> > --- In [email protected], "shanti2218411" 
<[EMAIL PROTECTED]> wrote:
> One of the most powerful elements of any effective
> treatment whether psychiatric or medical is HOPE. The 
> instillation of  hope will frequently evoke the placebo 
> response.

The mere act of "doing something" (taking a pill daily
or multiple times daily) often triggers the placebo
response.  I agree with you that a major factor in the
apparent success of these drugs is hope.

Unfortunately, another major factor contributing to how
often they are prescribed is cold, hard cash.  I dated
a nurse in Santa Fe who worked for one of the most
successful psychiatric clinics there.  What she told
me of *common* practices in the doctor/drug salesman
relationship were shocking.  You seem to be in the
field yourself.  Perhaps you could comment on this
from your own experience.

My friend the nurse told of drug salesmen who offered
the doctors free vacations to Hawaii for prescribing
certain "guotas" of certain drugs.  Or who actually
offered cash payments to them, based on numbers of
prescriptions.  Or who contributed to the doctors'
income directly by giving practices that had their
own pharmacy *huge* quantities of the drugs free so
they could make 100% profit on selling them, as 
opposed to only 50% profit if they'd had to purchase 
the drugs from the company.  The "free merchandise" 
stops being free after three or four months, but by 
that time many of the patients have an ongoing pre-
scription for the drug in question, so the doctors 
have to prescribe more, and their pharmacies have 
to order more, and this time pay for it.  It's the
counterpart of the schoolyard drug pusher saying,
"The first one's free."

This practice seems to me to be the drug industry
equivalent of "spiffs" in other sales situation.  If
you ever shopped for a stereo in the 70s through
the 90s, you know what spiffs are.  Spiffs are pay-
ments made by the manufacturer directly to the sales-
person, as a reward for selling its merchandise. The
spiffs are *in addition to* any commissions the sales-
person earns from the company he works for.  The 
company most famous for doing this was Pioneer.  Try
to remember back...when you entered a stereo store
and asked, "What's the best equipment you sell?" how
often the answer was "Pioneer."  It wasn't.  But the
salesmen made more money for selling Pioneer equip-
ment than for selling any other brand.

Giving doctors large quantities of a new drug for
free so that they *automatically* make more money
by prescribing that drug than one of its competitors,
or by not prescribing anything at all, seems to me
to be an equally abhorrent practice, one that entices
the doctor to care more about making money than he
does about his patients' welfare, or about telling
them about the possible side effects of the drugs.

Unc






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