Portal de Periódicos da CAPES

Gifts and Integrity

2006; Lippincott Williams & Wilkins; Volume: 28; Issue: 12 Linguagem: Inglês

10.1097/01.eem.0000288894.89044.58

1552-3624

William H. Vederman,

Pharmaceutical industry and healthcare

Editior: I stopped expecting some decades ago that our “medical leaders” would do anything positive for the rest of us, but I find I'm still staggered when they take it into their heads to make up problems to belittle us. (“Medical Leaders: Industry Marketing Undermines Physicians' Integrity,” EMN 2006;28[6]:1.) To the best of my knowledge, there are only two studies that remotely suggest that drug company perks have a corrupting influence on target physician prescribing practices. One, cited in the article, notes an increase in the prescriptions written after the doctor sees the sales representatives. Isn't the most probable interpretation of this that the physician now knows the drug in question exists and has at least some useful attributes? The other is a European study that suggested that doctors under the influence of sales representatives may (my emphasis) make decisions “not in the patients' interest.” The objective drug testing capabilities of other advanced nations with a thousand years of civilization can't be trusted when deciding whether to release drugs here despite 30 years' experience there, but apparently that nebulous wording from the same countries is actual proof in this matter. Where is realistic, direct demonstration that drug rep contact causes physicians to ignore scientific facts known to them and robotically follow the dictates of the drug detailers in any significant way except in the minds of our leaders? Despite this, our leaders feel free to characterize adult men and women of exceptional accomplishment as categorically unable to escape mental enslavement caused by a pen with a logo or chicken dinner. Kenneth Iserson, MD, makes his view of the comparative intelligence of his charges painfully clear when he asked, “Do you really think the folks who run the pharmaceutical companies are stupid,” meaning, of course, too stupid to bamboozle the idiot residents? The residents, meanwhile, are of a generation that was subjected to 10,000 commercials by age 5. It would seem likely that they are more able to ignore commercial messages than their venerable “leaders.” If advertising and glad-handing are so influential, we should be using them to defeat urban crime and to convince the combatants in the Middle East to call it quits. It's not just the lunacy; it's the hypocrisy. A chicken dinner to improve the life of the poor wretch working 80 hours per week in the bowels of the hospital should be prohibited and the occasional free drug samples for everyman likewise. Our leaders are compelled to note that “it is easier to disclose [financial conflicts of interest] and then proceed as though [they] did not exist” where resident perks are concerned. Not in their own cases, though. The article noted that “although the leaders did not call for prohibiting consulting or accepting research support, they did advocate more transparency about the relationships…” Apparently, because they work only 40 hours a week in the more brightly lighted areas of the hospital, the fancy office buildings, and the adjacent tony restaurants, they may be better able to see through the three-card monte game being visited on them by the crafty drug reps. Finally, there's the sheer bloviating. Samuel Keim, MD, noted, “I think the time is extremely short for the profession to make some changes before the public trust is dramatically altered. Then I see the possibility of legislation.” In decades of practice, no patient has ever voiced an iota of concern about the baleful influence of drug reps to me; no patient has ever suggested that drug samples are some kind of mind control. Doctors getting a free pen or meal (just as the patients occasionally do) is possibly number two million on a list of things patients worry about. If there is ever legislation on this issue, it will be because our own Torquemadas have created the issue and demanded vengeance, and for no other reason. If doctors at any stage of their careers can't stand up and say unapologetically that they are entitled to enjoy a few harmless perks when the pilot and his family get free plane rides, every professor gets his kids in tuition-free, and every waiter eats at a discount, they must have hostage syndrome. Small wonder their “leaders” have contempt for them. William H. Vederman, MD Oakland, CA