SPEAKER_01 0:00

There's this thing that happens in the medical system that is quite controversial. And it happens to us pretty regularly. We get meals by pharmaceutical reps. Absolutely. So there I feel like there's a lot of uh debate about should we have pharmaceutical reps? Are they good? Are they influencing doctors poorly? Are they cost c making the costs of pharmaceuticals go up?

SPEAKER_00 0:31

Because from my point of view, it's always funny. We talked about this on a previous episode. We had a post and I knew it was gonna go semiviral because it's just it's it's so prevalent in the world today, which is doctors are not paid in any capacity to prescribe medications. There's no the we had a post go viral on TikTok and it was just you saying that fact. Now, there's like pharmaceutical reps giving Danishes and they have to track that because of certain laws and all this kind of stuff. But it's funny the comment section was full of like, well, yeah, if you hit a certain quota of patients, you get golf clubs.

SPEAKER_01 1:07

Oh, yeah, right. No. I've not seen any golf clubs. Not yet.

SPEAKER_00 1:13

It is so fascinating to me the uh the the world of pharmaceutical reps, the world of pharma, pretty much everyone thinks is the bane of everyone's existence. And funny enough, correct me if I'm wrong, as much as you two love the power of medications, it's not the end-all be-all. And they you know as well as anyone, they're salespeople.

SPEAKER_01 1:34

Absolutely. And they're, yes, you can tell they're salespeople. And they're good at it, to be honest. They're very good. A lot of them. Yeah. Yeah. At selling their drug. So Jan is joining us today because she also has experience. Hello. Thanks for being back at Concierge Medicine of West Michigan with pharma reps.

SPEAKER_00 1:51

This is actually a fascinating one, kind of unpacking this whole episode and the dynamic of it all, is because crazy enough, I was unaware, at least from Lara's experience, that when you guys were at the big box uh hospital systems, you almost had no touch point with pharmaceuticals. Zero.

SPEAKER_01 2:09

No, we had none. None.

SPEAKER_00 2:11

See, I would have thought the same experience here was what you were dealing with at the previous practices. No.

SPEAKER_01 2:18

So the larger healthcare systems, and I don't know how I don't know that it works this way in all specialties, but at least in the primary care that we worked in, pharma reps were not allowed in the door to talk to doctors. They were hardly allowed in the building, from what I heard. Yeah, occasionally I would have to sign something to get uh continuous glucose monitor samples from that rep. That was literally my only interaction. I didn't even do that. Yeah, that was just that was one thing I did. But otherwise, we did not have reps that the any of the physicians talked to. But that changed dramatically. When you open your own practice, they all come calling. Yeah. And they want in.

SPEAKER_00 2:54

It's so funny because at the big systems, that's where they have gatekeepers where it's like you're not getting near our doctors because they actually have to make money with patients. Because that's where you actually make money. It's not from kickbacks from pharmaceutical companies. Right.

SPEAKER_01 3:08

So we have had a lot of pharmaceutical reps come a calling since we opened our practice. And I guess we wanted to talk about that experience and how it influences us, if it influences us.

SPEAKER_00 3:26

What is your experience with a pharma rep? What is from from how you re how you expect what their goal is versus how you receive that? What like how has that experience been experiencing these pharma reps at such a level?

SPEAKER_01 3:42

I mean, a lot of them will walk in the door or they will call, but a lot of them come in themselves. When you open a medical practice, they find you and they show up with pamphlets and handouts. And they want to give you all the information. They want to tell you all. And they're like, uh, I got this great med. I want to tell you all about it. And can I set up a lunch? That's typically how that goes. Yep. And they set up a lunch. If we let them. Yes, if we let them. And then they come in and we sit down and have, as David says, sandwiches.

SPEAKER_00 4:13

Sandwiches. Sometimes a salad.

SPEAKER_01 4:15

Sometimes it's a salad. I mean, we often get salads. I don't we don't usually get sandwiches, actually. They bring us food, they bring us coffee, and then we listen to them tell us all the wonderful things that their medication can do for our patients and how easy it is to get it covered. Yeah. Which is not always always happen. And I mean, I think that both you and I, the reason that we allow them in and find them valuable is because first we curate which meds, uh, which drug, which meds we allow the pharma rep to come from. Because we they need to be meds that we use. I'm not going to have a random medication I'll never prescribe. I'm not going to sit down and talk to the pharma rep. Right. So we need it to be uh relevant, relevant to what we do.

SPEAKER_00 5:00

Well, because like you just had one recently where it was dad makes this joke because it's such a rare med that it's like, why is this? How does this even come about? Which is this the disconnect the tardive disconnected, which is fascinating.

SPEAKER_01 5:14

I don't know if you've noticed. We when we've been watching TV the last couple nights, there have been ads for this drug every night.

