Practicing while under the influence of Pharma

(image courtesy of The Ethical Nag)

Just how much are physicians influenced by pharmaceutical reps bearing gifts? It’s a question recently posed in this report on Medscape, based on posts at a physician-only discussion group.

The original question seems simple enough: “Are you influenced by the ads on paper and pens?” It was asked by a family physician in a recent posting on Medscape’s Physician Connect (MPC).

What follows are several indignant responses from fellow physicians about how they could not be bought with coffee mugs or pens, “or any other gift worth only pennies at best.”

Others disagree, and the doctors debate the relative merit of the current system, with some of them acknowledging that they rely on Pharma for their continuing education:

Still other physicians argue that there is a benefit to having drug reps visit the office with samples and gifts. A urologist says, “Shutting your doors to the pharma world is limiting your exposure to new meds, new applications of old meds, and the changing patterns of insurance coverage.”

A general practitioner agrees, “How [else] would you make yourself aware of new drugs that have arrived on the scene? Read the ads in journals? Where would you get the details you need to know about the drug? How long would it take before you became aware of what’s new? When you have a question about a drug, if there were no samples and no package inserts to view, what resource would you use?”

The cost for this pharma-funded continuing education delivered to the front door of physicians’ practices?

Indeed, a meta-analysis published in JAMA in 2000 found that the estimated $8000-$13,000 spent per year on each physician does affect prescribing and professional behavior.^[1] A small study published in the International Journal of Health Services in 2009 suggested that patients, too, are aware of the pharmaceutical gifts that doctors receive.^[2] Furthermore, researchers found that patients’ approval of gifts was related to the perceived value of the gift to patients as well as its monetary value.

Eight to 13 thousand dollars, per physician, per year?   That’s a lot of pens and coffee mugs.

Articles like these reinforce for me that what is being called “health care” in the United States is nothing more than “medicine peddling”. Medical training for doctors is all about… well, medicine, which is not the same thing as health. So why are doctors referred to as “health care providers” when their training and practice is so limited and narrow?

If you need a drug, visit your doctor. If you need help improving your health, find a healer. Hint: they are not listed in your “health” insurance provider directory.