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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by BekkaH on January 3, 2003, at 22:51:33
In reply to Lexapro and the Pharmrep, posted by Ethicalpharm on January 3, 2003, at 22:08:21
EthicalPharm,
Thank you for your post. I wish Dr. Bob had written something like that months ago. I assumed that the pharmaceutical representative from Forest was part of the Direct-To-Consumer advertising division of Forest. In my opinion, advertising has no place on a board like this.
Posted by bobo on January 4, 2003, at 3:37:10
In reply to Lexapro and the Pharmrep, posted by Ethicalpharm on January 3, 2003, at 22:08:21
well said EthicalPharm---and if you have the time--maybe print the post and send it to his company--as they say---what goes around --comes around
Someone that----(words escape me)needs to be taught a lesson.P.S. Dr Bob--I am trying VERY hard to be civil.
Posted by JonW on January 4, 2003, at 6:04:53
In reply to Lexapro and the Pharmrep, posted by Ethicalpharm on January 3, 2003, at 22:08:21
I'm skeptical that you are a real pharmrep yourself. Your post seems more emotional than professional. Nonetheless, I agree with what you wrote.
Jon
Posted by Phil on January 4, 2003, at 7:27:01
In reply to Re: Lexapro and the Pharmrep, posted by JonW on January 4, 2003, at 6:04:53
"I am sorry that these people are so desperate for advice and help that they are seeking out your "brainwashed" ideas. It really is a diservice to them. I have been in the business long enough to know that we can all put a "spin" on things, studies included, to make our products sound like "the best" Afterall, that is what we get paid for. Giving advice to innocent consumers is sinking pretty low. You must be desperate for sales."
_______________Being a person that is a consumer of your products and no stranger to depression, I tend to be a bit sensitive. Something you said about these people being so desperate doesn't sit well.
You also say that you, unlike him, you are honest and ethical but you know all about "spin" to make your product 'sound like' the best. Although I know sales, the idea of either of you putting spin on your products to the people that then treat us does not put either of you in a good light. So you are saying you are all paid to put spin(lies or omissions of negatives. ie sexual SE's)on your product and the studies of that product. Don't your monographs have enough spin?
You say pharmrep has sunk pretty low, I agree, but if you "spin doctors", then we are being mislead from your BS(I'm sorry, it's called spin now.) Spin sounds harmless. But when we see our doc, he knows less than us because WE go in armed with facts and docs don't want our 'facts' because you guys have said things like..the study showed 5% sexual SE's. The doctors then see 70-80% of their patients having sexual problems or complete shut downs.
I'm not pointing the finger at just you two but your industry. Doctors are bought, period.
I think your products should not be advertised because docs have to convince patients another drug besides, say Nexium(sp), is better for them. Patients want the drug on TV.
If drug companies weren't spending a fortune on advertising, spin doctors, free samples, coffee mugs, pens, donuts, dinners, company cars, vacations, etc., they could send the doctors the bottom line from an unbiased source in a 5 minute video.
When you go through your day, I hope some of you know how important FACTS are to mentally ill people and realize that your job isn't a hair pulling contest or putting spin on your products. There are people who are in desperate need of effective medications and the facts so we know what lies ahead.
When business owners have to make a decision, they need facts/information. We, as consumers, deserve better information than what we get.I'm not trying to be disrespectful but by the same principle, I deserve respect. We all do.
Phil
Posted by Ritch on January 4, 2003, at 10:10:42
In reply to Re: Lexapro and the Pharmrep, posted by Phil on January 4, 2003, at 7:27:01
.....I think your products should not be advertised because docs have to convince patients another drug besides, say Nexium(sp), is better for them. Patients want the drug on TV.
If drug companies weren't spending a fortune on advertising, spin doctors, free samples, coffee mugs, pens, donuts, dinners, company cars, vacations, etc., they could send the doctors the bottom line from an unbiased source in a 5 minute video.....Well put Phil! Another thing: The medications might be a tad cheaper too.
Posted by Gabbix2 on January 4, 2003, at 14:49:49
In reply to Re: Lexapro and the Pharmrep » Phil, posted by Ritch on January 4, 2003, at 10:10:42
EthicalPharmrep? isn't that an oxymoron?
Really though I agree with what you said, but
your post sounds dubious to me.
"Innocent consumers"?
Thats a little patronizing.
Regardless, why post to him here, now? You must have been around before to know what was going on, why didn't you say anything then, if you are so passionate about ethics.
You waited until the "innocent consumers"
couldn't tolerate him any more.
Does any of this really matter? probably not.