SPEAKER_00 5:20

Yeah, and that drug is a it's the people that are on like antipsychotics. Yeah. And it makes people's faces get weird on those drugs movements with those weird movements.

SPEAKER_01 5:30

Which is not something I think most typical primary care doctors are seeing a lot of. So uh I talked to this uh drug rep on the phone and I was like, you know, we don't use, we're not gonna use this med. I think it's a waste of your time and my time, so you don't need to schedule something. And that was that. But we have other medications that we prescribe frequently, and we do find some benefit from talking to their reps. And a big reason is we do get free samples from them, which can significantly help our patients with the cost of medications. And it's it's super nice for our patients to, when they're having a problem, to be able to walk out that door after they see us with something in their hand. I can help them. And if it's an expensive medication and they want to try it and make sure they don't have side effects, it's really nice to be able to do that for free. Yeah, so they don't have to try spend the money on it, then realize they can't tolerate it, and then be out the money. And so that's, I mean, uh, that's a big one. And then understanding how to get it covered by insurance is a big help that the pharmaceutical reps do for us. Which insurances cover it? If they don't cover it, what is the process to try to get it covered? It it just streamlines the process for us and our patients to make um to make our care better. So I think there this I there are plenty of benefits that the pharmaceutical reps have. And uh I think people think that we're just getting whined and dined by these people.

SPEAKER_00 6:54

I think I think one of the funniest stories on like the whining dining part is like the okay, the uh Zetbaum guys. Zetbaum and okay. These guys are hysterical. I mean, don't kid yourself. I feel like if you're if you're promoting a drug that pretty much everyone and their grandma wants, it makes their lives really easy and fun.

SPEAKER_01 7:16

Yeah. I don't think their job is that hard.

SPEAKER_00 7:18

It's it's a pretty easy, and like they get to go around with like little little uh uh Santa Claus, like free samples. Yeah. Like you guys, I know every single one of your patients wants this. Here's it, here you go, free samples. And uh, but at the same time, I still will never forget like I don't know, it was middle of the winter. Yes, and they wanted to do a uh a dinner at the Ada Hotel after work. And you were in the depth of your relationship with Chris and and getting engaged and being with the family, and it was useless. Like you're just sitting there going, tell me this, tell me the story behind it.

SPEAKER_01 7:54

Well, I mean, they pushed and pushed. They have been trying to get us to come to a uh a dinner, a zip-bound dinner for months and months. And I kept saying no. And then, of course, I had to talk to them face to face, and they were very convincing about how this was so important, and it would be as short as possible, and it would be as convenient as possible. And they just begged you. And they begged me. So I finally gave in, but I told them I would do it on one condition. It was at somewhere in Ada because I wasn't driving anywhere, and it had to be immediately after work. I was not waiting till six or seven o'clock. Because, okay, so people that don't know, there's a lot of these drug rep so drug reps will come into the office to individual offices and talk about the meds, but then they set up these bigger events at usually restaurants in the area, nice restaurants in the area where they bring together multiple providers from different offices or healthcare systems to and they have usually a physician that works for them that speaks on the medication. And so that's what this was. And we have we have been invited to so many of these dinners. Oh, so many. And that was the literally the only one we've ever gone to. And it will be the last one that I will go to. Because Wow. I didn't know she felt so strongly. I just don't need to spend my time with drug reps after work learning about medications I already know enough about. I mean, I found it it was like I was like informative, but I it wasn't necessary. It's informative, but it didn't change anything with how I practice or what you know how I use that medication on a regular basis. No, I knew the basics. I didn't need to hear more. So though it sounds nice to be invited to a really nice dinner after work, it's really not that fun. No.

SPEAKER_00 9:31

I like to put it out there. You guys didn't invite me.

SPEAKER_01 9:34

Uh they didn't they don't let us. What? Yeah, because they they can't they can't pay for your meal.

SPEAKER_00 9:41

That's shenanigans.

SPEAKER_01 9:43

Yeah, I would have invited you.

SPEAKER_00 9:45

I felt so like the Zetbaum guy's actually was super funny too because one of the we he's he's on the weight loss trend too. Yeah. He he had lost like 40 or 50 pounds on it. We've teased about the weight loss, and we just clowned at each other.

SPEAKER_01 9:58

But I think like I don't even know if like non-clinical staff can always go to these things. Sometimes they can. Sometimes they can, but sometimes I don't think they can. So it's very, I don't know what their rules are, but they have certain rules. So anyway, yes, we do get fed. We get lunches, we get coffee, we get dinners. We do not get paid in money. And we get all of those lunches and dinners, regardless of if we ever prescribed the med or ever do prescribe the med. Yep. And I mean, I don't know how every office does this, but I know we, like I said, we really try to curate which drug apps we bring in. So we're not just like, oh, I want a free lunch. Because you know what, people, it is annoying sometimes in the middle of the day to have a drug bother you. I don't want to sit down with lunch with these people. Sometimes they're really efficient and in and out in five minutes, but sometimes they sit and want to tell you their life story. And that's not what I want to do at lunch. So um it is a strain on the time in an office. And we are conciers, we have more time with them, but in a regular office, I can't even imagine having any time to sit down and talk to the drug reps.

