When I was a medical student we used to have “Liver Rounds” at the hospital on Friday afternoons – a happy hour, keg, and pizza party, compliments of some pharmaceutical companies. Variations of this continued throughout my internship and residency. Later, as a practicing psychiatrist, I would see drug reps in the office and used their pens and pads and ate their lunches. Colleagues and I would often remind ourselves that we needed to see the reps because they gave us samples of medications we could give to our patients. We reassured ourselves that we wouldn’t change our prescribing habits based on the gifts we received.
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TPG
9:35 am on
January 7th, 2010Accepting a free dinner from a drug company rep, or a trip to a conference? Wrong. Agreed. Don’t do it.
Not accepting samples of drugs that you can use with your patients to see whether an actual prescription is in order? Also wrong. Prescriptions can cost a ton these days. If you have the opportunity to save a patient a significant amount of money by having them try a pharmaceutical before buying it, why wouldn’t you do everything you can to make that happen? If the sample has its intended effect, great. If it’s ineffective, you’ve just saved the patient — and, by extension, the insurance pool or Medicare or Medicaid — a significant amount of money.
Floyd Pennington
9:14 am on
January 8th, 2010Nice recounting of your experience but there is a role, perhaps an obligation, for industry to provide evidence based information to the medical community about the safe an effective use of their products. One place his can occur is in independent CME activities (not marketing information or “educational” events) – even those that receive industry support. Take a look at some factual informaton that CME providers are providing to help address some of the real concerns related to industry support of CME.
I have spoken to a ton of doctors and after getting them to be 100% honest, they said that all these gifts from drug reps do influence which medications they prescribe.
With disorders like bipolar disorder it’s even worse because many times the best medications like lithium don’t have drug reps and are UNDER prescribed in my opinion.
Great blog! Pharmaceutical companies are masters at using the psychological principles of influence as detailed in Robert Cialdini’s book, “Influence: The Psychology of Persuation” (Harper Paperbacks). The principle you are mainly referring to is known as reciprocity. When given things, people have a virtually innate, not always conscious, desire to reciprocate.
As you may know, there’s been a trend toward states opening up prescription privileges to psychologists who obtain a couple of years of extra training. Without taking a position per se on that trend, I will say that I have substantial concerns that many in my profession are rather naive about pharmaceutical companies adroitness at manipulating the principels of influence.
Carnas
6:51 am on
January 12th, 2010@TPG: The free samples are great until someone suffers a major, possibly fatal, side effect and then the pharmas will just lie, bullshit, and wash their hands of the affair. A major side effect can cost a lot more then a prescription in terms of time, damage and maybe even life.
I had some major side effects from a well known and highly prescribed SSRI. My body clock turned day into night, and in the middle of summer I was wearing all my winter clothes AND a think winter coat and still shivering my backside off. That isn’t beneficial to one’s mental well being.
Before anyone cries “bias”, patients are just as bad for not asking questions before eagerly popping about 18 different pills down their necks. Many conditions, like ADHD, can be managed without drugs it’s just that a lot of people don’t want to put the time or effort in and want some sort of magical wand to be waved. To some respect this can include the system.
SS
9:34 am on
January 12th, 2010Thank you Dr. Fink. I was so relieved to see this article and see someone, a medical professional of all people, finally admit to the power of the drug lords. My own experiences with meds have been horrible and I truly doubt the drug companies’ claims that most of their products work for their intended claims. Their greed is only going to further diminish any chance we on the patient end have for getting better. And for some of us, there wasn’t much of a chance to begin with. I think you made a wonderfully smart decision to avoid all drug reps or drug company sponsored events. I wish more doctors would follow suit and do the same.
TPG
10:42 am on
January 13th, 2010@Carnas — With all due respect, your argument is an argument for better FDA drug testing, not an argument against samples of approved drugs being provided to doctors for their patients. In a perfect world, no one would ever, ever have a bad reaction to any FDA approved medication. Alas, we do not yet live in a perfect world. I myself found myself with a 1-in-150,000 bad pancreatic reaction to a common prescription diuretic, a reaction that was potentially life-threatening but from which I thankfully recovered. Honestly, I don’t blame the doctor who wrote the scrip or the drug company that made the diuretic. I blame very bad luck.
Kelly
2:52 am on
September 27th, 201017 years of sitting in doctors waiting rooms watching the reps do their song & dance, circles of bipolar friends, and medication blogs about this topic, has made blatantly clear that doc’s are all too often being bribed.
I am a seasonal bipolar patient, and I have had a number of occasions where I been prescribed medications ( same medication as their pens, calenders, trashcans, and staplers advertise) that are geared towards the manic phases, when I am clearly in a depressive state. What happened to treating the patients current symptoms? Appeasing the beautiful drug rep in her couture wardrobe & eating the Steakhouse lunch she brought in for the entire office is not benefiting my state of mind. The free flight to Bali is not making my mental health anything but more detrimental.
Instead; Saying thanks for the stapler, and then focusing on my symptoms could have saved me from …. myself.
A very good article about how Big Pharma have evolved, their roots and mindset is outlined in ‘Return To Nuremberg: Big Pharma Must Answer For Crimes Against Humanity’.
It makes very interesting reading.
Dr David Hill
Executive Director
World Innovation Foundation Charity
Bern, Switzerland
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