Physicians, drug sales

In a medical system where the reimbursement rate is set above the actual cost of drugs while reimbursement rates for physicians services, which are also set by the MHW, are set below cost (344), doctors and hospitals have depended on the sale of pharmaceuticals to make money. Profits from drug sales made up about 37 percent of the independent doctor s wages in 1987 (344). Since the Japanese health system offers few additional subsidies (outside the doctor s salaries or fees) to help clinics and private hospitals purchase equipment or maintain facilities, the sale of pharmaceuticals has become a primary source of revenue to ensure the normal functioning of nongovernmental medical facilities. With no formal method to keep track of physicians prescription habits,44 the incentive is strong for doctors to prescribe unnecessary and excessive medications (139, 163,344). 

Its unobtrusive but wide illicit diffusion is attributable in part to a reputation for being similar to—but safer than—LSD. Physicians, however often find PCP trips difficult to treat due to ignorance of the drug s identity it is often sold to the unwary as mescaline, LSD, THC, or mixed with other drugs for illicit sale. 

Finding that "elixir" in the possession of the sick, or in the hands of survivors of those who had died, led to many adventures on the part of food and drug officials, and gave them a gloomy picture of the state of health care in the nation. At the start, getting records from the Massengill detail men posed some difficulties. Most were cooperative in indicating where sales had been made and physicians samples left (23). But some salesmen proved to be elusive, and a few reluctant to provide... 

In addition, physicians may be invited to serve as a drug company consultant. These consultants are invited to a company-sponsored symposium, which is sometimes nothing more than a sales pitch for that company s products with little real interaction or consultancy. le consultants who provide genuine services... 

Sales Channels. Prescription drugs can only be purchased by the public at a pharmacy with a physician s prescription. OTC drugs are available at convenience stores. Most OTC drugs are generics. 

Upjohn claimed that documents it submitted, largely testimony from clinicians of the benefits of the drugs, demonstrated substantial evidence. Further, the prescription of the medicines by 23,000 physicians over past years demonstrated effectiveness. If the drugs failed to help in treatment, patients would object and physicians would discontinue the prescriptions. Sales and popularity of the drugs would fall. That widespread use and acceptance of the products thus met the standard of the law. 

---