At Least Kiss Me First!
With physicians and the pharmaceutical industry cozily in bed together, it is the health care consumer that often feels like a nonconsenting adult who has just been violated. “At least kiss me first” is the initial reaction of those of us who are resigned to the interference of Big Business in the art and science of the practice of medicine. The statistics are disturbing, and it is ludicrous for today’s physicians to assert that their Hippocratic oath guarantees patient and provider protection against industry’s preemptive onslaught.
No physician is immune. In fact, almost all physicians, 94 percent according to estimates and surveys, have some tie to the pharmaceutical industry, whether it be something as simple as the acceptance of trinkets (for example, free pens, clipboards, calculators, or even pizzas) or something slightly more exotic, like junkets to industry-sponsored meetings in faraway places. As we all know, nothing is free in this world, and the pharmaceutical industry would not be spending upwards of $7 billion a year on such frivolities, and another $18 billion a year on free drug samples for doctors, if Shakespeare and Shylock’s famous “pound of flesh,” in the form of increased prescriptions of company-sponsored medications, were not required in return. We must ask ourselves, have our men and women in white sold their souls to the devil, or is this just the way of the world? Perhaps industry-marketing practices are nothing more than simply getting the word out about the latest advances in the pharmaceutical sector, destined to ease our suffering and make enjoyment of white picket fences and those golden years exercises in disease containment.
Actually, pros and cons abound, depending on which side of the proverbial divide you are on. One thing is undeniable, however. Each day an estimated 101,000 drug company representatives descend upon our nation’s doctors, hawking their wares in much the same way that traveling salesmen pushed their elixirs and potions, just before the turn of the nineteenth century. The unwitting public was a lot less discerning at that time, when they purchased tonics, liniments, and oils from those bards of the Old West, who gesticulated on the podiums of creaky, old, medicine show wagons. We’ve come a long way since then, and, yet, even with more education we are witnessing a revival and a return to the future. With morning stubble, expensive mortgages to pay, and waiting rooms filled to the brim with harried, hurried, and verbally trigger-happy patients, physicians seek the easiest way out. It is often much easier to acquiesce and accept the pitch of pharmaceutical reps, than to do the research and literature searches necessary to confirm the efficacy of new drugs. Indeed, industry reps have the ears of our physicians, as a minute spent with a doctor has been shown to increase drug prescription of a particular medication by 16 percent. Lending ears for a mere three minutes of time increases those same drug prescriptions by 52 percent. Wow, and to think that a common primary care physician has an average of 28 such encounters per week with drug company reps.
But are we being unfair here? Isn’t there a positive side to pharmaceutical reps and the companies they represent? Isn’t that the American way, and aren’t they just practicing the capitalism we preach? The enormous financial outlays for the marketing of new medications to physicians, up 275 percent from 1996 to 2004, are fully warranted according to industry sources, given the obvious utility of pharmaceutical marketing to disseminate education, information, or propaganda, whichever you prefer, to health care providers, in order to influence and promote evidence-based treatment decisions. Damn medical school, clinical training, experience, personal research, unbiased literature, and an objective clinical eye, it is now “the suits” who mentor.
This piece would not be complete without a further ranting and raving on the downside of such business practices. While professional etiquette and legal repercussions bar true expression of sentiment here, several points can be made categorically. When you don’t “kiss us first,” we, the public, and even doctors themselves, feel excluded from the sacred patient-doctor relationship, and we feel powerless to take ownership of our manifest health care destiny. If that alone were not enough, current pharmaceutical marketing practices are extremely costly to our slumbering U.S. health care giant, not to mention the expense of new medications versus older, generic versions, the adverse side effects that are unknown in the long term, the effects of new drugs on older patients (who have been underrepresented in clinical trials), and the prescription of medications according to company profits rather than patient needs. Need we recall the debacle of the painkiller Vioxx!
Whether you kiss us on the lips or merely hold our hands, all we are asking of our health care providers, apothecaries, and pharmaceutical companies is that you sacrifice a bit of profit for the greater good. After all, not only do you, too, have fathers, mothers, husbands, wives, sons, daughters, brothers, and sisters to think about, but also, if you do not take responsible action soon, the U.S. Congress and individual states themselves, via the Physician Payments Sunshine Act and other such pending legislation, are going to shackle your future freewheeling days. Big Brother, at times, can be a blessing in disguise.
