Respectful Insolence

Doctors as drug reps

Fellow ScienceBlogger Abel Pharmboy over at Terra Sig pointed me in the direction of a rather fascinating and disturbing article about physicians being recruited as “thought leaders” by pharmaceutical companies. Abel’s discussion is well worth reading for yourself, but I thought I’d chime in my two cents, as always.

From a surgeon’s perspective, these sorts of “opportunities” are much different, because most of us general surgeons and surgical oncologists only prescribe a rather limited range of drugs. For example, I rarely prescribe anything other than narcotics for postoperative pain relief and antibiotics. And my prescribing needs are generally simple. Nine times out of ten, Percocet is all that I need to prescribe for pain, and a first generation Cephalosporin is fine for most surgical site infections. These are all generally available as generics; so there’s not much in the way of profit to be made getting someone like me to shill for them. Moreover, because I spend more time doing research than doing clinical work, I’m not “busy” enough. Don’t get me wrong; I’m plenty busy, just not in the way that my prospective audience would care about: clinically busy.

Surgeons like me may not be prime candidates for this sort of pharmaceutical company shilling, but we are prime candidates for ethically dubious forms of marketing by other sorts of companies: Device manufacturers. For example, in the specialty of breast surgery, I could if I wished probably agree to give talks for manufacturers of breast core needle biopsy systems or other such devices, such as the Mammosite catheter for delivering radiation therapy. I happen to like the Mammosite catheter, but I view it as still more or less experimental and wouldn’t feel right taking money to give talks on it.

There’s also a downside to becoming a pharmaceutical or device company shill. Believe it or not, other physicians start to view your pronouncements about the company’s products with suspicion. Some physicians will actually look at you as ethically compromised.

And there’s a good possibility that they’d be right.

Comments

  1. #1 dr. luba
    November 26, 2007

    Back in the day (80s), my specialty (OB/GYN) was the bane of the cost-containment folks because we used gentamycin and clindamycin a lot. Really expensive stuff in those days.

    Now we’re liked because we use….gentamycin and clindamycin a lot. Although we have added cephalosporins, all of the ones we use are generics.

  2. #2 N.B.
    November 26, 2007

    I have to wonder about the choices docs make when prescribing sometimes. We’ve got one MD around here who works at a local urgent care, and the guy has a real kick for sending his patients out with scripts for Keflex 750 mg and signing them dispense-as-written. He refuses to change the scripts no matter what his patients want, and most of them are definitely interested in switching to something cheaper. Is this an example of the infiltration of reps into prescribing practices, just a particularly hard-headed prescriber, or both?

  3. #3 Schwartz
    November 27, 2007

    I fail to understand why this is such a surprise to people. This has been a well documented problem for a long time. There have been many articles recently released by states showing how many doctors are receiving money from Pharma. (a few states have laws forcing declaration)

    If you read that article, you’ll see how widespread the practise is. And why not? These doctors are being targeted very accurately, with very effective campaigns. Pharma keeps a lot of data on the doctors, and they target the ones most likely to turn a better profit for them — why would we expect otherwise? Their mandate is to make money.

    I worked for big Pharma almost 15 years ago now, and I can tell all that has changed is that the databases are more accurate, and the laws are even more relaxed.

    It’s pretty clear, the primary driver in this area of medicine is not efficacy, but profit.

    Now, that people are starting to figure this out, why not review the number of financial conflicts of interests that are declared in committees for the FDA and CDC?

  4. #4 Schwartz
    November 27, 2007

    One other interesting thing to take from this article is the way that Evidence Based Medicine was so easily manipulated to counter the anecdotal experience of individual practitioners.

    An interesting lesson there as well.

  5. #5 abc
    November 27, 2007

    I had no idea the AMA was in on the prescription mining–that surprised me.

  6. #6 Joseph j7uy5
    November 28, 2007

    Physicians can opt out of the AMA data mining here.

    Schwartz: I don’t think the intent of this post is to express “surprise.” Rather, the intent is to reinforce what is already known about the subject, to underline it, to call it to wider public attention.

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