…several commenters in the AMA thread mentioned drug costs, and Anna applauded one academic center’s banning of drug reps. Thanks for the segue, people!
I was literally weaned on drug company samples – formula given to my dad by a drug rep. He wasn’t a pediatrician, but the rep was trying to build a relationship. Now, my dad, like most of my colleagues, would have told you that he wasn’t influenced by drug reps (he called them “detail men”). He would have said that he made his own independent decisions, that he only saw the reps so he could get samples for the benefit of his patients. And my dad did read peer-reviewed journals, and he subscribed to the Medical Letter, an independent drug-review bulletin. So I grew up understanding that this was how the game was played. Getting stuff from drug reps was one of the perks of being a doc. And I took some of that stuff to college with me – anatomical models, charts and diagrams suitable for a diligent pre-med student. I probably used a drug company pen to sign the registration form when I started med school.
Then I met a drug rep in the parking lot. I had to; my residency didn’t allow drug reps to give us stuff. I’d worked with the rep from Genentech when tPA was first introduced for heart attacks, and the day we used our first dose the rep called me and said “I have something for you, but I can’t give it to you at work because I don’t have enough for everyone”. He told me he could tell I was special, since I’d worked so hard to get tPA approved at the hospital. He met me one night in a parking lot and gave me three cardiology textbooks, nearly $300.00 worth of books I couldn’t afford. I was interested in cardiology, and I had organized the effort that got the expensive and novel clot-busting drug approved for administration in the ER of our hospital. Pretty unusual for a second-year resident. But there was something wrong with getting books in the parking lot. There was something not quite right with profiting personally from work I’d done for patients, and there was something really unpleasant about this guy pretending he liked me when I knew, rationally, that he only cared about the money his company would make from the medication. This was first time I was aware of the real cost of a medication – one dose of tPA cost $2000.00. How much of that, I wondered, came out of patient’s pockets to put books in my hands?
I never did take those books out of my car. Eventually I tossed them in a dumpster. Instead of reading them, I started reading studies about the effectiveness – and the cost – of marketing to docs. I learned that a majority of drup rep presentations include false or illegal statements. I found www.nofreelunch.org and I stopped taking pens. Or memo pads. Or tote bags. I won’t eat the food the drug reps bring to my office. My staff always makes a point of telling me if there’s food in the back that came from patients, or that someone brought in for a birthday, but mostly I bring my own lunch and eat alone at my desk. I force the practice to pay for prescription pads and print out work excuses so we don’t use the forms the drug reps give us; I took down the Lipitor clock and threw out the Rhinocort tissues that were in my exam rooms. I don’t take samples for my own use, or for my family. A few weeks ago I went to a local deli for breakfast and the owner served my coffee in a drug company mug; I made her take it away and bring me a different one. I buy my own pens at Staples. My partners think I’m nuts. I try not to show what I think of their participation.
We like to think of ourselves as scientific, us medical folk. And we are committed to the well-being of patients. But we refuse to look at the evidence that the current system benefits docs and drug companies and costs patients money. Worse than that, it drives inappropriate drug utilization. Brand new antibiotics that kill off broad categories of bacteria are used indiscriminately for uncomplicated infections that can be adequately treated with older, narrow-spectrum drugs. That’s how we end up with MRSA in healthy people. Docs jumped on the bandwagon with Celebrex and Vioxx when there was never any real evidence that they were better than the older drugs for most people. It’s not scientific, and it’s not good for patients, and in truth it’s not even ethical.
I almost resigned my ACP membership when they supported the Medicare Part D plan, because it’s a handout to drug companies that does nothing at all to control costs. The ACP was responding to pressure from its membership. Apparently my colleagues aren’t yet ready to give up their free lunch.