“Doctors must not be lapdogs to drug firms” (!) Posted by Earl Lui at 11/14/06 04:09 PM

A great article in the British Medical Journal, “Doctors Must Not Be Lapdogs to Drug Firms,” gives great examples of how drug companies get doctors to prescribe their company’s drugs. Andrea Fugh-Berman’s article recounts how drug companies boycotted a medical conference after she gave a presentation to doctors about drug company marketing tactics.

Forget for a minute (if that’s possible) about drug ads on TV. The drug industry actually spends far more marketing to doctors than it does to consumers. Those dollars go for hiring sales reps to call on doctors and for “educational” seminars for doctors to learn about a company’s drugs. Fugh-Berman’s article explains:

Corporate support of continuing medical education courses, meals, and treats are not merely our just rewards for being hardworking, dedicated doctors. The illusion that the relationship between medicine and the drug industry is collegial, professional, and personal is carefully maintained by the drug industry, which actually views all transactions with physicians in finely calculated financial terms. Drug representatives are paid to be nice to us, as long as we cooperate, sustaining our market share of targeted drugs and limiting our continuing medical education lectures to messages that increase drug sales. This is an unspoken agreement, but no less clear for being covert.

The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies. Any subject with the potential to reduce drug sales is anathema. Fair enough. He who pays the piper calls the tune. If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation.

Fugh-Berman’s article generated a flurry of responses from doctors around the world. One U.S. doctor dismissed the article’s concerns, saying the issue of drug companies influencing doctors was “an imaginary problem.” But a doctor from Australia countered that “the main barrier to progress is doctor’s denial that we are often adversely influenced by drug promotion.” Maybe it’s too bad the drug industry can’t make a pill to treat denial.

comments (3)

1 Posted by John Goeke at 11/16/06 08:47 AM

This issue seems blown out of proportion. The practice of medicine is a business like every other in America. All businesses interact with their suppliers of goods and services. Part of the marketing process is the giving of token gifts. It is a cultural means to create good will. It is no different from events created for contractors by shingle manufacturers, and is much more benign than the lobbying efforts that take place with our elected representatives in every part of our government from the local to the national. Physicians are not being asked to write prescriptions for snake oil. Big Pharma markets medications that have passed the scrutiny of the FDA and have demonstrable efficacy in treating illness. The newer medications often have the advantage of having fewer side effects or being more effective than their predecessors. The value of a medication to a physician's practice is in its efficacy with the physician's patients. Just as a contractor will not continue to use shingles that are suppose to last for 20 years and break down after 5, physicians won't prescribe medications that don't help their patients regardless of what gifts they may receive. It's just not worth it.
Physicians are a part of the marketplace. Gifting is a part of the marketplace. All professions participate in the marketplace. If you want things to change then change it for everyone. If not, then get over it.

2 Posted by Julia Schopick at 11/20/06 11:48 PM

Adriane Fugh-Berman’s BMJ article does an excellent job of exposing the unfortunate attitudes of pharmaceutical company executives who view "all transactions with physicians in finely calculated financial terms." While I find her assertions upsetting (because they are true), I find some of the responses to her article equally upsetting -- especially that of Dr. Peter Lavine, who states (in the BMJ) that her article is "dramatic and misleading," and that the problem she writes about is "imaginary."

This is hardly true. What Dr. Lavine fails to mention is that he has been widely quoted in the press as favoring sponsorships by pharmaceutical companies. In addition, he downplays and trivializes the effects gifts and meals provided by pharmaceutical companies have on doctors. In a September, 2004 "American Medical News" article ("D.C. surgeon touts own ideas for reform, gifts"), Dr. Lavine downplays the roles these gifts play, when he is quoted as saying, "I don't think people are going to change their practice parameters over a couple of steak dinners. . . "

The problem Dr. Fugh-Berman is writing about is not imaginary. Pharmaceutical companies encourage many kinds of financial ties between physicians and themselves. The recent flap that resulted over the fact that the Journal of the AMA (JAMA) published the results of studies whose physician/authors failed to disclose their financial ties to relevant drug companies is just one example. My 3-part article, "The JAMA Controversy" -- http://301url.com/jama-all --provides lots of information about that scandal. And, my site also contains links to several articles that point to similar financial ties. (Please see the links on the left side of my site, www.honestmedicine.com, under “CANCER” and “Pharmaceutical Companies.”)

So, no, Dr. Fugh-Berman is hardly imagining the problem. She is just reporting it. And doctors would do well to listen to her.

Julia Schopick
Medical Advocate
http://www.honestmedicine.typepad.com

3 Posted by freedom at 08/06/07 07:39 PM

The whistle must be blown--doctors are bought by drug companies. Entire organizations of physicians are given millions by the drug companies.

I think that the free meds and even lunches are fine. However, worse is the fact that medical organizations and societies are just "fronts" for the pharmaceutical industry as they are heavily funded by them.

I was previously employed by the National Medical Association (based in DC) which is an association of black doctors. Over 80% of all of their revenue came from the drug companies either from the convention (this year Hawaii--1st week in August) which is always held in some expensive city where doctors and familes are wined and dined or from the "journal" which is another front for drug promotion. The organization would be called and asked to speak up for a pharmaceutical industry issue and true to form, they would if they were given enough money.

This organization is supposed to represent black physicians and patients-- it really is a hoax and a disgrace. I want to be clear, most black doctors don't belong to the organization-- despite what they put in print...while I worked there only about 1,700 physicians belonged although they would put that over 20,000 were members in the publications. I think that this is a crime. However, they get millions from the drug companies.

The conferences which we had to attend as employees were filled with huge exhibits and the scientific meetings were barely attended and were usually just promotion for a drug. Each year the drug companies are paraded in and given "awards" based on how much money they gave to the organization. In the meantime, patients suffer while doctors continue to take the perks. I had to leave and am now working another organization that has absolutely no drug company influence and I can sleep better at night.