SPEAKER_00 11:03

Now, from the um obviously there's kind of the the good, the bad, the uncomfortable. We've kind of leaned into a couple of the pharma uh rep good side of things, like samples. Um I know when it comes to like the weight loss medications, uh, they ain't cheap. No, no. And the fact that they can give a uh one month or six-week free sample for somebody that doesn't as maybe doesn't know if they want to drop 400 bucks a month because their insurance ain't gonna cover it. So like there, there's that merit. Um uh how like what other good aspects of pharma reps of like how do they help um streamline the process in education for you?

SPEAKER_01 11:45

I mean, it is helpful when a new medication comes out that I may not have been aware of um because there's new meds coming out all the time, when I at least can hear about a new medication. A lot of times that doesn't mean I might I will be prescribing it anytime soon, but at least it keeps me up to date on some of the newer options out there. And they do uh give, I think it makes me think back to okay, what are the indications for these certain meds? It helps me kind of revisit some of the clinical data myself. And yes, they bring clinical data to us, and could that be biased? Sure. I think um if you have a good physician, they are weighing that in their decision still.

SPEAKER_00 12:28

Well, and that's where um like uh where was I going with this? The I mean that was actually one of the bad side of things, but like so the curating the indications, counterindications, um one of the things it seems that they're on the pulse of like, for example, insurance coverage. Like I'm sure they help you work through if insurance is denying somebody that whole process.

SPEAKER_01 12:54

Yeah, it is nice to have them on speed dial. So if we do have a question and are really struggling to get something covered for a patient, they are the ones that would know the best how to hopefully walk or get through all the loopholes that are needed to walk through. Sometimes it's just like the dumb administrative things, like, oh, you have to make sure you code this or you write this. And it's like if but if the med is not covered, it's not covered. They can't even fix that. There are times that it doesn't matter.

SPEAKER_00 13:21

Yeah. Now, what's what's also fun to realize is being on the other side of this for a year now, understanding, for example, for me from a marketing standpoint, knowing all the anti-kickback laws, all this kind of stuff that we've had to learn, one of my favorite strategies in marketing is compensate for results. Like I know we when we work through like marketing strategies, I'm like, if we can create a deal with a marketing company where we just give them a 5% kickback of new members, new patients coming in, why is that a problem? Like, they're not medical professionals, they're just helping us market. This sounds like a win-win, but because of all the all the laws of anti-kickback, you it's illegal. And it's been frustrating to me because I'm like, that just seems like a pretty straightforward thing, but you can't do it inside like the reason why I'm bringing that whole full circle uh of like, no, there is no compensation for pharmaceuticals. How often on a day-to-day basis with your patients are you actively working on lifestyle to get people off medications?

SPEAKER_01 14:25

Every day. We prefer not to prescribe any.

SPEAKER_00 14:29

Yeah. And like, how's that process actually? I mean, this is a little tangent, but how's that process been being in a in a concierge side of things? Have you, with the added time and focus with patients, have you seen some success on helping patients work through some of those lifestyles to help pull them back on medications?

SPEAKER_01 14:49

I I mean, we definitely have, but I would also say that I think sometimes people underestimate how big of lifestyle changes have to be made to make the difference that would take them off the medication.

SPEAKER_02 15:01

Yes.

SPEAKER_01 15:02

And so sometimes it's just a lot of education of like, well, those are really great changes, but it's not going to move the needle very far. Or not enough, at least. Or not enough. And so there is a lot of that that happens too. But I know Jana had somebody that was on a medication for years. What med was that?

SPEAKER_00 15:21

Like a thyroid med.

SPEAKER_01 15:23

Yes, I had a patient who was prescribed thyroid medication in her early 20s when she was trying to get pregnant, has been on it for 15, 20 years. We went back, we talked through everything, and I realized that the reason she was on it was probably not because of Hashimoto's thyroiditis, which would be a make it a chronic medication, but probably had to do with her um restrictive eating. So we stopped the medication, rechecked her labs, and they're completely normal. She was no longer restrictive. Because she was no longer restrictive eating. And so she was on a medication for close to 20 years that she didn't need to be on. And that one, it was probably fairly like not or fairly benign for her, but it's like, but she shouldn't be on it, get a med for that long. Yep. And so uh yes, we're very happy to do those things. So I don't know why people think that we're just trying to push medications all the time.

unknown 16:14

Yeah.

