What If It Were Docs Versus Drugs?

The latest Therapeutics Letter out of Canada points out that Canadians now spend 25 percent more on drugs than on physicians. Why? Drug spending more than doubled between 1996 and 2003, while physician payments lagged. I suspect a similar study in the U.S. would find the same trend.

Moreover, the study showed that fully 80 percent of the increased spending on drugs went for so-called "me-toos," which are drugs that are no different therapeutically from other drugs already on the market. Companies bring them through the expensive clinical trial process so they, too, can have an entry in lucrative markets like pain relief or gastric distress -- hence the name, me-too.

Their conclusions? "Since most new me-too drugs are much more expensive than equally effective older drugs, they represent a waste of health care resources. Physicians collectively have the power to prevent this waste and thus free up money for other sectors of the health care system," the report said.

That suggests a powerful argument that could be addressed to those doctors whose offices still accept pens, mugs and lunchtime pizzas (today's New York Times reports on a new rule at Stanford University Medical School prohibiting these forms of marketing): If you start prescribing equally effective generics instead of the pricey me-toos, you'll lose the mugs and pens. But you might get a raise.