Question:
I have recently (one month ago) been diagnosed with open angle glaucoma. I am a 48 years old, and have worn glasses for near sightedness since I was 10. My doctor started me on Lumigan for one month, and I recently checked back for another IOP test. He says it dropped a few points, but wants the IOP to be lower. He gave me two months supply of Lumigan and I will check back with him in Jan. My doctor says that sometimes it takes a few months for Lumigan to work at its best. He also found what he described as tiny cataracts in both eyes, and stated they were not the type found in elderly people. I did read the brochure that came with the first sample of Lumigan he gave me. On my second visit, I addressed my concern to him about the changing of the color of the iris. He stated, I have never known that to happen. Dr. Cohn’s statement makes me more concerned that ever. I would rather not have dark circles under my eyes or different eye color. Longer lashes, however, sounds interesting! Dr. Cohn: Why did my doctor asked if I smoked? Would this affect the potency of Lumigan, or does smoking affect glaucoma and/or cataracts in general? Regards, Ira Prince
Response:
On 27 Nov 2003 08:01:36 -0800, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->Ann B. <annREM…@pipeline.com> wrote in message <news:std1svsprm1l4o4pupsitfuat10ptpnduh@4ax.com>… >> On 22 Nov 2003 21:40:27 -0800, eyegu…@aol.com (Rick Cohn, M.D.) >> wrote: >> >Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… >> >> I’ve been using Lumigan for over a year now, and am comfortable with >> >> it. I don’t have any significant side effects, other than nice dark, >> >> long lashes. It does a good job of lowering IOP, although I also use >> >> Timolol in one eye. My drug plan just notified me that Lumigan will >> >> no longer be a ‘Preferred Medication’, meaning the prescription will >> >> cost me significantly more out-of-pocket. They recommended I speak to >> >> my doctor about using either Travatan or Xalatan instead. >> >> I’d appreciate it if anyone can give me any information about the >> >> qualitative differences if any, between these meds in terms of >> >> effectiveness, side effects, tolerance, and frequency of >> >> administration. Has anyone used two or three of these (at different >> >> times, of course 
) ? >> >> Thanks for the help!! >> >> Cheers, >> >> Ann >> >> To email: replace ‘REMOVE’ with ‘b’ in email address. >> >These three meds are all in the prostaglandin family, and they are all >> >used once a day at bedtime. They all may cause a little redness, >> >though much more so with Lumigan or Travatan than with Xalatan. All >> >may darken the iris color gradually, cause increased length of >> >eyelashes, and mild increased pigmentation of the skin beneath the >> >lower lid (making it look a little like you have circles under your >> >eyes)…I’ve had more complaints about this with Lumigan than with the >> >others. A large study by Parrish, et. al. at Bascom-Palmer Eye >> >Hosopital in Miami showed that all three drugs are equally effective >> >at controlling IOP. Other studies show Lumigan to be slightly more >> >effective, lowering IOP on average 2 points lower than the others. >> >Unless you have very advanced nerve damage and need a particularly low >> >IOP, Xalatan should be an excellent replacement. >> > On the other hand, there is little more annoying to physicians (and >> >patients) than having an insurance company dictate which medications >> >they prefer for their patients. Those decisions are made solely on >> >which company is the lowest bidder by 5 or 10 cents a bottle compared >> >to their competitor. You should make the switch, but write a stern >> >letter to your carrier telling them to let your doctor practice the >> >way he/she sees fit to help take care of you the best way possible. >> >Good luck. >> >–Rick Cohn, MD >> >Glaucoma Specialist >> >Winter Park, FL >> Dr. Cohn, I must address the issue you raised about health insurers >> determining which meds to prescribe. In general, I agree with your >> view. However, sometimes (and quite often, I’m afraid), physicians >> prescribe meds based on the perks they’re given by the drug company, >> which can in the extreme run to very expensive weekends at posh >> resorts. The increased price paid forthe drugs supports these >> practices, and it is the patient (or their insurance footing the high >> bill). My brother and his wife were the recipient of one of these >> weekends, a guest of a physician friend of his, paid for entirely by >> the drug company, and he isn’t even a physician! They sat through an >> hour presentation then had the whole weekend to play! I think large >> purchasers ie; insurers, have not only a right but an obligation to >> protect their pocketbooks (and thus, ours, since we pay for insurance) >> by discouraging such irresponsible spending which doesn’t further >> development of better meds. That said, if there is a