $20 for unlimited CME/CPE credits outside of DC. (Anyone can view the modules at no cost.)

News Round-Up

(For more, follow @Pharmed_Out on Twitter!)

Aug 1

More Coca-Cola Ties Seen Inside U.S. Centers For Disease Control by Carey Gillam (The Huffington Post)

University Of California OKs $8.5 Million Payout In Spine Surgery Cases by Chad Terhune (Kaiser Health News)

July 28

Stem Cell Therapies Are Still Mostly Theory, Yet Clinics Are Flourishing by Gina Kolata (The New York Times)

July 26

FDA enhances warnings on group of strong antibiotics by Dipika Jain (Reuters)

July 25

Surgery Fixes a Ligament (if It Exists). Does It Fix the Knee? by Barry Meier (The New York Times)

July 21

Medical groups push to water down requirements for disclosing industry ties  by Ed Silverman (STAT)

New warning rule for users of generic drugs is left in limbo by David G. Savage (Los Angeles Times)

July 20

Medicaid spends a lot on outpatient drugs, but which cost the most? by Ed Silverman (STAT)

July 19

Bristol-Myers pays $30 million to settle kickback charges by Ed Silverman (STAT)

No Clear Survival Benefit Seen Among Diabetes Drugs by Parker Brown (MedPage Today)

July 17

As need grows for painkiller overdose treatment, companies raise prices by Melody Petersen (Los Angeles Times)

July 14

Drugmakers’ Pricing Power Remains Strong by Joseph Walker (The Wall Street Journal)

July 13

Senate sends first major opioids legislation to Obama’s desk by Dylan Scott (STAT)

The one that got away: Obamacare and the drug industry by Brett Norman and Sarah Karlin-Smith (Politico)

July 11

Pharma trade group helps fund patient fight against Medicare project by Jayne O'Donnell and Fernanda Crescente (USA TODAY)

Need for a National Evaluation System for Health Technology by Jeffrey Shuren, MD, JD and Robert M. Califf (JAMA)

July 6

Pfizer highlights risks of opioid painkillers by Kate Gibson (CBS News)

Pfizer agrees to opioid marketing deal to escape a lawsuit by Chicago by Ed Silverman (STAT)

July 5

Pfizer agrees to truth in opioid marketing by Lenny Bernstein (The Washington Post)

July 1

Senate should release opioid report by Paul D. Thacker (The BostonGlobe)

June 30

Are Copay Coupons Actually Making Drugs More Expensive? By Charles Ornstein (ProPublica)

Drug and device makers paid $6.5 billion to docs and teaching hospitals last year by Ed Silverman (STAT)

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