Posted by Gabbix2 on January 4, 2003, at 15:09:53
In reply to Re: Lexapro and the Pharmrep, posted by Gabbix2 on January 4, 2003, at 14:49:49
>Ethical Pharmrep? isn't that an oxymoron?
Sorry, uncalled for.
I'm withdrawing from yet another non-addictive A.D. I suppose I have an axe to grind.
Posted by Phil on January 4, 2003, at 18:22:11
In reply to Re: Lexapro and the Pharmrep » Phil, posted by Ritch on January 4, 2003, at 10:10:42
Why are drug prices higher in the states than elsewhere?
Shouldn't all other countries be cut the same deal? I'm not much on exchange rates or square roots.
Can someone explain this to me?Phil
Posted by Ethical Pharm on January 4, 2003, at 22:00:31
In reply to Re: Lexapro and the Pharmrep, posted by Phil on January 4, 2003, at 7:27:01
This is in response to Phil and his comments to me.
I certainly did not mean to offend you or anyone else. When I used the word “desperate” for help what I meant was ..I realize that nowadays (especially in my state) it can take weeks, even months for a new patient to be seen by a mental health provider. It can sometimes be difficult to find a provider that takes your insurance and can fit you into their schedule. This can leave depressed/anxious patients feeling even more anxious and desperate for advice. That is what I meant by “desperate” As far as my term “brainwashed” ideas of this Forest rep. Those of us who have been in the business for a while can see past the fancy marketing that the big companies provide us with (believe me, most of us don’t like it and wished they would stop) Most Drs. just want the facts of your drug and why they should use yours over others. I myself, never will tell a provider that my medications are for “everyone”. There is no “perfect” drug, like I felt the Lexapro rep was implying.Also, you didn’t like my term “spin” on things. Perhaps that was the wrong term. Many studies, however, can be broken apart, numbers dissected, patient populations scrutinized, and many other areas debated. The best Drs. are the ones that read the studies and discuss the outcomes and implications with a knowledgeable rep. We all like to have positive outcomes to the studies that our drugs are in; sometimes this isn’t always the case. We tend to pull out the positive information and let the Drs. read the entire study for themselves. Don't you always like to put your best foot forward and show others what is best about you? I know I do. I am always honest when discussing studies and my drugs. That is the reason my Drs. respect and like me. I am honest, even when it is negative info on my meds. A Dr. will never trust you if and when they find out you were lying. My relationships are long-term. Enough of my own horn tooting.
I hope this clarifies a few things.
Posted by Ritch on January 4, 2003, at 22:02:04
In reply to Re: Lexapro and the Pharmrep, posted by Phil on January 4, 2003, at 18:22:11
> Why are drug prices higher in the states than elsewhere?
> Shouldn't all other countries be cut the same deal? I'm not much on exchange rates or square roots.
> Can someone explain this to me?
>
> PhilPhil, no controls on pricing here (pharm. companies are charging what the market will bear). There are enough folks with decent private insurance to *insure* a steady demand despite the prices. That will be (and already is) changing, however with a slow economy and companies slashing benefits. Look for higher deductibles and higher copay percentages, exclusive formularies, etc., in the coming months. Nobody is going to whine much and look for a different company to work for with superior benefits when your current job is threatened.---Mitch
Posted by Ethical Pharm on January 4, 2003, at 22:13:02
In reply to Re: Lexapro and the Pharmrep » Phil, posted by Ritch on January 4, 2003, at 10:10:42
I agree that drugs should not be advertised on T.V. It takes a lot of the professionalism out of the business and Drs feel less in control of their patients care. Sometimes, however; certain disease states are important to make public. A lot of people can be walking around with soemthing they are either embarrassed to discuss with their Drs. or not know they have until they see it on T.V As for the free samples...I always thought patients appreciated them. It's nice to be able to walk out with a few pills in hand and give them a try before you committ financially to a full prescription. Samples are also very important to patients that don't have health insurance. We as reps, know that financially strapped patients often walk out with a months supply. We also know that the office staff often help themselves to the samples, which we do frown upon, since they are for patients. There is a policy (policy 511) that has gone into affect, so Drs. will not be wined and dined like in the past. Some Drs. are upset about this and some feel the time has come. I, myself am glad. It puts us all (the pharmaceutical companies ) on the same playing field.
Posted by Ethical Pharm on January 4, 2003, at 22:34:49
In reply to Re: Lexapro and the Pharmrep, posted by Phil on January 4, 2003, at 18:22:11
Gabbix,
I was a bit offended by your remark about EthicalPharmrep being an oxymoron. You don't know me at all and shouldn't generalize. I know many Pharm reps that are honest and ethical people. Some unfortunately aren't, as you will find in any business or walk of life. As for "innocent" consumers, I too find myself in a position as an innocent consumer at times. It's unfortunate, but it happens to all of us. And why did I post here and now? I just found this site the other day and was reading through the comments. It also seems that this Lexapro rep was very much welcomed, respected and sought out for advice. You say that he wasn't tolerated any more. How was this ? Can you tell me what happened? I didn't know the gender of this person. And yes, it does matter.