SPEAKER_01 16:15

So not only like the count like going back to your question about are we counseling people to get them off meds, yes, but we also have time to dig into why they were on it in the first place. And then again, like that example, maybe realize that they don't actually need the medication for that. Yep. There's also a lot of people that actually want to stay on their meds. Yes. I mean that might be a shocking statement to some people, but there are people that like their medication. Yep.

SPEAKER_00 16:41

Now we kind of laid some of the the good aspects of where pharma reps come in capacity. The bad ones. Like where you kind of alluded to a big one, which I think is very true, is pharma reps are there to sell.

SPEAKER_02 16:56

Yep.

SPEAKER_03 16:56

Yeah.

SPEAKER_00 16:57

So they'll it at least pharmaceutical companies have to have some data to justify their drug versus supplement companies and all these wellness influencers need nothing other than testimonials. And they can sell their drug. At least there's a little bit of better support there. Um cherry picking studies. How often are you put in positions uh where you know this pharma rep is probably cherry picking a study to justify? Has that happened quite a bit?

SPEAKER_01 17:26

It happens sometimes. And sometimes you like ask a question, call them out, and you're like, oh, they don't know what they're talking about. That does happen. Or not even just cherry picking, but I know data can be um it can be presented in ways that looks better or it looks worse. And I'm not one to know in three seconds with the data they show me how correct? How robust that data actually is. Um and so I just take it for a grain of salt and say, you know what, yes, there's probably a benefit, like they're saying. Is it as great as as they say it is? Well, maybe not. I'll go back and look later. Um, but I'm not taking everything they say for gospel. No. No.

SPEAKER_00 18:09

Yeah, it's like it's like one of dad's uh things with uh contrary to public belief. I would find it funny where even last time we talked with dad, um, even the end of the podcast episode on interventional cardiology, he alluded to some of the statin st uh studies. Yeah, he did. And he he remembers going in these battles with these pharma reps going, yo, absolute versus relative risk direction. What you're talking about is so minimal that it's negligible. Like if you want to do it, cool. If you don't, don't. And I'm not gonna do it. And I remember dad would talk about he'd get in these little scuffles with these pharma reps telling him he needs to have more and more people on statins. And he's like, you show me this study, I'm reading it, you are massively inflating what this claim is actually saying.

SPEAKER_01 18:58

It's like, of course they're doing that. They are trying to sell a product. So we're well aware of that when they're here. Yeah, and I think there, I mean, there is some data that shows that there is, you know, increased cost of meds because of pharmaceutical reps, and there is increased prescribing rates. Now, how that breaks down, I don't fully know. Because yes, I mean, if I have if there's like three different meds that are all indicated for a condition, and I have a rep for one of them and they give me a sample, am I more likely to use that sample? Yes. Yeah, absolutely. But that's not because that one's better than the other two. It's a very reasonable choice between all three of those. And yeah, the rep happened to come in. So you're right, I probably will prescribe that one slightly more. So what's other draw sometimes? Yeah. What rep. But it's not that if a patient wants a different med, that's fine. I don't care.

SPEAKER_00 19:44

Yeah, because like uh this one came up a lot on our uh comment section of that post that went viral, which is like there's the the ProPublica's dollar for docs database, which is like just so we're like there is a public database for every doc that you know every single dollar who is who is paying who is gifting in anything that's financially like lunches, dinners, travel, consulting fees, whatever, doesn't matter if you if a doctor is receiving anything from a pharmaceutical rep and technologies, it has to be public knowledge. Now, big numbers sound scary, but I had to break it all down because that's the how this works. Over a 10-year time period, pharmaceutical companies spent 12, just over 12 billion dollars on whining and dining and all this kind of stuff to doctors. Okay. And out of 800,000 doctors, 56% received compensation or gifts or whatever term you want to use. First off, you said this, which means 44% aren't receiving any gifts. Anything. So you immediately go, you see these big numbers, and it's like almost half of all doctors never receive any gifts. Like that's what you experienced at a job. And then of that 56% of 800,000 doctors, so 450,000, that's$1.2 billion a year. Sounds pretty big. Pretty big. That's$2,600 a year. Okay. That's$51 a week.$51 a week out of all pharma and all these groups, whining and dining, a doctor who more than likely is making a quarter million to a half million dollars a year.

SPEAKER_01 21:31

And let's be real, most of those people are not getting the$51. Because I know what is also included in that. And this is not, I don't think we have we're not going to go into uh the pros and cons of physicians taking on roles to speak for pharmaceuticals. I that's a whole nother topic. But if you are hired by a company as a physician to speak on the medication, that will go into that number. And you can make money doing that because you are hired by the company to do that.

