We expect others working in potentially life-and-death situations to have proper background checks.  Why would we not expect the same from those looking to purchase deadly weapons?

From NPA member Lenny Lesser:

Like many doctors, but not enough gun purchasers, I have some experience with background checks. When I first moved to California, I worked at UCLA. I had graduated from an accredited medical school in the United States, passed three sets of medical board examinations, and graduated from an accredited family medicine residency. Yet this was not enough to practice at UCLA. First, I had to get a background check that included fingerprinting.

I passed and received my license to practice medicine in the state of California. This was not enough. UCLA required me to get a second (slightly different) background check. When I passed this, I was qualified to practice medicine as a physician at UCLA.

This process took a few months. In the meantime I could have purchased many deadly firearms from an online website, or at a gun show.

The Senate failed to pass a comprehensive background check law. I guess the senators think physicians trying to practice in California are more dangerous than criminals who want to buy a gun.

(Dr. Lesser’s post was initially published on SFGate.com April 19, 2013)

Shahram Ahari is a former sales representative for Eli Lilly who left the pharmaceutical industry to become a public health advocate.  He has since completed his MPH at UC Berkeley, become a researcher at UCSF School of Pharmacy, testified before Congress and the Supreme Court, and will be graduating from UC Davis School of Medicine this summer to begin his emergency medicine residency in Rochester, NY.

Image taken from “How Drug Reps Size Up Doctors,” May 3, 2013, http://authenticmedicine.com/?page_id=417

For the sake of simplicity, I will translate what this data sheet means in industry terms. Its broader significance to public health and the pharmaceutical industry I’ll leave mostly to your interpretation.

First of all, the sheet catalogs the list of top 10 targets for a particular sales representative. Targets are prioritized accordingly for a number of reasons. The most common ranking metric is based on sheer prescribing volume. However, other factors come into play. Is the target a “thought-leader” – do they have an editorial role in a prominent peer-reviewed journal, or are they particularly well published?  Does the target show great resistance or susceptibility to our marketing methods?  Is the target on a hospital’s formulary committee?  All of these sway one’s “popularity” with the representative accordingly.

Second, the use of the term “target” is fairly standard despite the fact that the goal for sales representative to establish a friendship-like rapport with their clients.  It was made clear to me by a mentor that “while the doctor may be sitting with a friend, [the sales rep] is merely sitting with a client.”

Third, the graph lists whether the target is a primary care physician or a pain specialist.  In spite of selling an identical product to both types of physician, the manner in which product data is presented varies from target to target.  While there is nothing obviously wrong with that idea, it does suggest that, in the world of drug sales, how you deliver your message is more important than what the content of your message is.

Pharmaceutical sales representatives are well-trained to ferret out the reasons for a physician’s reluctance to use their product. Once identified, the goal of the drug rep is to batter that rationale until the beleaguered target alters their prescribing patterns favorably to the representative. The fourth column identifies exactly what barriers each target is putting up and it is up to the savvy yet charming representative (armed with an expense account and a multi-million dollar marketing budget) to overcome them.

There are, among doctors, the mistaken beliefs that drug representatives either provide valuable, up-to-date, objective evidence or offer only blatantly self-serving information. Neither is usually the case.  Instead, they offer reasonable yet edited information with a subtle twist so that a physician is presented only a parallax of the FDA-approved data. Typically, this means the sales representative will present the most favorable information regarding their product while juxtaposing it against their competitor’s most glaring shortcomings.  And the converse is also true: the sales representative will fail to mention his/her products’ flaws as well as their competitors’ strengths.  This is done far more pointedly when the comparison is done against the target’s medication of choice.  It should be pointed out that sales representatives receive no incentives for “educating” their targets.

The last column refers to how far along the representative is in influencing his or her targets.  Much like a 12-step program, this is an incremental behavioral modification process.  Based on the graph, Target 1 is far closer to the end of their particular “sales 12-step program” and may soon be invited to “educate” their colleagues on the merits of this sales rep’s products.  On the other hand, Target 5 is simply beginning.  It is of interest to note that Target 8’s “Decile 10” reflects how highly they rank in sheer quantity of prescriptions for this rep’s particular class of drugs.  “Good access” refers to how easy it is for the drug representative to meet with the physician.  The general rule in sales is that increased face time leads to increased sales by way of subtle rapport.

As I prepared for NPA’s recent board meeting, I thought about the email I received from a pediatrician after the Newtown shootings. The email said simply, “I’ve had it.”

That message not only represents the reaction of many NPA members (and many Americans) to the epidemic of gun violence. It also describes the moment for many of us that kick starts us from frustration to action. For me, that moment came early one morning when I was called to see a young man who had collapsed on the sidewalk and hit his head while waiting in line as a new patient. He was there because he had just been discharged from a local hospital after an admission for pneumonia, but had no way of obtaining the expensive antibiotic he had been prescribes to take after discharge. I realized that day that I would need to find a way to act outside my clinic if I wanted to see the changes I believed our health care system needs.