Posted by gabbix2 on January 4, 2003, at 23:16:01
In reply to Re: Lexapro and the Pharmrep-to Gabbix2, posted by Ethical Pharm on January 4, 2003, at 22:34:49
Sorry I apologized for that generalization right after I made it,Under "I'll P.B.C. myself" but if you are new you wouldn't know what a P.B.C. is.. It stands for Please Be Civil, and usually Dr.Bob or a deputy uses them to let you know that under the guidelines you were not being civil.
So I gave one to myself and it was genuine, I don't like generalizations, and it was remarkably unclever. I do know better actually. Andrew Sullivan mentioned in his book "Noonday Demon"
that he was actually surprised at how many in the pharmeceutical industry genuinely wanted to help others he's fairly cynical so I trust him.Oh and the "it doesnt' Matter"
sorry that was me again, chastising myself "I agreed with what you said, why am I griping?"What you can't read my mind either? geez
Umm yeah, sorry I really shouldn't post when I'm going through a.d withdrawl its counterproductive.
Don't know the details about the why Pharmrep left, he had a few posts directed to him questioning what he was doing and then he was made conspicuous by his abscence. I didn't follow it closely until recently. Maybe it was just timing. Anyhow anything I inferred that from would be in the Nov/Dec archives. I'm sure someone, actually anyone else would be far more clear on what happened.
Sorry, my brain's been through a lot lately.
Never a dull moment when you play with your own neurotransmitters.
Posted by BekkaH on January 4, 2003, at 23:22:28
In reply to Re: Lexapro and the Pharmrep-to Gabbix2, posted by Ethical Pharm on January 4, 2003, at 22:34:49
It also seems that this Lexapro rep was very much welcomed, respected and sought out for advice. You say that he wasn't tolerated any more.
**********************************************
I objected to the pharmaceutical rep's presence from Day One, and I was shocked and disillusioned to see how many gullible - and desperate - people turned to him for advice, AS IF he were a doctor or other medical professional. It was distressing to see the blind faith placed in what was clearly direct-to-consumer advertising. I'm not absolutely certain when the pharm.rep. disappeared, but I think it was around the time that another PB member told us that she believed Lexapro caused and/or contributed to her daughter's death.
Posted by Dr. Bob on January 5, 2003, at 0:33:32
In reply to Re: Lexapro and the Pharmrep -I'll P.B.C Myself., posted by Gabbix2 on January 4, 2003, at 15:09:53
Posted by Dr. Bob on January 5, 2003, at 0:47:10
In reply to Re: Lexapro and the Pharmrep-EthicalPharm, posted by BekkaH on January 4, 2003, at 23:22:28
> Since I have noticed that you haven't responded to this site in a while, I can only assume you have been justly fired from your job with Forest! As an experienced, honest and ethical Pharmaceutical sales rep, I have to say I was astonished at the advice and "promotion" of your product to consumers over the internet and your condescending attitude towards a practicing Psych...
>
> EthicalpharmDifferent points of view are fine, but please don't jump to conclusions about others or post anything that could lead them to feel accused or put down.
> Someone that----(words escape me)needs to be taught a lesson.
>
> P.S. Dr Bob--I am trying VERY hard to be civil.
>
> boboThanks, but if you need to try hard, it may be better not to post right then.
> gullible - and desperate - people turned to him for advice
>
> BekkaHI understand that that came from concern for them, but please don't post anything that could lead them to feel put down, either.
Discussion about the pharmaceutical industry as a whole should be redirected to Psycho-Social-Babble, that about posting policies to Psycho-Babble Administration. Thanks,
Bob
Posted by ZeeZee on January 5, 2003, at 9:42:45
In reply to Re: Lexapro and the Pharmrep-EthicalPharm, posted by BekkaH on January 4, 2003, at 23:22:28
It also seems that this Lexapro rep was very much welcomed, respected and sought out for advice.
*********************************************
I too, strongly objected to his/her presence on this board from day one, and as a result received a block from posting. I was appalled by the amount of liberty this person was given in what was said, while other's of us were chastized.I agree totally with your perception of the interactions that took place and hope it does not occur again.
