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Indio, Ca. del 16 al 22 de Septiembre, 2016
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GENERAL
Local Casino plans major remodel
ugustine Casino has been a locals’ favorite for more than 14 years now. After all these years of wear and tear, the Augustine Band of Cahuilla Indians felt it was time to upgrade its guests’ experience. As a result, this Fall the casino is undergoing a dramatic transformation. The tribe announced this week that it is launching into a full-scale remodel. The entire casino, inside and out, will be improved with new paint, carpet, wall-covering, lighting, signage and more. While
the bulk of the project will commence Monday, Sept. 19 and continue through Sunday, Oct. 16, the exterior work has already begun. In order to expedite the project, during the major work phase Augustine will temporarily suspend casino operations. The casino will temporarily close to the public on Sept. 19 at 3 a.m. Plans are to reopen in 30 days. “We are very happy to have partnered with world-renowned casino architects I-5 Design to refresh Augustine Casino
and create a beautiful retreat in the desert for our locals,” said General Manager Jef Bauer. “Rest assured, when we reopen, we will continue to operate in our 14-year tradition—offering locals the very best value on the loosest slots around, a great dining experience and the friendliest team in the valley. I promise we’ll hurry and, soon, it will all be available in a brand new beautiful casino environment. “ To learn more about I-5 Design visit www.i5design.com/ Design.Plan.Build. About Augustine Casino: Augustine
Casino features approximately 800 of the most popular slot machines as well as table games including Blackjack, Three Card Poker and Ultimate Texas Hold’em. Open 24 hours, Café 54 offers a casual dining experience as well as daily and nightly buffets. Augustine Casino is nestled in the shadows of the beautiful San Jacinto Mountains, just three miles east of PGA West in the Coachella Valley. 84001 Avenue 54 in Coachella. For more information call (760) 391-9500, or visit www.augustinecasino.com.
Doctors Aren’t Selling Out for Sandwiches A JOEL ZINBERG
recent study in the journal JAMA Internal Medicine shows that drug companies are bribing doctors with food to prescribe their expensive, brandname medicines. At least that’s the way it’s been reported in the media. Dig deeper into the study, however, and it becomes clear that doctors aren’t selling out for sandwiches. There’s no proof that industry-sponsored meals drive prescribing behavior. In fact, the relationships between pharmaceutical sales representatives and physicians may actually benefit patients. The study reported that physicians who received even one industry-sponsored meal were more likely to prescribe the brandname medicine that was being promoted. Receipt of additional meals was associated with greater increases in relative brandname prescribing rates. And receipt of costlier meals was associated with increased target drug prescribing for 3 of the 4 drugs
studied. These findings were based on flawed methodology. The study examined physician prescribing over the entire year of 2013 but only looked at meals provided in the last 5 months of 2013. As the authors conceded, “The findings reflect an association and not necessarily causality.” Indeed, it is hard to fathom how lunch in October could have persuaded a physician to prescribe a particular drug the previous February. The overwhelming majority of the studied physicians did not receive any industry-sponsored meals promoting the studied drugs. Among those that did, nearly all had a single meal. The notion that the pharmaceutical industry is buying off physicians en masse is hyperbole. So are reports of industry largesse. The average values of the sponsored meals for the 4 study drugs ranged from $12-$18 -hardly lunch at the Four Seasons. When the authors arbitrarily set the threshold for expensive meals at $20 they presumably
found costlier meals were associated with increased prescribing. But this claim was based on “predicted probabilities” for selected physicians who are most likely to prescribe rather than actual probabilities for all physicians. And close examination of the study graphs only showed significant differences in prescribing based on meal cost for 1 of the 4 drugs, not 3 out of 4 as claimed by the authors. This new study is not the first to connect drug industry gifts and physician prescribing behavior - an editorial accompanying the study cited 2 recent publications. But the link was as tenuous in those studies as in this new one. The first was a 2011 Massachusetts study which found a positive association between industry payments and higher rates of prescribing brand-name statins. But it was only significant for physicians who received at least $2,000 from industry and the effect was miniscule -- for every $1,000 in payments received, the brand-name statin prescribing rate increased 0.1%. In the second study, ProPublica looked at 2014 contemporaneous payment and prescribing data and found that physicians who received any kind of industry payment, even just meals, had higher rates of brand-name prescribing. But the study didn’t link payments for specific drugs to increased pre-
scriptions for those drugs. Nor did the study link payments by particular companies to increased prescriptions of those companies’ drugs. As ProPublica’s authors acknowledged, “We have not established a causal link. There is certainly a plausible reverse causation here -- that drug companies give money to physicians who already are heavy brand-name prescribers.” Physicians who eschew interactions with pharmaceutical representatives could be under-prescribing brand-name drugs and harming their patients. Industry-sponsored meals are merely an entry point for drug representatives to present product information to physicians. If that presentation is truthful there is no harm. The new study’s authors admitted, “If events where industry-sponsored meals are provided affect prescribing by informing physicians about new evidence and clinical guidelines, then the receipt of sponsored meals may benefit patient care.” There are many reasons brand-name drugs are prescribed. Well-fed physicians are not among them. Joel Zinberg, M.D., is a visiting scholar at the American Enterprise Institute. This article first ran in The Hill: http://thehill.com/ blogs/congress-blog/healthcare/291913doctors-arent-selling-out-for-sandwiches
East Valley Republican Women Federated
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