One medical blog that I follow, KevinMD, is a very refreshing and candid account by numerous physicians on a variety of topics. A recent post, Is there a harm to not seeing drugs reps? examined whether drug sales reps exert improper influence on doctors.
Here’s how it works: a manufacturer of the newest drug gives a sheet of talking points to its sales reps about the benefits of their drug. It then sends them out on the road, and the reps try to get in to see the doctors, whether by appointment or by “just stopping by.” If they can get in (sometimes by bribing the staff with doughnuts), they ply the doctor with freebies—pens, pads of paper, stress balls, the occasional continuing medical education seminar in Hawaii where there is one hour of learning and 47 hours of surfing, and other small stuff. They talk shop for a minute, and the drug rep goes off on his merry way.
The doctor, recipient of cool free stuff that he is, now has to decide whether to return the favor by prescribing the new drug to his patients. Maybe he thinks he can be dispassionate, and can make the decision based only on the medical evidence. But, the reality is that doctors are busy, they don’t always have time to conduct a thorough review of the scientific literature, and they can be subconsciously (if not consciously) swayed by a desire to quid pro quo.
In recent years, this has become more and more of an issue, with major hospitals and other institutions imposing complete bans on these types of reps. Some rules and laws are being put into place requiring doctors to report the value of all of these gifts, so that John Q. Public can go online and see if his doctor, who prescribed him Pradaxa, has had any gifts from Boehringer Ingelheim.
The comments to the KevinMD post are instructive. A post by someone calling him/herself MarylandMD (I promise I didn’t author this):
Painting restrictions against drug reps visiting physicians’ offices and hospitals as “policies that restrict information” is a complete farce. The pharmaceutical industry is one of the most wealthy and powerful industries in the world, and they have their mouth on a bullhorn that spreads their “information” far and wide throughout medicine. They can publish their research in reputable journals, they can print up pamphlets and mail them to me, they can put ads in the journals I read, they can put ads on TV, they can get my patients to bug me to prescribe their expensive medications, they have academic physicians act as shills who put their names on papers pre-written by the drug company, and they can sponsor bogus throwaway journals posing as scientific publications. They can even have their minions run throughout the internet and promote weak studies as real science…
But THEN the drug companies want to impose their drug reps on my office, and if I say no, they whine as if it is somehow a violation of the bill of rights. They fall back on the fainting couch, shocked that I have the temerity to “restrict information.” They cry as if somehow they can’t get their ideas across. The poor, poor drug companies.
Really, the act gets old after a while.
KevinMD wonders, and rightly so, whether there could be disadvantages to preventing sales rep access. Without it, doctors are more likely to be unaware of the latest drugs and devices, some of which are genuinely useful for their patients. So, to a degree, patient care could suffer. On the other hand, one problem I have witnessed firsthand is that sales reps, often being paid on commission, are willing to go to great lengths to convince a doctor start using their products. Overpromotion, false statements, and misleading statements about acceptable uses are commonplace in the sales rep world.
There’s no right or wrong answer, here. The question is how to get good, reliable information into the hands of doctors so they can make proper decisions?