Posted by Geezer on January 5, 2003, at 14:01:53
In reply to Re: EthicalPharm, posted by ZeeZee on January 5, 2003, at 9:42:45
The Lexapro rep. departed this board when some kind pbabbler offered to make the FDA aware of the postings. Sorry Dr. Bob....this will be my only comment on the topic.
Posted by Gabbix2 on January 5, 2003, at 14:28:02
In reply to Re: thanks (nm) » Gabbix2, posted by Dr. Bob on January 5, 2003, at 0:33:32
Posted by beardedLADY on January 6, 2003, at 14:34:07
In reply to Re: Lexapro and the Pharmrep -I'll P.B.C Myself., posted by Gabbix2 on January 4, 2003, at 15:09:53
It really is confusing, isn't it, Gabbi?
SSRIs and ADs are not addicting. They're not habit forming. Yet if you try to stop taking them too abruptly, they cause horrible side effects.
But surely there's a difference between "gotta get more coke, gotta have a smoke," and "man, I need to score another hit of Effexor."
But once you go off these drugs, you pretty much return to the way you were before you started taking them, and that's no good, really.
Oh, well.
beardy
Posted by gabbix2 on January 7, 2003, at 21:38:06
In reply to addictive/non-addictive » Gabbix2, posted by beardedLADY on January 6, 2003, at 14:34:07
It doesn't matter if you're going through hell, just as long as you aren't bugging anyone else.
Really though, that "discontinuation syndrome"
euphemism used for the Ad's is such crap Its every bit as dreadful for me as the "withdrawl" I get from the evil Benzo's and as the side effects are worse when I'm ON the A.D's I think
the whole situation is absurd.As you said.
'Oh well"
Its not like there was ever a time we could look back on when life was fair...
Posted by fachad on January 11, 2003, at 1:38:03
In reply to addictive/non-addictive » Gabbix2, posted by beardedLADY on January 6, 2003, at 14:34:07
> SSRIs and ADs are not addicting.
Well, that depends on your definition of "addicting". If you define addiction as "strong internal incentive to continue taking the drug" then SSRIs and ADs are VERY addicting.
Posted by viridis on January 11, 2003, at 4:00:45
In reply to Re: addictive/non-addictive = double talk, posted by fachad on January 11, 2003, at 1:38:03
"Addiction" occurs when you crave a substance that causes you harm, and you will go any lengths to get it, despite the consequences (e.g., crack cocaine, heroin, tobacco).
"Dependency" occurs when you become physiologically adjusted to a substance and need it to function normally (e.g., many ADs, benzos, insulin, blood pressure drugs, caffeine).
"Tolerance" occurs when you require a greater dose of a substance to achieve the same effect you once achieved at a lower dose (e.g., most of the above, for some).
"Discontinuation syndome": a term coined by pharmaceutical companies to distinguish withdrawal from costly prescription meds (due to dependency) from withdrawal (also due to dependency) from meds that are now off-patent, and thus too inexpensive for them to bother with.
Addiction is a strong term, and really doesn't apply to most people who are using psychiatric meds for legitimate reasons.
Posted by jodeye on January 11, 2003, at 18:37:36
In reply to Re: addictive/non-addictive = double talk, posted by viridis on January 11, 2003, at 4:00:45
Thanks for the definitions.
I know what stimulant tolerance means.
But I have no idea what stimulant sensitization means.
I have read preclinical data that states memantine may prevent stimulant sensitization.
What exactly does this mean?Thanks.
Posted by viridis on January 13, 2003, at 0:52:36
In reply to Re: addictive/non-addictive = double talk » viridis, posted by jodeye on January 11, 2003, at 18:37:36
Sensitization is a process by which exposure to a substance "primes" the brain such that further exposure produces a stronger, often pleasurable response. There's certainly anecdotal evidence of this with marijuana -- quite a few people don't get high (or not very) the first few times they smoke, and then bam -- it really hits them. In the case of some stimulants, there's evidence to suggest that after a certain amount of use, the brain actually starts to respond differently, such that even the same dose may produce a more euphoric effect than previously.
Sensitization is a particular concern with respect to use of stimulants in children with ADD/ADHD; the fear is that even if the treatment is effective, it may predispose these individuals to stimulant abuse later in life. A study that was in the news in the last week or so seems to contradict this (at least with respect to behavior), suggesting that children treated with stimulants for attention disorders are actually less likely to abuse drugs later in life than peers who didn't receive such treatment.
While looking this up, I also ran across the recommended definitions of addiction, dependence, etc. on the American Society of Addiction Medicine website (these are given in a discussion of terminology that should be used regarding opiates, but obviously are intended as general definitions). They're pretty much what I described in my earlier post, but here's the wording:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definitions and recommend their use:
Addiction: Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical Dependence: Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
This is the end of the thread.
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