true >> difference in the effect of a higher priced med, it should be allowed >> by the insurer. If in fact, my GS feels I should stay on Lumigan, I >> defintely will appeal this decision to the insuerer based on medical >> need. >> Cheers, >> Ann >> To email: replace ‘REMOVE’ with ‘b’ in email address. > First of all, Ann, these perks from drug companies are getting >fewer and farther between. New laws passed last July prevent >companies from giving doctors vacations, sleeves of golf balls or >rounds of golf, or anything else that is not directly related to >physician education. The way certain companies get around this is to >have teaching conferences in nice locations, of course the lectures >being mandatory attendance. > Secondly, you must give your doctor some credit…I would never >use a product on a patient in the treatment of any condition that I >felt was inferior. A perfect example is Rescula, made by Novartis. >When this came out 3 years ago, the company’s promo material sounded >great. When most of us tried it and found that it had minimal to no >effect on IOP, pretty much all of us abandoned it or moved it way down >on our list of preferred medications. Don’t you think the rep still >came by and offered to take me golfing? (before the laws changed to >prevent that)…of course he did. I let him know that he was free to >take me golfing but as long as he understood that I wasn’t a big fan >of his product and that wasn’t going to change after golf (we never >actually scheduled the outing). If your doctor honestly changes >his/her prescribing patterns based on who takes him/her for the nicest >lunch, than you need a new doctor. ALL of the companies take us for >"teaching" lunches or dinners pretty much the same. Since cutting out >all the lavish gifts to doctors, I haven’t seen drug prices come down. > Let’s not be naive here…if the company saves more money, it simply >means more profit to the VP’s in the Armani suits…it’s not coming >back to you in the way of savings. > If I have a new glaucoma patient with an IOP that I feel is too >high for the health of their optic nerve, what medication I start them >on is based on my assessment of how much IOP lowering we need, their >overall health and presence of conditions like asthma or heart >disease, their likelihood of being compliant with the medication based >on frequency of use, probable side effects, and cost of the >medication. NEVER does which drug rep is the cutest, takes me to the >nicest dinner, or needs the most Rx’s to get her bonus vacation come >into play here. To be honest, Ann, your comments border on insulting, >and if that’s what you think of doctors in general, then I would stick >with accupunture or meditation to lower your IOP, because every doctor >gets visited by drug reps and few will say no to a free lunch. >–Dr. Cohn
Dr. Cohn; I am quite surprised at your response above. You seem to have taken my remarks on a very personal level, which they were never meant to be. Cheers, Ann To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
Have used Travatan. Had so many problems with eye drops stopped. 98 years old, have honest doubts about being blind. "Ann B." <annREM…@pipeline.com> wrote in message
news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com… – Hide quoted text — Show quoted text -> I’ve been using Lumigan for over a year now, and am comfortable with > it. I don’t have any significant side effects, other than nice dark, > long lashes. It does a good job of lowering IOP, although I also use > Timolol in one eye. My drug plan just notified me that Lumigan will > no longer be a ‘Preferred Medication’, meaning the prescription will > cost me significantly more out-of-pocket. They recommended I speak to > my doctor about using either Travatan or Xalatan instead. > I’d appreciate it if anyone can give me any information about the > qualitative differences if any, between these meds in terms of > effectiveness, side effects, tolerance, and frequency of > administration. Has anyone used two or three of these (at different > times, of course ) ? > Thanks for the help!! > Cheers, > Ann > To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
On 22 Nov 2003 21:40:27 -0800, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… >> I’ve been using Lumigan for over a year now, and am comfortable with >> it. I don’t have any significant side effects, other than nice dark, >> long lashes. It does a good job of lowering IOP, although I also use >> Timolol in one eye. My drug plan just notified me that Lumigan will >> no longer be a ‘Preferred Medication’, meaning the prescription will >> cost me significantly more out-of-pocket. They recommended I speak to >> my doctor about using either Travatan or Xalatan instead. >> I’d appreciate it if anyone can give me any information about the >> qualitative differences if any, between these meds in terms of >> effectiveness, side effects, tolerance, and frequency of >> administration. Has anyone used two or three of these (at different >> times, of course ) ? >> Thanks for the help!! >> Cheers, >> Ann >> To email: replace ‘REMOVE’ with ‘b’ in email address. >These three meds are all in the prostaglandin family, and they are all >used once a day at bedtime. They all may cause a little redness, >though much more so with Lumigan or Travatan than with Xalatan. All >may darken the iris color gradually, cause increased length of >eyelashes, and mild increased pigmentation of the skin beneath the >lower lid (making it look a little like you have circles under your >eyes)…I’ve had more complaints about this with Lumigan than with the >others. A large study by Parrish, et. al. at Bascom-Palmer Eye >Hosopital in Miami showed that all three drugs are equally effective >at controlling IOP. Other studies show Lumigan to be slightly more >effective, lowering IOP on average 2 points lower than the others. >Unless you have very advanced nerve damage and need a particularly low >IOP, Xalatan should be an excellent replacement. > On the other hand, there is little more annoying to physicians (and >patients) than having an insurance company dictate which medications >they prefer for their patients. Those decisions are made solely on >which company is the lowest bidder by 5 or 10 cents a bottle compared >to their competitor. You should make the switch, but write a stern >letter to your carrier telling them to let your doctor practice the >way he/she sees fit to help take care of you the best way possible. >Good luck. >–Rick Cohn, MD >Glaucoma Specialist >Winter Park, FL
Dr. Cohn, I must address the issue you raised about health insurers determining which meds to prescribe. In general, I agree with your view. However, sometimes (and quite often, I’m afraid), physicians prescribe meds based on the perks they’re given by the drug company, which can in the extreme run to very expensive weekends at posh resorts. The increased price paid forthe drugs supports these practices, and it is the patient (or their insurance footing the high bill). My brother and his wife were the recipient of one of these weekends, a guest of a physician friend of his, paid for entirely by the drug company, and he isn’t even a physician! They sat through an hour presentation then had the whole weekend to play! I think large purchasers ie; insurers, have not only a right but an obligation to protect their pocketbooks (and thus, ours, since we pay for insurance) by discouraging such irresponsible spending which doesn’t further development of better meds. That said, if there is a true difference in the effect of a higher priced med, it should be allowed by the insurer. If in fact, my GS feels I should stay on Lumigan, I defintely will appeal this decision to the insuerer based on medical need. Cheers, Ann To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
On 22 Nov 2003 21:40:27 -0800, eyegu…@aol.com (Rick Cohn, M.D.) wrote: – Hide quoted text — Show quoted text ->Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… >> I’ve been using Lumigan for over a year now, and am comfortable with >> it. I don’t have any significant side effects, other than nice dark, >> long lashes. It does a good job of lowering IOP, although I also use >> Timolol in one eye. My drug plan just notified me that Lumigan will >> no longer be a ‘Preferred Medication’, meaning the prescription will >> cost me significantly more out-of-pocket. They recommended I speak to >> my doctor about using either Travatan or Xalatan instead. >> I’d appreciate it if anyone can give me any information about the >> qualitative differences if any, between these meds in terms of >> effectiveness, side effects, tolerance, and frequency of >> administration. Has anyone used two or three of these (at different >> times, of course ) ? >> Thanks for the help!! >> Cheers, >> Ann >> To email: replace ‘REMOVE’ with ‘b’ in email address. >These three meds are all in the prostaglandin family, and they are all >used once a day at bedtime. They all may cause a little redness, >though much more so with Lumigan or Travatan than with Xalatan. All >may darken the iris color gradually, cause increased length of >eyelashes, and mild increased pigmentation of the skin beneath the >lower lid (making it look a little like you have circles under your >eyes)…I’ve had more complaints about this with Lumigan than with the >others. A large study by Parrish, et. al. at Bascom-Palmer Eye >Hosopital in Miami showed that all three drugs are equally effective >at controlling IOP. Other studies show Lumigan to be slightly more >effective, lowering IOP on average 2 points lower than the others. >Unless you have very advanced nerve damage and need a particularly low >IOP, Xalatan should be an excellent replacement. > On the other hand, there is little more annoying to physicians (and >patients) than having an insurance company dictate which medications >they prefer for their patients. Those decisions are made solely on >which company is the lowest bidder by 5 or 10 cents a bottle compared >to their competitor. You should make the switch, but write a stern >letter to your carrier telling them to let your doctor practice the >way he/she sees fit to help take care of you the best way possible. >Good luck. >–Rick Cohn, MD >Glaucoma Specialist >Winter Park, FL
