Drug companies, dollars, and doctors

Pediatrics for Parents, April, 1992 by Richard J. Sagall

The advertising activities of pharmaceutical companies have been making the news with great, regularity. Their methods of influencing physicians' prescribing habits have been criticized. The expensive gifts, trips, and even cash "honoraria have been cited as being nothing less than bribes to reward doctors for prescribing a company's products.

My first encounter with drug company gifts was during my first week of medical school. One company, I forget which one, was giving out stethoscopes. Every student got one -- each inscribed with the company's name. Later we received books, reflex hammers, and other "educational" items. During residency they gave out endless pens, pads, books, and "usefull" items. They also sponsored speakers and provided meals.

Once I entered private practice I saw many more detail people (pharmaceutical company salespeople). They come into my office trying to convince me that their drugs are better than their competitor's. They still leave endless pads, pens, and other give-aways.

These activities alone wouldn't draw the attention of any investigator. But there were all-expense paid trips to conferences sponsored by pharmaceutical makers. The meeting is advertised as educational, yet there is concern that the information is slanted to make the drug company's product appear to be the best on the market.

I have to confess that I went on one of these drug company-sponsored Junkets. In the middle of the Maine winter, the offer of an all-expenses paid, three day trip to Tarpon Springs, Florida sounded nice. The topic was of interest to me, so my wife and I went. The lectures were actually quite good and not very biased towards the sponsor's drug. (I can honestly say I don't remember which ulcer medication was being pushed.) But I felt funny during the trip -- somehow I was compromising myself.

Another interesting approach which the drug companies have used was to pay doctors $100.00 plus a meal for two hours of their time to listen and evaluate marketing brochures. The presentations were softsell, but I was never sure if they were really interested in my opinion on their marketing approach, or if it was a sly way to make me aware of their product's superiority over the competition. (Since payment for attendance is now considered inappropriate, doctors are offered textbooks, medical equipment, or subscriptions to medical Journals that, coincidentally, are worth around $100.00.)

Each doctor has to decide how to best deal with drug companies and their marketing efforts. I listen to the detail people and see one or two a day. They present some new and interesting material and help keep me abreast of new drugs. (Everything the detail people say and all the printed information they leave has to be approved by the Federal Drug Administration.) I take what they say with a grain of salt because, even though they have to tell the truth (as determined by the FDA), they don't always have to tell the whole truth. When they try to convince me to use their drug as opposed to a competitor's (which is probably very similar) important facts are often omitted.

Perhaps the most important reason that I listen to the sales talks is to get the samples. Sampling is a big part of drug promotion, and perhaps, the most useful aspect of the process. It allows me to give patients a drug before they spend their money. The patients can try the drug to make sure that it's effective and doesn't cause any reactions before buying it. For some patients with little or no money, I have enough samples for the entire treatment. I don't think it's fair to the pharmaceutical companies to take their drugs without listening to their sales pitch.

What do I do about all the goodies they give out. I accept most of them. Some are educational (medical books, patient handouts and information sheets, etc). Some are useful around the office (endless pens, pads of paper, paperclip holders, etc.) Sometimes they bring food or even supply a lunch for my office staff in exchange for a few minutes of my time.

I have stopped going to the compensated dinners. Even if they give "educational materials" instead of cash, it's really not very different. I think the allexpense paid trips are a thing of the past, but even if they are still around, I wouldn't go on one again.

Pharmaceutical companies have the right to market their products as they wish. Physicians are the people who have to decide what is reasonable marketing and what is really bribery or payola. Richard J. Sagall, MD Editor