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Genes for Sale

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In an amazing confessional cleanse, click here former drug company shill, Shararam Ahari, and investigative physician policing her own profession, Adriane Fugh-Berman, have crafted a piercing analysis of the tactics used by Big Pharma ---shilling through its horde of drug reps---to try every technique from ego-polishing to direct gift-giving to boost physician prescribing, and hence, to create an army of high-prescriber-MDs for top-earning drug products. Describing in gory detail the categories of physician personalities and the prime techniques used by drug reps to influence prescribing patterns in each personality type, “Following the Script: How Drug Reps Make Friends and Influence Doctors” paints a sordid picture of a shadowy universe behind the scene of the patient-physician interaction. This is a universe of scripted interplays among wooden puppets made to appear like genuine interpersonal caring by the puppeteers, those greed-driven executives at the top of the Big Pharma food chain. “It’s my job to figure out what a physician’s price is . . .” states Ahari, unabashedly, about his former life as a drug rep; “ . . . at the most basic level, everything is for sale and everything is an exchange, ” he adds. Depending on the measure used, the drug companies currently field one drug rep for every three to six doctors, meaning that each rep can give his or her target physicians almost his or her undivided attention. To state that in some instances, the drug rep becomes almost a de facto member of the medical practice’s office staff would not be to severely overstate the situation.

The Pharma drug rep-MD interactions stun even the most vivid imagination, far worse than even the “ask your doctor” TV appeals to patients, which in their, “Viva Vigra,” musical spots and their mendacities (such as defining viral infections as a “mild side-effect”) are horrendous in their own right. Everyone who believes that “for-profit” and “health care” are somewhat inconsistent ideas---at least the way the enormous profit taking is currently structured--- should read and absorb every word, every tactic described in the aforementioned article. It simply offers some of the best evidence that the current system stands to serve the agendas of the super-rich drug barons as much, if not more, than it serves the health maintenance of the patient; it offers some evidence regarding tangible factors underlying the U.S.’s decline from the best health care in the world, 50 years ago, to, by some measures, one of the least efficient, considering the per-capita cost and less-than-superb outcomes. How good can a healthcare system be, driven by Madison Avenue on the one hand, and by disingenuous play-theatrics on the other, while the percentage of healthcare spending on drug therapy continues to grow annually?

Now picture this scenario in 20 to 50 years. As presaged by the website of the FDA itself, the products being hoisted onto physicians consciousnesses by drug reps will likely include snippets of human DNA, potent little genetic powerhouses capable of some fancy biological-radio tuning. The site ( http://www.fda.gov/cber/gene.htm ) tells us the following: “. . . the amount of gene-related research and development occurring in the United States continues to grow at a fast rate and FDA is actively involved in overseeing this activity. FDA has received many requests from medical researchers and manufacturers to study gene therapy and to develop gene therapy products. Such research could lead to gene-based treatments for cancer, cystic fibrosis, heart disease, hemophilia, wounds, infectious diseases such as AIDS, and graft-versus-host disease.”

And more, undoubtedly. Used wisely, judiciously, using genes as therapy, to replace or enhance biological functionalities lost or diminished either through heredity (cystic fibrosis) or through disease (cancer) could be a great boon. But the story could readily grow from there; what about creating physiological advantages----athletic or otherwise---through gene therapy. It’s easy to scoff at such “brave new world” scenarios, but picture gene therapy, likely very expensive, in the context of our current for-profit healthcare scenario, with the decisions about its application to some extent determined by interactions between the Big Pharma patent-holders of the gene sequences and the MDs who would serve as conduit to the potential patient population. Is it not daunting enough to have non-psychiatric MDs freely, even loose-cannon-like, prescribing Prozac and other anti-depressants, motivated by the just-described system of drug rep-to-physician gift-giving? Imagine this scenario translating to genes, potent snippets of DNA, as the product to be aggressively marketed in this fashion. Should we persist on our current course, fail to take this opportunity to follow the world’s other first-world nations into some form of universal health care (where profit-motive is at least somewhat diminished), this troubling scenario may well be a portion of the inheritance that we pass on to the next several generations!
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VinyL is a molecular biologist who's passion is the philsophical and pragmatic expansion of the US healthcare system away from its insane addiction to physician-lock, reductionistic, simpleminded drug therapy toward a more-global view based on (more...)

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