Thanks alot forthe valuable information, Dr. Cohn. I’m stocking up on Lumigan now (to the extent that I have refills left and can fill them before Jan 1). That should give me enough medicine at the lower cost to last till my next appointment with my GS in March, at which time I’ll ask about switching. Cheers, Ann To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
- Hide quoted text — Show quoted text -Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… > I’ve been using Lumigan for over a year now, and am comfortable with > it. I don’t have any significant side effects, other than nice dark, > long lashes. It does a good job of lowering IOP, although I also use > Timolol in one eye. My drug plan just notified me that Lumigan will > no longer be a ‘Preferred Medication’, meaning the prescription will > cost me significantly more out-of-pocket. They recommended I speak to > my doctor about using either Travatan or Xalatan instead. > I’d appreciate it if anyone can give me any information about the > qualitative differences if any, between these meds in terms of > effectiveness, side effects, tolerance, and frequency of > administration. Has anyone used two or three of these (at different > times, of course ) ? > Thanks for the help!! > Cheers, > Ann > To email: replace ‘REMOVE’ with ‘b’ in email address.
These three meds are all in the prostaglandin family, and they are all used once a day at bedtime. They all may cause a little redness, though much more so with Lumigan or Travatan than with Xalatan. All may darken the iris color gradually, cause increased length of eyelashes, and mild increased pigmentation of the skin beneath the lower lid (making it look a little like you have circles under your eyes)…I’ve had more complaints about this with Lumigan than with the others. A large study by Parrish, et. al. at Bascom-Palmer Eye Hosopital in Miami showed that all three drugs are equally effective at controlling IOP. Other studies show Lumigan to be slightly more effective, lowering IOP on average 2 points lower than the others. Unless you have very advanced nerve damage and need a particularly low IOP, Xalatan should be an excellent replacement. On the other hand, there is little more annoying to physicians (and patients) than having an insurance company dictate which medications they prefer for their patients. Those decisions are made solely on which company is the lowest bidder by 5 or 10 cents a bottle compared to their competitor. You should make the switch, but write a stern letter to your carrier telling them to let your doctor practice the way he/she sees fit to help take care of you the best way possible. Good luck. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL
Response:
I’ve been using Lumigan for over a year now, and am comfortable with it. I don’t have any significant side effects, other than nice dark, long lashes. It does a good job of lowering IOP, although I also use Timolol in one eye. My drug plan just notified me that Lumigan will no longer be a ‘Preferred Medication’, meaning the prescription will cost me significantly more out-of-pocket. They recommended I speak to my doctor about using either Travatan or Xalatan instead. I’d appreciate it if anyone can give me any information about the qualitative differences if any, between these meds in terms of effectiveness, side effects, tolerance, and frequency of administration. Has anyone used two or three of these (at different times, of course ) ? Thanks for the help!! Cheers, Ann To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
It would be nice if all doctors had higher moral standards than your brother, his wife and their doctor friend. There is no free lunch — somebody had to pay for that weekend, and I hope it’s not you or me, or, more to the point, some poor person going without needed pharmaceuticals because of their inflated price. I suppose there are doctors who reject such payola and others who accept it. But there’s something a bit disgusting about the way the drug companies woo the doctors, and the way some of the doctors participate. – Hide quoted text — Show quoted text -"Ann B." wrote: > On 22 Nov 2003 21:40:27 -0800, eyegu…@aol.com (Rick Cohn, M.D.) > wrote: > >Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… > >> I’ve been using Lumigan for over a year now, and am comfortable with > >> it. I don’t have any significant side effects, other than nice dark, > >> long lashes. It does a good job of lowering IOP, although I also use > >> Timolol in one eye. My drug plan just notified me that Lumigan