Drug reps and the bribing of the modern U.S. physician

Yesterday, I was reading a fascinating inside story
about the life of a psychiatrist who became drug rep, or as some politically correct people would say -- a pharmaceutical salesperson. The psychiatrist wasn't literally selling the medications but he was providing the sales pitch that led to the sale in the end. The article raised many interesting ethical issues and brought to mind that this was a topic I had some strong opinions on yet never voiced on this blog before. So, here we go….

The bottom line to me is that the practice of giving doctors gifts in exchange for a chance to swindle them into selling a certain medication should be illegal. Told you I had a strong opinion on this. For me, it’s a matter of common sense. We are talking about people's health and treatment decisions such as medication selection should be based on the experience of the physician and objective research data. It should not be because I feel like I owe Joe the drug rep for the 10 pepperoni pizzas he just brought by to feed me and my residents.

I am a neuropsychologist and I do not prescribe medications. Despite this, in all of the medical settings I have trained in, I was always encouraged by the drug rep to attend the talk. Now why would that be? Because psychologists are prescribing medications in some states such as New Mexico and they know it is just a matter of time before this happens in more states than not. So why not build the relationships early, they figure. They do not know that I have no intent to prescribe medication one day, but there may also be another reason why they wanted me to attend. Believe it or not, physicians are always asking neuropsychologists what medication they recommend for certain conditions. Knowing this, the drug reps want to get the word out on their medication to as many people as possible. Or maybe they just want me to grab some of the promotional materials and distribute them so as many patients see these as possible and see it as a possible endorsement of the medication.

To those outside the medical community, here is the typical situation: A meticulously dressed young male or female, usually quite attractive, arrives to the hospital with a room set aside to do a talk on a specific medication. The drug rep spends time prepping the room, making sure the food is there and that promotional materials are spread out everywhere. So when you eat the food for the "Wonder-drug" you best believe you will be eating it on a Wonder-drug plate, wiping your face with a Wonder-drug napkin, and drinking from a Wonderdrug cup. You'll be taking notes with your very elegant and shiny looking Wonder-drug pen on some very fancy Wonder-drug paper. You may be slightly distracted by the Wonder-drug clock you received, or maybe you'll be busy reading the pamphlet of glossy Wonder-drug propaganda sheets you were handed about the medication. You'll hear some of the presentation, but you'll probably be distracted by going up for seconds in the lunch line since the selection of food and the quality of it is ten times better then anything the best chef can hope to serve up in the hospital cafeteria.

Physicians do not have a lot of time to read research independently, but they need to make the time. If they don't and they rely on their information from biased sources who have essentially bribed them, how are the patients supposed to benefit? If anyone thinks bribe is too strong a word, consider that there used to be (and maybe there still are) programs in which physicians can earn points for how many of a certain medication prescribed. Earn more points and you get a bigger gift, such as a trip to the Bahamas. How is that not corrupting? Is any physician doing this with bad intentions? I doubt it. But do many physicians have their eyes closed as to how they are being manipulated, however so subtly? Probably not, or if they do, the thoughts are likely minimized. Also, not all physicians attend these lunches and some are able to see through the fog. But too many are not and it those physicians that concern me. As a patient, how am I to know? The only answer is to make it illegal for drug reps to provide gift-based lunches when trying to sell a medication. Can't make it illegal. Then have the American Medical Association implement this into the ethical code. Oh, sorry, can't do that because they are making millions off providing the drug companies ways to identify physicians and their prescribing habits. Click the story in the first paragraph to read more.

Lastly, I am not opposed to drug reps speaking to physicians, but it needs to be done without any type of gifts. Just come by, let people bring their own lunches again (gasp!), do the talk, take some questions, and end any sense of impropriety.