Obviously the total number of doctors who attend a lecture is much higher than the number who give lectures. Lectures come in many sizes from those given to hundreds of doctors ( usually these are at symposiums where pharma is not providing any food etc to the doctor) to smaller meeting hosting only a handful. I can’t really give you a good figure on where the mean is though except that my experience at the dozen or so I have gone to over the past 23 years is that most are attended by 10-20 doctors. That may simply be due to the fact that I don’t often travel to places where they would have large meetings.
While it would be naive to believe that people are not influenced at these meetings I think its a lot like any sort of marketing. Some people are heavily influenced, others mildly so and some not at all by the message. I tend to be an inherently skeptical and suspicious person ( hence my time here). I don’t trust a source unless I can verify it. Other people are more than happy to accept what they hear as gospel if it seems to be coming from a friendly somewhat reliable source.
Patients ( consumers) are equally if not more vulnerable to this sort of marketing. I am deluged daily with men asking about “Low-T” because they saw the ads on TV and are convinced this is their issue. Patients also ask almost exclusively for Viagra even though there are two other drugs that actually work better. Name recognition is everything in marketing and that’s the biggest reason pharm markets to patients and doctors because they know we are more likely to ask for or prescribe something that is familiar.
As far as the amenities, as I said earlier there are strict limits on how much can be spent to provide food at a meeting and to whom. Since the rules changed about 10 years ago doctors are not allowed to bring a spouse, family member, or any member of their office staff who is not a doctor. A meal can be provided but as I also mentioned it may be provided but that is where it ends. There was a time when the meeting could take place at a ball game or a show but that is no longer permitted and rightfully so. I just wish the people in washington who passed these rules applied the same rules to themselves.
Regarding your question about psychotropic drugs, This requires the longest answer and I will try to organize it as best I can.
First of all anyone who is an MD can prescribe these. Obviously you don’t want to limit this to psychiatrists since there are no where near enough psychiatrists as it currently stands to treat all of these people, and many patients who need help refuse go to one. The vast majority of meds that are used for these conditions are used to treat depression and anxiety which are not difficult conditions to recognize or treat in most cases. Due to the way our health care system has evolved, the way professionals are trained and the way reimbursements are designed psychiatrists (MD’s) rarely provide what you would think of as psychotherapy or talk therapy. They use meds as their primary tool. Psychologists ( PhD’s) do most of the psychotherapy and are not allowed to prescribe at all. Because their skills are so labor intensive ( an hour is an hour is an hour. You can;t work faster and squeeze more patients into an hour session), many psychologists do not accept insurance. Because of all these limitations the lions share of people with psychological disorders are diagnosed and treated by their primary care doctor. 99% of this is depression and anxiety though. Patients with bipolar disorder and schizophrenia would almost exclusively be treated by a psychiatrist.
Why is there such an increase in the number of people being treated? I hate to sound like a broken record but this is multifactorial answer. I’ll list as many as I can think of.
* Public acceptance - psych illness used to be kept in the closet. People suffered and wouldn’t go to the doctor or admit they had a problem because it as deeply stigmatized. That has changed a lot in recent years. We can all have misgivings about pharm marketing but one of the positive things that comes out of it is that it can also make something seem normal that was previously snickered about. Before Viagra came to market men almost never admitted to me that they had ED. now its common and no one seems embarrassed. I think the same is true for psych disorders.
* Public awareness - As the public becomes more aware of what to look for many people may be gong to the doctor for depression who previously thought they were just sad and had to suffer through this sadness. This has resulted in more legitimately ill people being treated but unfortunately has also led to a lot of people being treated with meds who might be able to work through their problems easily on their own.
*We have a tool we didnt have before -Obviously if you don’t have the tools to build a house not a lot of homes get built. If we don’t have meds to treat psych illness not a lot of people will be treated. Prior to the development of Prozac 20 years ago the only meds we had for depression and anxiety were less effective and had far more side effects and drug interactions. Prozac and the drugs that came after it changed that.
*There are few alternatives - psych illness is difficult to treat with non medical means Its time consuming, It requires the help of highly trained expensive professionals, and its inconsistent in its application and results. Primary care doctors are not trained to do psychotherapy nor do they have the time so they have few options when treating a desperately depressed or anxious patient then to offer them medication especially if availability to psychotherapists is limited.
*Marketing - both to patients and to doctors. No doubt this is playing a big role in both good and bad ways. Marketing affects usage because it influences the factors mentioned above. The more you hear about a treatment the more the doctor and the patient will become comfortable talking about the disease and accepting the medication as a solution. It also may lead to over usage if it becomes the cur all for every anxious or sad individual. If society is unwilling or unable to pay for other forms of treatment then we have no other option.
I think we all need to look at ourselves too. I find these days that an awful lot of people are unwilling to wait for things to get better on their own, whether its a cold, a back ache, or depression. A lot of people also have difficulty accepting the changes that come with age. When thats the case many people look for an easy answer and something that works quickly. The result is often a prescription.
From the viewpoint of the physician, time is money and non-med psych care takes a lot of time. The invention of managed care 20 years ago forced physicians to find ways to see more patients in less time. If a patient comes in with a complaint of depression and I spend 15 minutes with him and write a prescription I may get paid $50. If I spend an hour talking to him about the problem I get paid $50 or maybe $65. When it costs nearly $170/hr just to pay the overhead to run the office you can see pretty quickly why physicians are under intense pressure to try and provide the best care they are able to in the least amount to time they can. If we aren;t trained to provide psychotherapy, are forced to treat most psych illnesses rather than refer them out, and aren’t given the opportunity to spend the time we would need with the patient the only option is often to use medication.