The NPA has accomplished a tremendous amount in its short existence. We have developed a group of articulate, well-informed physician leaders who are comfortable talking to the media, to our legislators, to the FDA, and to other policy makers about a wide range of issues that affect our patients. Whether it is access to health care, physician free speech, conflict of interest, gun violence prevention, or other pressing issues, we are committed to being there and to the role of physicians in public policy.

I am grateful to the many physicians who step forward to meet each of these challenges. For each of you, I hope that NPA is the organization that give  you the tools and the fellow physicians to speak out on the issues with which you have “had it.” If you haven’t yet found your way to connect, please write to us at npa@npalliance.org and share your thoughts.

And for all that you do for patients and to make our health care system better everyday, I thank you!

-Cheryl Bettigole, MD, MPH

The National Physicians Alliance strongly supports bipartisan efforts to reform our immigration system to create a roadmap to citizenship. However, as physicians deeply committed to addressing our country’s health disparities, we have serious concerns about the Border Security, Economic Opportunity, and Immigration Modernization Act in its current form—specifically, concerns about its potential impact on the health of immigrants and their families.

As currently constituted, the bill would require the vast majority of immigrants who are adjusting their status to purchase insurance, but to also wait at least 10 years before they would have any access to the current measures that make health care more affordable. Only those who could pay for insurance at full price could buy it. They would also be ineligible to qualify for Medicaid during that same waiting period. And even DREAMers and farm workers who are prioritized for citizenship would likely wait at least 5—7 years before having access to affordable coverage options.

Millions of people would continue to be subject to the injustices of a health care system that often charges the uninsured substantially more than those with health insurance for even basic health services. They could further be penalized because they are required to purchase insurance even though they are ineligible for any financial assistance. This would mean the continuation of the status quo, a system in which being an immigrant to the US means that preventive care is unattainable and that chronic diseases cause significant morbidity and mortality due to lack of access to simple treatments. Lack of prenatal care too often leads to increased maternal and fetal morbidity and mortality, driving up costs. Current data suggests that immigrants overall use considerably less health care including emergency department care than US citizens, but that they are also more likely to lack access to primary, preventive, and prenatal care. These care barriers include the citizen children of non-citizen immigrants.

As physicians, we see the devastating effects of a system that separates our patients into “haves” and “have-nots.” People who do not have health insurance wait too long for necessary care. They don’t get prenatal care. They skip cancer screenings. They fail to control chronic conditions like high blood pressure and diabetes until complications set in, and they lack resources to address serious symptoms until it is too late. This is a waste of human potential and a moral failing we cannot abide. To allow people to enter our country, work our farms, watch our children, and even care for our sick, yet deny them access to basic health care for themselves and their families is an act of political cynicism no American should countenance. We can and must do better. Every person in America needs access to quality health care and we need to ensure that this is the case or we will be paying the price for years.

Contact: Becky Martin
Tel: 202-420-7896
E-mail: npa@npalliance.org

PDF download

###

Uniting physicians across medical specialties, the National Physicians Alliance creates research and education programs that promote health and foster active engagement of health care providers with their communities to achieve high quality, affordable health care for all. The NPA offers a professional home to physicians who share a commitment to professional integrity and health justice. www.npalliance.org

“Today we watched the U.S. Senate cave in to pressure from NRA lobbyists—again. Many of us had hoped for better, had hoped that the lost lives of so many young children would push our Senators to act for good. As a family doctor, I routinely see families of gunshot victims, and the immense, horrific, lifetime consequences of these gunshots on victims’ mothers, fathers, sons, daughters, siblings, and partners.

Today’s vote was pitiful. A disgrace.

U. S. Senators know how to read polls. They know that the vast majority of Americans support commonsense gun safety legislation including background checks, a ban on military-style assault weapons, a ban on high capacity magazines, and increased funding for mental health. Yet they caved.

The bill that the Senate blocked by threat of filibuster had only a fraction of what Americans are asking for, but a handful of Senators shrank even from the watered down compromise before them. Those who opposed today’s bill may have earned an “A” from NRA officials, but for the American people, for doctors like me, for teachers, law enforcement officials, and for parents, they failed. Dismally.”

While the sudden loss of so many young children in Sandy Hook was heart wrenching, there are many more young lives lost in relative anonymity. The statistics are stunning. Across the country, a child is injured or killed by a gun in the United States every thirty-one minutes.

According to research from the Harvard School of Public Health, a child in the United States is thirteen times more likely to be killed in a gun homicide than a child in Finland, France, or New Zealand. In other words, living the United States is a risk factor for gun injury and death.

While we don’t live in a war zone, the numbers suggest otherwise. More children were injured by guns in 2008-2009 than the number of U.S. personnel wounded in action in Iraq. Last week, David Wheeler, a parent who lost his first grade son at Sandy Hook pleaded on CBS’s 60 Minutes, “It’s going to happen again. Every time, it’s somebody else’s school, it’s somebody else’s community, it’s somebody else’s town. Until one day, you wake up and it’s not.”

One year ago this month it happened in my community. On a campus in Oakland only eight miles from my clinic, an angry gunman shot and killed seven nursing students. Nearly all of the students killed had come to my clinic for training only weeks prior. Gun violence is not an issue in someone else’s community. It is in yours and mine.