SPEAKER_00 22:00

percent of doctors, I looked this up.1% of doctors make uh over over a hundred thousand dollars a year from speaking engagements and consulting to big pharma.

SPEAKER_01 22:10

Which okay, if people are those actively clin like clinically A lot of them are a lot of them are clinically practicing, but they also they I know people that speak for meds because they feel strongly about the meds being very helpful for their patients, which I mean I know you feel like there's a bias here and so that's fine. I do. See crazy enough people. Again we're not getting into that. We're not getting into it.

SPEAKER_00 22:28

We're not going to detail but but again it's like even me, like I think there is an issue there.

SPEAKER_01 22:32

But but to say like doctors are paid by pharma to prescribe meds, that's not the same as a physician is being paid as a employee or a consultant to speak for them. I mean that that is not the same thing. So yes do physicians get money from pharmaceutical companies yes but that's that those things do not equal each other. I also want to say that if if some of that money isn't includes like the$51 per physician includes lunches that they're given. It does a lot of times the doctor isn't even eating the lunch and it's their staff. Yep I was I was gonna bring out a ton of times the staff is who are getting the the food not the doctor uh two days ago someone came in with donuts uh uh guilty you ate one did you eat my sour cream donut because I noticed that it was gone no I don't think that was him I think other people ate that one I didn't eat donut though he looks really suspicious I didn't do it yeah exactly so it's not always the doctors or the prescribed I did not eat a lot of those donuts but they did get eaten I think is the point. Yes. So it's not it's not that the$51 is going directly to the doctor it's it's going to the entire office a lot of times. And I think they like to provide that for their staff. It's like hey well this is great that you're happy that my staff gets free lunch. That's great.

unknown 23:56

Yep.

SPEAKER_00 23:57

All right we're gonna pivot this to we kind of hit a lot of the main talking points story time.

SPEAKER_02 24:03

Yes.

SPEAKER_00 24:04

Who's got some fun stories because obviously this was a completely new thing to me. I thought for sure uh pharmaceutical reps had their time uh in your previous practices but that's not true. So that's actually kind of an eye-opening experience. So either of you guys have some fun stories either good bad or kind of just goofy on experiences of pharmaceutical reps.

SPEAKER_01 24:26

One time our dad was here because dad steps in a lot he brings us coffee he's not a rep though he should he should be that that should be compensation we should put him in the sunshine we should yeah um so he came in and was giving us coffee and then the rep came in and then we all sat down together and we chatted and my dad learned all about this this medication and uh we had a grand old time. Yeah I think that was fun. So so patient education right there right? Yeah exactly for the rep. So that was good. Do you have any I mean I just enjoy every time our Zephon and Mandara reps come in because they're hilarious. I laugh so hard. I mean it's like a a comic show. It's they know all about our lives and that you got married and I'm getting married and they know David and you've got a relationship with them. They are hilarious. So it's it's a good time it it puts a bright spot in the day. So it can be kind of fun at times. But then like you said there are some like there is a um uh a lady who sometimes comes in and I was like I don't want to have a long conversation with this lady so I sat down and I was like okay great what are your updates? Give me your updates and she started to proceed to tell me all of her personal life updates which is not what I was asking for. I guess I should have been more specific. Um but then I had to hear all of her rather sad stories about how bad her life was going before we got into the updates for the meds. Makes you want to sell to buy uh to prescribe her medication these people are salespeople but some are definitely better than others.

SPEAKER_00 25:52

Yeah I mean I've experienced that too like when you people walk through the door you can tell who's well who's good at what they do and some of them are like used car salesmen and some are not so much that way. You have uh an a a fun or a unique one.

SPEAKER_01 26:06

I will say it's kind of funny that sometimes there's a rep that comes in multiple times for one medication and then all of a sudden they show up with another medication and it gets very confusing. They switch jobs all the time and it's just hilarious that like all of a sudden there's a new person for this med and there is also the first rep is is selling a different drug and then sometimes two of them show up at once and I feel like they're fighting each other as like the that actually is hysterical.

SPEAKER_00 26:33

That's gonna actually happen quite a bit two pharmaceutical reps come at the same time like why are they covering the same territory?

SPEAKER_01 26:40

I'm I'm so confused. I have no idea we don't need two this is probably why pharmaceuticals are too expensive.

SPEAKER_00 26:46

Well actually this but this goes off of one that I find funny. We've had this pharmaceutical rep come in two or three times now.