No physician is immune. In fact, almost all physicians, 94 percent according to estimates and surveys, have some tie to the pharmaceutical industry, whether it be something as simple as the acceptance of trinkets (for example, free pens, clipboards, calculators, or even pizzas) or something slightly more exotic, like junkets to industry-sponsored meetings in faraway places. As we all know, nothing is free in this world, and the pharmaceutical industry would not be spending upwards of $7 billion a year on such frivolities, and another $18 billion a year on free drug samples for doctors, if Shakespeare and Shylock’s famous “pound of flesh,” in the form of increased prescriptions of company-sponsored medications, were not required in return. We must ask ourselves, have our men and women in white sold their souls to the devil, or is this just the way of the world? Perhaps industry-marketing practices are nothing more than simply getting the word out about the latest advances in the pharmaceutical sector, destined to ease our suffering and make enjoyment of white picket fences and those golden years exercises in disease containment.
Actually, pros and cons abound, depending on which side of the proverbial divide you are on. One thing is undeniable, however. Each day an estimated 101,000 drug company representatives descend upon our nation’s doctors, hawking their wares in much the same way that traveling salesmen pushed their elixirs and potions, just before the turn of the nineteenth century. The unwitting public was a lot less discerning at that time, when they purchased tonics, liniments, and oils from those bards of the Old West, who gesticulated on the podiums of creaky, old, medicine show wagons. We’ve come a long way since then, and, yet, even with more education we are witnessing a revival and a return to the future. With morning stubble, expensive mortgages to pay, and waiting rooms filled to the brim with harried, hurried, and verbally trigger-happy patients, physicians seek the easiest way out. It is often much easier to acquiesce and accept the pitch of pharmaceutical reps, than to do the research and literature searches necessary to confirm the efficacy of new drugs. Indeed, industry reps have the ears of our physicians, as a minute spent with a doctor has been shown to increase drug prescription of a particular medication by 16 percent. Lending ears for a mere three minutes of time increases those same drug prescriptions by 52 percent. Wow, and to think that a common primary care physician has an average of 28 such encounters per week with drug company reps.
But are we being unfair here? Isn’t there a positive side to pharmaceutical reps and the companies they represent? Isn’t that the American way, and aren’t they just practicing the capitalism we preach? The enormous financial outlays for the marketing of new medications to physicians, up 275 percent from 1996 to 2004, are fully warranted according to industry sources, given the obvious utility of pharmaceutical marketing to disseminate education, information, or propaganda, whichever you prefer, to health care providers, in order to influence and promote evidence-based treatment decisions. Damn medical school, clinical training, experience, personal research, unbiased literature, and an objective clinical eye, it is now “the suits” who mentor.
This piece would not be complete without a further ranting and raving on the downside of such business practices. While professional etiquette and legal repercussions bar true expression of sentiment here, several points can be made categorically. When you don’t “kiss us first,” we, the public, and even doctors themselves, feel excluded from the sacred patient-doctor relationship, and we feel powerless to take ownership of our manifest health care destiny. If that alone were not enough, current pharmaceutical marketing practices are extremely costly to our slumbering U.S. health care giant, not to mention the expense of new medications versus older, generic versions, the adverse side effects that are unknown in the long term, the effects of new drugs on older patients (who have been underrepresented in clinical trials), and the prescription of medications according to company profits rather than patient needs. Need we recall the debacle of the painkiller Vioxx!
Whether you kiss us on the lips or merely hold our hands, all we are asking of our health care providers, apothecaries, and pharmaceutical companies is that you sacrifice a bit of profit for the greater good. After all, not only do you, too, have fathers, mothers, husbands, wives, sons, daughters, brothers, and sisters to think about, but also, if you do not take responsible action soon, the U.S. Congress and individual states themselves, via the Physician Payments Sunshine Act and other such pending legislation, are going to shackle your future freewheeling days. Big Brother, at times, can be a blessing in disguise.
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/23/2008 05:56:00 AM
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