Bioethics Discussion Blog: Drug Company Gifts to Doctors:Prescribing Under the Influence

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Saturday, April 16, 2005

Drug Company Gifts to Doctors:Prescribing Under the Influence

E. Haavi Morreim's article "Prescribing Under the Influence" in the publication of the Markkula Center for Applied Ethics of Santa Clara University clearly provides realistic examples of the influence of pharmaceutical companies "gifts" to doctors. If you don't yet know what has been going on to get physicians to prescribe and advertise their drugs, please go to the site and read her entire article. The excerpt from the first part is posted below. ..Maurice.



Gifts to doctors from drug companies have implications for patient interests.

It’s morning report in the Department of Pediatrics at an academic medical center. A senior faculty member is working through a case with a group of residents and interns. "First we saw these symptoms. Now that the laboratory results are back, how does that change what we think?"

In the back of the room, there’s a table with bagels and juice. On the table is a supply of pens, notebooks, and little stuffed toys, all with a pharmaceutical company logo prominently displayed. Next to the table is a representative from the drug company.

When you ask doctors whether this kind of drug marketing is effective, the answer is always the same: "It doesn’t influence me at all. They’re not going to buy my soul with a laser pointer." In a recent syndicated newspaper column, one doctor commented, "I blame the pin-striped MBAs, who mistakenly believe that physicians are going to prescribe certain medicines because the company plies them with pens."

The truth is, the physicians may need to reconsider. This kind of advertising is crucial to sales. A doctor is not going to prescribe something he or she has never heard of, and it’s the drug representative’s job to get the products’ names in front of the physicians. Maybe the drug representative does that while the resident is slathering cream cheese on a bagel; maybe it’s while the intern is saying, "Oh, what’s this cute little stuffed bear?" Either way, the doctor stops and spends a moment.

In private practice, the little gifts are often even more important. If you’re a drug representative, physicians are usually not interested in talking to you unless you have something to catch their attention. Then you can get your three sentences in: "We’ve got such and such on the hospital’s formulary now." Or "The new form of this drug can be given once a day instead of four times a day. The patients will love it." It’s a way to get in the door so that your information rather than somebody else’s reaches the doctor’s brain.

5 Comments:

At Tuesday, April 19, 2005 8:53:00 AM, Anonymous Mark Little said...

As a patient, the cheesiest thing I've seen are the rolls of paper for the examining tables with logos on them. As far as I'm concerned it's just a billboard shill for the drug company.

A pen in the pocket is pretty subtle, but the paper is in-your-face shouting about your flexible ethics.

 
At Tuesday, April 19, 2005 9:49:00 PM, Blogger Maurice Bernstein, M.D. said...

I would worry most about the physician who would apply the paper to the patient examining table. ..Maurice.

 
At Wednesday, April 20, 2005 8:18:00 AM, Anonymous Anonymous said...

For the average doctor-the one most of us have access to-how much education about new medications actually comes from the companies that make the drugs?
5in9years

 
At Wednesday, April 20, 2005 4:19:00 PM, Blogger Maurice Bernstein, M.D. said...

To Anonymous: I would estimate "much". Of course there are journal articles and clinical review articles (some written by researchers with ties to the drug companies), but these are usually late. after the new drug has gone public for a while. The information about the indications (uses) and toxicities of the new drug is provided to doctors by the medical journal ads and by the drug detail men and women. There is also information for physician who access various Internet resources but I am not sure whether they are all objective without pharmaceutical companies writing up their products.
There is also some education for physicians by word of mouth by other physicians who have used the new drug.

I have not prescribed new drugs. I usually wait a year or so and if they are still on the market and would be cost/benefit/safety effective for the patient then I would prescribe them. By this technique, I have avoided exposing patients to serious side-effects of drugs, undetected at the time of release, but later taken off the market. And I don't think I have denied any patient an essential medication for their health which couldn't be substituted by one with a longer history of efficacy and safety.. and cheaper! Remember, new drugs are usually much more expensive! ..Maurice.

 
At Wednesday, April 20, 2005 6:20:00 PM, Anonymous Anonymous said...

Truly frightening, but that was my point. Few doctors are as cautious as yourself, and an astonishing number don't appear to read any current research, based on their practice. Something is really wrong with a system in which education is provided to the person who usually decides (because, face it, most patients defer to their physician's judgement) whether someone will ingest/apply/inhale a substance that is potentially harmful by the company which made said substance and stands to lose significant amounts of money if it is not used.
5in9years

 

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