SPEAKER_01 26:51

He only came in today with the new blood pressure med because there hasn't been one in whatever walk me through this because this is well so he came in I don't know last week or the week before and he gave me this flyer for this new med for blood pressure that hasn't been a new blood pressure med in I don't know how many years and he was all excited about this. I'm like great what's the name of the med oh we can't tell you that yeah and I'm like oh okay well that's very useful. Um but I got all the pamphlets on this med, which then that is where uh they could save some money is I just throw away all these pamphlets that they give me. I cannot keep all the pamphlets. But uh so he did that and he's like I would love to set up a lunch for like when this med is out. Okay, fine. So he set the lunch up and then he came in today with the same pamphlet that still doesn't have the name of the med on it to drop that off again. So I miss both of these visits. All of a sudden there's a pamphlet on my desk and I looked at it I was so confused because there was no donation name so I turned to Lara and I said what is this for she said oh it's a med without a name yeah not very useful.

SPEAKER_00 27:48

The flyers went straight to the trail you just but now you know there is a med coming out you're very excited for the name and this and this is like some of the the thought process of a physician okay new med. Cool. Money money money money it's gonna cost more it's gonna cost more expense is there any comparative data that this med is better than any of the cheap generic ones on the market?

SPEAKER_01 28:10

Well that's the thing so this one I know what class of medication it is and there already are medications in that class that are very cheap. Let me tell you if if this does the same thing as those I am definitely using the cheap ones. And even if it lowers blood pressure another four points systolic is that really that relevant for$400 more dollars a month?

SPEAKER_00 28:31

Probably not probably not yeah and that's and that's where things get really fun where it's like uh the the power of truly knowing biostatistics, knowing this kind of front there's a lot of people that talk a big game on the internet that have never learned absolute relative release reduction how to all the science biostat stuff I enjoy it. He's a nerd I'm a nerd and uh it is so funny to me where occasionally that does come up I'm sure where maybe it's not even worth it while you're talking to a rep.

SPEAKER_01 29:03

Oh it's yeah but I don't I then you're gonna be there too long.

SPEAKER_00 29:07

Actually no I have a story that I know both of you are going to get lit up on of a rep wasn't a pharma rep, but it was a tech rep who had the electric bioimpedance can you guys walk because it made you both say you were obese or something?

SPEAKER_01 29:24

No only Lara did it. He only allowed one of us to try it.

SPEAKER_00 29:28

All right walk me through this again.

SPEAKER_01 29:30

Oh that was a while ago let's think comes in so you do this whole test thing you have you have monitors on your arms and legs and pressure coughs and and different bioelectrical impedance yeah and then they give you like a report and it said that uh did it say that I was obese it said you were I think it said you were overweight even though your BMI is not in the overweight so my BMI is for everyone to know is 23 and a BMI of 25 and above is considered overweight. And this report literally told me I was overweight and then it also told you based on whatever data it collected that you have pots. And um not going into what pots is but like I do not have pots like you have no pot symptoms you're not it also told me I should like exercise less or something. No it told you you had poor exercise capacity. Oh yeah it said I had poor exercise capacity and anyone who goes to my gym with me knows that that is not true. Absolutely not she has excellent exercise capacity and has a fantastic engine. So that's true.

SPEAKER_00 30:35

So um I we did not purchase this device as you may imagine it's you if you add this device it's it's all these and and you make money doing it.

SPEAKER_01 30:45

Absolutely not this we are not here to sell products to people that they don't need. No. Now especially if it tells you incorrect so I told him like I'm sorry you cannot recreate what BMIs are considered overweight. Like you can't just decide on your own for your company and he did come back and tell us that he told the like owner of their company that they had to change that. Yeah and he said they were going to change it.

SPEAKER_00 31:08

Because it's ridiculous you can't start telling people they're overweight when they're not so contrary to public belief when these different reps of technologies and like come in you're putting on the concern of is this effective just as much as anyone.

SPEAKER_01 31:25

Absolutely and I think we learned you know from when we opened our practice and we had like very few patients coming in initially right and we're just like we just want to get our name out there. We want to you know meet people do things and so we were pretty open to any type of rep, I think when we initially opened and then I mean it becomes very clear very fast that it can be very much a waste of time to meet with people that you know you're never gonna buy their product or use their product or prescribe their med. And so we have we've learned how to then utilize the reps that are actually going to be helpful to our patients not to us but to our patients. To help them get the care they need. And are there bad doctors out there that are trying to get free stuff sure but like the vast majority of the peop doctors people are going to are they're trying to help their patients.

SPEAKER_00 32:18

Well I mean we could we could talk about the past I experienced it. You did I didn't see this is always a funny pun. So back in the day they called it like the triple D's it was doctors, drugs and farm Ds and there was a uh golf trip back in this was like the 90s back when there was a lot more whining and dining compared to today and dad would go on these golf trips to up north or whatever and the pharmaceutical reps would pick up all the tabs and it'd be tens of thousands of dollars um and it'd be like a golf trip over like play 18, 36, 18, then come home. Funny enough dad was a horrible golfer so half the time he didn't want to go just because it was not even fun to do.