will > >> no longer be a ‘Preferred Medication’, meaning the prescription will > >> cost me significantly more out-of-pocket. They recommended I speak to > >> my doctor about using either Travatan or Xalatan instead. > >> I’d appreciate it if anyone can give me any information about the > >> qualitative differences if any, between these meds in terms of > >> effectiveness, side effects, tolerance, and frequency of > >> administration. Has anyone used two or three of these (at different > >> times, of course ) ? > >> Thanks for the help!! > >> Cheers, > >> Ann > >> To email: replace ‘REMOVE’ with ‘b’ in email address. > >These three meds are all in the prostaglandin family, and they are all > >used once a day at bedtime. They all may cause a little redness, > >though much more so with Lumigan or Travatan than with Xalatan. All > >may darken the iris color gradually, cause increased length of > >eyelashes, and mild increased pigmentation of the skin beneath the > >lower lid (making it look a little like you have circles under your > >eyes)…I’ve had more complaints about this with Lumigan than with the > >others. A large study by Parrish, et. al. at Bascom-Palmer Eye > >Hosopital in Miami showed that all three drugs are equally effective > >at controlling IOP. Other studies show Lumigan to be slightly more > >effective, lowering IOP on average 2 points lower than the others. > >Unless you have very advanced nerve damage and need a particularly low > >IOP, Xalatan should be an excellent replacement. > > On the other hand, there is little more annoying to physicians (and > >patients) than having an insurance company dictate which medications > >they prefer for their patients. Those decisions are made solely on > >which company is the lowest bidder by 5 or 10 cents a bottle compared > >to their competitor. You should make the switch, but write a stern > >letter to your carrier telling them to let your doctor practice the > >way he/she sees fit to help take care of you the best way possible. > >Good luck. > >–Rick Cohn, MD > >Glaucoma Specialist > >Winter Park, FL > Dr. Cohn, I must address the issue you raised about health insurers > determining which meds to prescribe. In general, I agree with your > view. However, sometimes (and quite often, I’m afraid), physicians > prescribe meds based on the perks they’re given by the drug company, > which can in the extreme run to very expensive weekends at posh > resorts. The increased price paid forthe drugs supports these > practices, and it is the patient (or their insurance footing the high > bill). My brother and his wife were the recipient of one of these > weekends, a guest of a physician friend of his, paid for entirely by > the drug company, and he isn’t even a physician! They sat through an > hour presentation then had the whole weekend to play! I think large > purchasers ie; insurers, have not only a right but an obligation to > protect their pocketbooks (and thus, ours, since we pay for insurance) > by discouraging such irresponsible spending which doesn’t further > development of better meds. That said, if there is a true > difference in the effect of a higher priced med, it should be allowed > by the insurer. If in fact, my GS feels I should stay on Lumigan, I > defintely will appeal this decision to the insuerer based on medical > need. > Cheers, > Ann > To email: replace ‘REMOVE’ with ‘b’ in email address.
Response:
- Hide quoted text — Show quoted text -Ann B. <annREM…@pipeline.com> wrote in message <news:std1svsprm1l4o4pupsitfuat10ptpnduh@4ax.com>… > On 22 Nov 2003 21:40:27 -0800, eyegu…@aol.com (Rick Cohn, M.D.) > wrote: > >Ann B. <annREM…@pipeline.com> wrote in message <news:24survgajeplc0a10g9d5c1jrvpkonr2oo@4ax.com>… > >> I’ve been using Lumigan for over a year now, and am comfortable with > >> it. I don’t have any significant side effects, other than nice dark, > >> long lashes. It does a good job of lowering IOP, although I also use > >> Timolol in one eye. My drug plan just notified me that Lumigan will > >> no longer be a ‘Preferred Medication’, meaning the prescription will > >> cost me significantly more out-of-pocket. They recommended I speak to > >> my doctor about using either Travatan or Xalatan instead. > >> I’d appreciate it if anyone can give me any information about the > >> qualitative differences if any, between these meds in terms of > >> effectiveness, side effects, tolerance, and frequency of > >> administration. Has anyone used two or three of these (at different > >> times, of course ) ? > >> Thanks for the help!! > >> Cheers, > >> Ann > >> To email: replace ‘REMOVE’ with ‘b’ in email address. > >These three meds are all in the prostaglandin family, and they are all > >used once a day at bedtime. They all may cause a little redness, > >though much more so with Lumigan or Travatan than with Xalatan. All > >may darken the iris color gradually, cause increased length of > >eyelashes, and mild increased