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.

About 10 years ago, a drug rep I was friendly with showed me this system he used to track exactly how many prescriptions I was writing for his company’s product and all the competing products. He had this information. I did not. So when a drug rep walked into my office and asked me how much I was prescribing her product, she already knew the answer and had already tailored her pitch based on data and facts I was blind to.

A couple of years later, one company became particularly pushy and intrusive about their product. They visited my office twice a week, called, emailed, and dropped off lots of merchandising materials. I guess I wasn’t writing enough prescriptions, because my rep’s manager accompanied her during one visit to try to explain to me how much better their product was than the one that was usually my first choice. We had a polite discussion about how I made my decisions – based on studies and my own experiences with patients. The manager became peeved when I said their product was my second choice because it often caused a certain side effect. She insisted she knew better and became flustered. I firmly but politely told her that I would make my decisions based on my expertise, not her sales pitch, and told them both to leave.

The next week, I told my assistant I would no longer see any drug reps – I didn’t want to hear from them, and I haven’t since. I avoid lectures and meetings that drug companies sponsor, and I use no drug company pens or notepads. The longer I avoid direct contact with drug company reps, the better I feel about it. The further removed I am from these things the more I realize I was getting a lot of my information about medications from company reps who had vested interests in my using their product. I realized that I don’t need samples, because the companies give samples only of their newest products, and those don’t have the research or track records that the older products have. Furthermore, the older products are now available as generics, which ultimately save my patients far more money than they save by taking a few free samples and then paying for the priciest, newest product.

That isn’t to say I don’t keep informed and try new products that are appropriate for certain patients, but I do so based on research and my patients’ needs, not who bought me lunch last week.

Maybe I have just gotten older and more cynical, but I am increasingly aware that no matter what we doctors tell ourselves about being “above the influence” of Big Pharma, those companies wouldn’t spend ludicrous amounts of money on marketing to doctors if it didn’t work. Everyone likes to think they’re impartial and above the influence of money or gifts, but we are all human, and if we don’t recognize it then we become pawns in the process.

A well known researcher in child psychiatry has been infamous for championing broader and more extensive diagnoses of bipolar disorder in children – and treating younger and younger children with more powerful medications. (See my post “Bipolar Disorder Overdiagnosed in Children?“) In the last year or two, the press has uncovered his financial connections to companies that market these powerful medications – financial connections that he either did not reveal or grossly under-represented to his academic institution. Given my own evolution through this process, I was not the least bit surprised. The increased rates of diagnoses of bipolar disorder in children did not match the data and results from studies, so learning that there were other powerful factors at work made a lot of sense.

All specialties and all the medical journals and continuing education programs and training programs are beginning to evolve in the same direction given numerous examples that have been uncovered similar to the child psychiatry researcher I talked about. And yet, over and over, I read letters and editorials from practicing physicians bemoaning this process and claiming that the pharmaceutical company role is positive if we only make sure we are not unduly influenced. I believe this to be a huge blind spot among physicians that is costing all of us money and possibly harming patients. I find a great parallel here to our legislators who claim that they are not influenced in their votes (for example, about health care reform) by the companies (for example, insurance and pharmaceutical companies) that dump huge sums of money into their campaign coffers.

The big piece of good news in this story is that medical schools are eliminating drug company interactions with students. Hopefully, as younger doctors enter the field without the assumption that drug companies are important to medical education and patient care, we will see this sphere of influence die out. Pharmaceutical companies are a necessary component of the healthcare system, but they need not be a necessary evil. Unless we remain vigilant and wary of their profit motive and well researched and effective marketing strategies, we are simply their mouthpieces and unwitting tools in their campaign to make money at all costs.

I would like to know what you think… whether you are a doctor, patient, or someone who works in the pharmaceutical industry. From your perspective, do you classify pharmaceutical company freebies as generous contributions to patient healthcare, bribery, or a little of both? How do you respond to these giveaways?