SPEAKER_01 32:57

Not how to play golf in your bad.

SPEAKER_00 32:59

Yeah. And um but one time it was like the second to last year they were doing it some doctor dropped out and they had an open spot and I think it was I think I was back into college maybe it was right in that time period and dad was like hey we have an extra spot you want to go? And I was like sure so I ended up going on this trip and it was on the back end where the the pharmaceutical reps couldn't pay the amount that they used to because all the laws were changing and all the rules were changing. And so but it was like yeah back in the day there was a lot more uh questionable payment strategies. Again it wasn't cash.

SPEAKER_01 33:38

Well that's the thing they're still they were not being paid to prescribe.

SPEAKER_00 33:42

No that's my they did it way more back like they they they were incentivized. They were incentivized Well the whole thing to me was you can argue no one can argue that guys it wouldn't influence you? Well no and like someone can question getting paid to go on a trip is questionable in like how much of influence that's gonna have anyone being honest is a grilled chicken salad from Panera going to affect your prescription pattern. Not not really like stop like it's like it's because it's so funny to me because that is such a known behavior in every industry. Like how many times I mean even for me in Bunker Social and in these different capacities I'm having um general contractors and uh architects go, hey, let's go out for dinner and they pick up the tab. Like of course like and it's no one questions it at all because that's just part of this whole process. People don't like it, but it's building relationships, it's having fun and someone's gonna pick up the tab. But a doctor getting a Danish everyone loses their friggin' minds.

SPEAKER_01 34:48

If someone's out there and they're like I can show this person literally got cash to because they prescribe this med, tell me when it happened but that's not happening. Plus the the reps come in before we prescribe like it's even if we never prescribe it they still come back. You know what I'm saying? It's not like they come in and say I saw that you prescribed this here's your donut. No they're just bringing donuts and coffee because that's their job.

SPEAKER_00 35:11

And then it's like the the classic one people always bring out because it's off that it's like the whole Purdue pharmacy and Oxycotton fiasco. And it's like all right first off let's let's unpack that if you people that aren't aware a pharmaceutical company named Purdue Pharma they fraudulently uh held information about their clinical trials on their opiates is addictive nature and they manipulated data which obviously that's illegal from the RIP. Yes, they had these pharma reps that were ruthless and then there was these doctors that ended up losing their medical licenses and going to prison for creating pill mills in like the like the like the areas of like Kentucky and North Carolina and stuff like and like South Carolina those places over there and people went to jail and people lost medical licenses over a horrible situation that it was that perfect storm of the like you guys experienced the other side which is eight eighties and nineties medicine dad talked about how it was suck it up buttercup. You got pain ibuprofen sorry like but then it was like nineties early two thousands pain is a is a vital sign and you have to deal with that. So then it was like okay here's a company that said illegally that their drug is not addictive it was and it created this momentum of everything that came from it.

SPEAKER_01 36:41

Yeah if people do things illegally then we do have issues. Yeah and it's like but there's nothing illegal about pharma reps coming in. Yep at this point. And again we aren't paid by pharma reps to prescribe medication. I wonder how many people are gonna say that I don't know I wonder how many times I wonder how many people are gonna come out of this and say that we are how many do you think are you show me how show me and don't tell me that someone got a a limo ride somewhere that's not that I've never gotten a limo ride.

SPEAKER_00 37:12

Yeah I know this so another comment was uh I was a some office in California and their uh pharma reps or their reps whatever the term was uh used to give them two hour lunches and then have a limo pick them up and do all day massages at like a physical therapy place. And then I come back to you guys and I'm like guys we're getting we're getting class B pharma reps because we ain't getting massages.

SPEAKER_01 37:40

No massages. Yeah massages are still not cash for prescribing I'd also like to put it out there going like who has the time for that? Well I know I don't want to take a two hour lunch sorry I have I have work to do. I really want to know what kind of if that person listens to this I want them to let us know what kind of office was that I'm so curious.

SPEAKER_00 37:57

On three we're gonna we're gonna guess which uh specialty this probably came from if it is even real one is this like a legit specialty longevity medicine no say say if if any group is gonna be able to have the time for two hour lunches and get get a private limo to get massages which specialty do you think that probably is happening to on three we're gonna say it one two three cosmetics like surgery oh save God said and probably a cash base office I thought for sure cosmetic surgery I'm like yeah that's what I was thinking too not to we're not gonna I was not dissing dermatologist I just uh because they see a ton of patients so they probably can't take two hour lunches no that's what that was my thing because I I understand why you thought that but I was like they don't got time for that no I think I was thinking more in the aesthetic aesthetic realm but same concept yeah but I don't know I just it's just funny all right final thoughts your experiences with pharmaceutical reps the process um I guess one thing as we kind of close this out since you've experienced both sides of it how would you like it changed?