Washington has a responsibility to help keep our children and our communities safe. Now for the first time in twenty years serious gun safety legislation will be debated. Our elected officials must have the courage to support sensible reforms like expanding background checks and limiting the size of ammunition magazines. These reforms can help transform our communities from war zones to places where newborns can safely grow to adulthood.

In California, where nearly 6,000 people are injured or killed by guns every year, there is an opportunity to take it a step further. A package of sensible bills in the LIFE (Life-saving Intelligent Firearms Enforcement) Act are under consideration. The bills include prohibiting large capacity ammunition magazines and strengthening California’s assault weapons ban. The state would prohibit firearm possession by convicted criminals and other serious misdemeanors. Together the LIFE Act is an important start towards curbing the gun violence in California. California’s legislators have an opportunity to lead the nation in protecting our children from gun violence.

A window of opportunity opened after the heavy price paid by innocent young children in Sandy Hook and many more across the country. When a rare window opens, we must go through it otherwise countless lives will be lost before it opens again. As President Obama warned a few weeks ago, “”The entire country pledged we would do something about it and that this time would be different. Shame on us if we’ve forgotten.”

Originally posted on Huffington Post April 15, 2013 at http://www.huffingtonpost.com/ricky-choi/stemming-gun-violence-a-w_b_3073586.html

Follow Ricky Choi, MD, MPH on Twitter: www.twitter.com/rychoiMD

The next step for gun violence prevention legislation is expected early next week when the Senate will take up the bipartisan compromise amendment on background checks announced on Wednesday by Senators Manchin (D-WV) and Toomey (R-PA).

A final Senate vote is not expected for another week or possibly longer. Contentious debate is expected on issues ranging from banning military assault weapons, regulating magazine size, reducing gun trafficking, improving school security, to the strengthening of background check provisions.

The threat of filibuster is not entirely gone. Senate Majority Leader Harry Reid is expected to force more cloture votes as he did today in order to keep this historic debate moving forward. Advocates are encouraged to continue to make their voices heard on this important issue during the coming critical weeks.

For more info about specific Senators who voted on today’s filibuster, check out today’s article from The Hill:  “Senate moves forward on gun control”

For more resources and action opportunities related to this important project, please visit: www.npalliance.org/gun-violence-prevention

• Read NPA Letter to U.S. Senators–Urging Vote for Commonsense Gun Laws
  (Letter to Senator Reid linked here, individualized letters were sent to each senator)
• Get involved with NPA efforts to prevent gun violence
• Share Your Story – tell your clinical or personal story about gun violence

Since the Newtown tragedy, awash in grief and bewilderment, Americans have voiced determination for action. Mercifully, the discussion is not about whether the time is right to talk about guns. Mercifully, we ARE talking about guns, and about their regulation.

The NPA views gun violence as a public health crisis, appropriately addressed through a preventive framework, and we support a comprehensive approach to this issue. Our policy recommendations include stronger regulation of guns; robust funding for research on gun violence; federal protection of clinical free speech; and improved access to and support for mental health services.  

• Get involved with NPA efforts to prevent gun violence
  & sign-up for action alerts
  
• Share your clinical or personal story about gun violence

For more information and action opportunities related to this important project, please visit npalliance.org/gun-violence-prevention

New NPA Resources on Gun Violence Prevention

• NPA Letter to U.S. Senators–Vote for Commonsense Gun Laws (April 2013)
  (Letter to Sen. Reid linked here, individualized letters were sent to each senator.)
• NPA Policy Statement: Gun Violence – A Public Health Issue
• NPA Physicians Urge Action for Gun Violence Prevention
• NPA Policy Statement: Protecting Free Speech between Patients & Physicians

Click here to preview.

NPA will ship these beautiful brochures to physicians about to share them with patients on a first-come, first served basis while supplies last.

To place your order complete this simple form and we’ll follow up!

Thanks for helping your patients learn all they can about the benefits available to them today, and those that are coming
around the corner in 2014.

In 2011 the NPA received funding through the Attorney General Consumer and Prescriber Education Grant Program to enhance the impact of our work through the Partnership to Advance Conflict-free Medical Education (PACME).  This three-year initiative is working to identify and promote best practices aimed at reducing conflicts of interest with the pharmaceutical industry. As part of this project, the NPA is:

• working to expand efforts to restore integrity and trust in the medical profession through our Unbranded Doctor Network – link to learn more

• hosting a bimonthly Avoiding Conflict-of-Interest in Medicine Leadership Development Call Series with advocacy and policy experts to provide technical assistance and leadership development to physicians and residents – link to Call Series Archive

• webcasting a series of National Grand Rounds presentations at academic medical centers to educate physicians and residents about the nature and influence of pharmaceutical industry relationships with the medical community – visit NGR webcast archive

NPA is a proud partner in the Partnership to Advance Conflict‐free Medical Education (PACME).  Our participation in these events is made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program which is funded
by the multi‐state settlement of consumer fraud claims regarding the marketing
of the prescription drug Neurontin.