Drug Company Dependent?

Peter Jhon

Disclosures

July 13, 2001

Introduction

Do you drink your morning eye-opener out of an advertisement-emblazoned coffee mug? Is there a medication logo on the pen you're using? Bob Goodman, MD, an Assistant Professor of Clinical Medicine at Columbia University in New York City and Director of the organization and Web site nofreelunch, wants to know if you have a problem that affects almost every physician in the United States: drug company dependence.

In a lecture to students at the 51st Annual Meeting of the American Medical Students Association in Anaheim, California, in March 2001, Goodman raised concerns about the $15 billion that pharmaceutical companies spend each year on promoting their products. He believes that the free materials distributed by these companies push physicians to make biased decisions when prescribing drugs.

Programs for doctors such as "Dine and Dash," "Gas and Go," and perks ranging from free Christmas trees to pedicures have been offered by pharmaceutical companies in order to entice doctors to listen to pitches from sales representatives intent on influencing physician prescribing patterns.

"Doctors are too busy to sit and have dinner with drug representatives, [so] the physician will order food from a restaurant and go to pick it up," said Goodman, describing a typical "Dine and Dash" scenario. "The rep will meet [the doctor], pay for the food, and talk to them for 60 seconds.' It is this type of behavior that just shouldn't happen, but it has become a part of the culture of the profession. It is seen not only as acceptable, but as an entitlement."

Although medical students do not yet have the authority to prescribe drugs, pharmaceutical companies target them because they have an entire prescribing life ahead of them. An informal survey of the roomful of medical students revealed that approximately half of the students had been approached by pharmaceutical representatives and had received some form of gift.

Jamie Morano, a 1st-year medical student from the University of Tennessee, noted, "The only way pharmaceutical companies can get people to attend meetings is by offering food. People will just take the food, but they won't remember the company. Medical students feel like they've pulled one over on the company, because they don't care about the talks."

Although Morano's statement reflects the sentiments of most students and physicians who do not believe that receiving perks will affect their decision-making skills, research indicates, that doctors do change their habits after receiving gifts.

For example, investigators conducting a study published in Chest in 1992,[3] which monitored pharmacy records pertaining to 2 groups of physicians that were scheduled to travel on drug company-sponsored, all-expenses-paid symposia to various resorts, found that members of the group prescribed these medications more often after the symposia. These increases were not consistent with the national prescription patterns for hospitals of similar sizes and locations.

Indeed, the amount of money that pharmaceutical companies spend on drug promotion is more than their budgets for research and development. There is approximately 1 drug rep and $100,000 spent for every 11 practicing physicians in the United States. In 1998, Merck and Pfizer increased their spending on details (free drug samples) by an average of 12%, as well as increasing the number of their sales representatives by 60% from 1994.

Goodman noted, "The fact that the pharmaceutical industry is spending billions of dollars would suggest that they know what works."

Another problem arising from receiving material from drug reps is that the information they provide is not just biased, it is sometimes inaccurate. In a study published in JAMA in 1995, investigators analyzed the statements made by drug reps at various lunchtime conferences and found that 100% were favorable to the drug being promoted, but approximately 11% of the statements were inaccurate. Of the physicians who were in attendance, only 7 of 26 (27%) recalled any drug rep making false statements.

In a separate study published in the Journal of General Internal Medicine in 1990,[5] it was shown that 25% of faculty and 32% of residents had changed their practice at least once during the year directly as a response to contact with a drug rep.

"Residents are prime targets for drug companies; they are tired, hungry, overworked, and underpaid junior people who probably do not have very much experience." Goodman stated, "They are trying to hook or buy the goodwill of these doctors."

Medical students also form an extremely susceptible population. According to the 2000 Medical School Graduation Questionnaire,[6] the average medical school student will graduate with approximately $88,000 in debt. Lunches, pens, and mugs are therefore welcome bonuses.

By accepting small presents, however, medical students are encouraged to think that these gifts are a natural part of becoming a doctor. In addition to their own interactions, medical students observe attending physicians, residents, and fellows accepting perks from drug companies; this further instills a sense of entitlement.

Goodman stated that "[these practices] are so embedded into the culture people don't realize or think about them... [We] must change the culture, which means reaching medical students."

It falls on established physicians to help to influence younger colleagues and students by acting as mentors and providing good role model behavior when it comes to not accepting free perks, Goodman said. He adds, "Our quarrel is not with the pharmaceutical industry, but with pharmaceutical industry promotion. The time has come to eliminate its influence from our practices."

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