pigmentation of the skin beneath the > >lower lid (making it look a little like you have circles under your > >eyes)…I’ve had more complaints about this with Lumigan than with the > >others. A large study by Parrish, et. al. at Bascom-Palmer Eye > >Hosopital in Miami showed that all three drugs are equally effective > >at controlling IOP. Other studies show Lumigan to be slightly more > >effective, lowering IOP on average 2 points lower than the others. > >Unless you have very advanced nerve damage and need a particularly low > >IOP, Xalatan should be an excellent replacement. > > On the other hand, there is little more annoying to physicians (and > >patients) than having an insurance company dictate which medications > >they prefer for their patients. Those decisions are made solely on > >which company is the lowest bidder by 5 or 10 cents a bottle compared > >to their competitor. You should make the switch, but write a stern > >letter to your carrier telling them to let your doctor practice the > >way he/she sees fit to help take care of you the best way possible. > >Good luck. > >–Rick Cohn, MD > >Glaucoma Specialist > >Winter Park, FL > Dr. Cohn, I must address the issue you raised about health insurers > determining which meds to prescribe. In general, I agree with your > view. However, sometimes (and quite often, I’m afraid), physicians > prescribe meds based on the perks they’re given by the drug company, > which can in the extreme run to very expensive weekends at posh > resorts. The increased price paid forthe drugs supports these > practices, and it is the patient (or their insurance footing the high > bill). My brother and his wife were the recipient of one of these > weekends, a guest of a physician friend of his, paid for entirely by > the drug company, and he isn’t even a physician! They sat through an > hour presentation then had the whole weekend to play! I think large > purchasers ie; insurers, have not only a right but an obligation to > protect their pocketbooks (and thus, ours, since we pay for insurance) > by discouraging such irresponsible spending which doesn’t further > development of better meds. That said, if there is a true > difference in the effect of a higher priced med, it should be allowed > by the insurer. If in fact, my GS feels I should stay on Lumigan, I > defintely will appeal this decision to the insuerer based on medical > need. > Cheers, > Ann > To email: replace ‘REMOVE’ with ‘b’ in email address.
First of all, Ann, these perks from drug companies are getting fewer and farther between. New laws passed last July prevent companies from giving doctors vacations, sleeves of golf balls or rounds of golf, or anything else that is not directly related to physician education. The way certain companies get around this is to have teaching conferences in nice locations, of course the lectures being mandatory attendance. Secondly, you must give your doctor some credit…I would never use a product on a patient in the treatment of any condition that I felt was inferior. A perfect example is Rescula, made by Novartis. When this came out 3 years ago, the company’s promo material sounded great. When most of us tried it and found that it had minimal to no effect on IOP, pretty much all of us abandoned it or moved it way down on our list of preferred medications. Don’t you think the rep still came by and offered to take me golfing? (before the laws changed to prevent that)…of course he did. I let him know that he was free to take me golfing but as long as he understood that I wasn’t a big fan of his product and that wasn’t going to change after golf (we never actually scheduled the outing). If your doctor honestly changes his/her prescribing patterns based on who takes him/her for the nicest lunch, than you need a new doctor. ALL of the companies take us for "teaching" lunches or dinners pretty much the same. Since cutting out all the lavish gifts to doctors, I haven’t seen drug prices come down. Let’s not be naive here…if the company saves more money, it simply means more profit to the VP’s in the Armani suits…it’s not coming back to you in the way of savings. If I have a new glaucoma patient with an IOP that I feel is too high for the health of their optic nerve, what medication I start them on is based on my assessment of how much IOP lowering we need, their overall health and presence of conditions like asthma or heart disease, their likelihood of being compliant with the medication based on frequency of use, probable side effects, and cost of the medication. NEVER does which drug rep is the cutest, takes me to the nicest dinner, or needs the most Rx’s to get her bonus vacation come into play here. To be honest, Ann, your comments border on insulting, and if that’s what you think of doctors in general, then I would stick with accupunture or meditation to lower your IOP, because every doctor gets visited by drug reps and few will say no to a free lunch. –Dr. Cohn