SPEAKER_01 39:14

Like is there anything um in the process right now with how you're experiencing pharmaceutical reps that you like wish was actually different I I this isn't really that big of a deal but I do wish they would just not bring in all their paperwork like it's not useful. It clutters things up I don't give it to patients.

SPEAKER_00 39:32

Maybe some offices do I don't know I I just see you guys throw away pamphlets every single day. Save the trees save the trees the trees and then I mean I don't and I would say I don't think these are necessary do I think I need a farmer rep absolutely not do I find them somewhat useful at times for my patients yes they could just fill me samples that would be fine I guess we try to avoid them when they stop by like I don't want to talk to them I think it happens all the time I will admit like front desk when if when some rep comes in I'm like you said so uh last thoughts on farmer farmer reps your experience anything last I think if we know anything uh the Zetbound guys gotta figure it out they're just funny they don't they don't they don't take it too serious I think if anything it's the pharma reps that kind of take things too serious.

SPEAKER_01 40:28

Sometimes they try like they feel like you feel like they're trying so hard to convince you of something and I'm like I mean you stop stop you don't need to try that hard just tell me what the med is what it's for and let me go from there.

SPEAKER_00 40:43

Well hopefully you guys learned a lot about the experience of pharma reps and medicine and uh it's not as glamorous as what people think it is. They could upgrade their Danishes the okay the one last thing I'll say is the amount there was a period of time where the amount of reps that were coming in with um the cookies. Crumble cookies there was a period of time where we were just getting crumble cookie after crumble cookie and I went and we had an episode where I had I we ate them and I bought more because I thought it'd be funny for the episode of the nutrition and I realized how expensive a crumble cookie is.

SPEAKER_01 41:17

Yeah how much are they?

SPEAKER_00 41:18

They're like four bucks a pop.

SPEAKER_01 41:20

Oh yeah because it's like it's a huge cookie yeah it's just crazy to me.

SPEAKER_00 41:23

And so you buy like four cookies and it's like twenty some dollars and you're like what is this?

SPEAKER_01 41:28

But you can cut them into little quarters.

SPEAKER_00 41:29

Or you eat the whole thing.

SPEAKER_01 41:31

Or you can cut them. It doesn't over six days.

SPEAKER_00 41:34

But it's one cookie one portion control. Right? No one cookie we're never gonna have the it does seem like pharma reps do things in phases.

SPEAKER_01 41:46

Like it's always at the same what can we bring this we do not and oh this is but this is one thing to know we can request what we want. Yeah it's really I do not want Jimmy Johns every day. In fact there were one person brought Jimmy Johns and we didn't eat it. One person brought us Chick fil A which didn't get eaten either.

SPEAKER_00 42:03

So we we was I not there that today I I don't know I would have ate the Jesus chicken.

SPEAKER_01 42:08

So I mean I also like to support my local businesses so we ask for food from local businesses. So we're actually supporting more than just pharma we're supporting the local businesses there's a way to make that positive you hadn't known us today right?

SPEAKER_00 42:22

Yeah I mean we bought that for Amanda's birthday that was not our rep in the past the pharmaps we have done that well great conversation guys got some great value out of this and learned you got to see behind the hood of the dynamics between doctors and pharma's pharma reps and it's not as glamorous as you think.

SPEAKER_01 42:40

And we'll say this is from a primary care perspective. Yes. I don't know what other specialties deal with this is really just from our perspective too yeah I know but I'm saying I I assume it's can be different different specialty it could be yes and I would love anyone who disagrees that we are wrong disagrees with us and says we are wrong to please give specifically not just say we're wrong. Yeah that's just give some specific examples of when um then when you know that doctors have been paid by pharma. To prescribe to prescribe yes I would like to I would like to know about it.

SPEAKER_00 43:12

Because we both agree that's not a good idea. I'm a huge advocate of conflict of interest in thisone is paying for your knowledge base and if you're getting a secondary kickback that's going to influence your decision making that's a problem.

SPEAKER_03 43:27

Big problem.

SPEAKER_00 43:28

Like I think we all agree with that. Like if that was actually happening inside of medicine the majority of doctors would be like no not acceptable behavior. Can't do that. Because you do have conflict of interests does seem to be less and less of an important value in a lot of people in a lot of different industries. Like well they don't disclose their conflict I mean I do recommend this product. I do make money doing it. Like that's so just normalized on social media and all this kind of stuff that no one even I I say it constantly if anytime I'm partisan something where I have conflict of interest, I n I need everyone to know.

SPEAKER_01 44:04

Yeah, which they should. Cool. Thanks everybody.

SPEAKER_00 44:07

Have a phenomenal day and we'll talk to you all later.

SPEAKER_01 44:09

Bye.