 |
 |
 |
 |
 |
 |
 |
 |
OK, so you’ve taken The Pledge, thrown out all your drug company pens, you bring your own lunch to work, and haven’t been in the sample closet for months. But the sample closet is still there, the reps are still coming, and two days a week there is drug rep-accompanied lunch for the staff. What’s the problem? It’s your colleagues. Either they say “we need the samples” or “I’m not influenced” or just shrug their shoulders and walk away, they are not yet ready to give up their samples, goodies, or least of all, free lunch. This page is intended to help you move them along in the process and break their “drug company habit.”
“I’m not influenced by any of this stuff anyway.” The medical literature suggests that doctors’ prescribing behavior is influenced by promotion. (See: Wazana A. Physicians and the Pharmaceutical Industry: Is a gift ever just a gift? JAMA. 2000;283:373-80) Doctors who practice on the basis of promotion, meet with reps, and use information provided by them are more likely to prescribe newer, more expensive, sometimes inappropriate medications. Doctors also do not recognize that they are influenced (though they do recognize that their colleagues are). Because gifts create relationships, they can also be inordinately influential (see below). Furthermore, there are abundant data from the social sciences literature that advertising and gifts influence behavior. And lastly, one wonders why the pharmaceutical industry would throw away $20 billion dollar per /year (In the United States alone) on ineffective promotion . . .
“ Isn’t promotion just a part of our society, and gifts just a form of promotion?” Gifts are a form of promotion, and like promotion they cost money (patients’ money?) and also like other forms of promotion, they influence behavior. But there is an important distinction: Gifts, unlike other forms of advertising, create a sense of indebtedness, and a need to reciprocate. When someone does us a favor (e.g., gives us a gift), we are expected to return the favor at some future time. Notably (and most relevantly in regards to pens and notepads), the sense of indebtedness is not related to the size of the gift. This obligation begets the conflict of interest. See: Dana J, Loewenstein G.A. social science perspective on gifts to physicians from industry. JAMA. 2003;290:252-5 Why should doctors be held to a higher standard than other people? Because the doctor-patient relationship, unlike many “business relationships” is a fiduciary relationship. Doctors have specialized knowledge and are held to a higher standard of conduct. Patients trust their doctors and rightly expect their physician to act in their (the patient's) best interest. Patients should be confident that the drug being prescribed is the most cost-effective, not the most promoted. And as fiduciaries, doctors are expected to avoid conflicts of interest.
But conflicts of interest are everywhere—what’s so different about this one? While conflicts of interest are ubiquitous, that doesn't mean they are all the same or are all acceptable. Not all conflicts are financial: There are conflicts resulting from academic, political, as well as family interests. Some conflicts are unavoidable; but that doesn't make all conflicts permissible. Conflicts of interest should be avoided when possible, and the conflict resulting from the acceptance of gifts from industry is both voluntary and unnecessary.
“That's all well and good, but I need the samples.” The pharmaceutical industry spends over half of its promotional dollar on “free” samples, and for good reason: Once a physician dispenses a sample--which is usually the newest, most expensive medication--there is a good chance that this patient, as well as other patients, will be prescribed that medication at a later date, even though equally effective, less expensive medications may be available. There are better alternatives to samples, as more and more medications have gone off patent, generic alternatives are available, and patient assistance programs have become easier to use. See Samples page for more information.
“Where else am I supposed to get information about new products?” There is no longer any reason (excuse?) for doctors to rely on promotional sources--which are likely to be biased--for information. While many reps may be knowledgeable about their products, they get paid for selling, not educating, and get rewarded when their products are prescribed, not when they are prescribed appropriately. There now exist many non-promotional and less biased sources of information that can be accessed via computer or PDA in a matter of seconds. True, these sources do not come with free lunch, but physicians may just have to get used to the idea of paying for their own lunch. See Sources of Drug Information.
In sum, this is our argument:
The argument is actually the same as that made by the American College of Physicians in its 2002 Position Paper. However, the College was unable to arrive at a conclusion that didn't contradict its premises (A valuable lesson regarding the risks and consequences of drug company dependence). Some additional arguments to be made:
Some additional things you can do:
|