Doctors and drug companies

One of the big news flashes this morning was the results of a study looking into the contact doctors have with the pharmaceutical industry. Nearly 95% of physicians accept some sort of gifts. That didn’t surprise me one bit–in fact, I thought it would be closer to 98% or 99%. Free lunches and other perks from drug reps are omnipresent in medicine.

The big question, which this study did not address, is whether receiving these perks influences the way doctors practice medicine. Common sense dictates that it would: you hear enough about the latest and greatest drug, and despite all attempts at objectivity, I’m sure you’ll prescribe it at least a little bit more. It is indubitable that such marketing affects prescribing habits: take Vioxx, for instance, which was still widely given for a long, long time after stories about heart trouble started coming out.

The other side of the coin is even more insidious: direct marketing of drugs to the public. Spending time shadowing a family practice doc a few years ago, I saw many occasions where a patient would come in asking whether a certain drug might be good for his condition, based upon what he saw on TV or in a magazine. Again, it is inevitable that such questions influence prescriptions, if only to appease a demanding patient. I am firmly convinced that the biggest factor affecting prescribing habits today is not drug company appeals to physicians, which are at least couched in the language of scientific study and real results, but ads that promote new drugs as panaceas to the generally ignorant general public.

So in an ideal world, medicine would be completely objective: doctors would have the best data at their fingertips for prescribing the right drug or therapy at the right time. And patients would accept the knowledge gap between themselves and their physicians, and follow their recommendations, not the promises made on television. But, the world will never be ideal. Even if we were to outlaw drug company marketing entirely, there would still be subtle influences. Perhaps it would be your doctor’s best friend, the research scientist at a big drug company who’s told him all about their latest product. Maybe it would just be the biases he has acquired through years of practice, sticking with drugs he knows best even when, if he looked at the data, there would be something better.

In the end, it seems like curbing drug company influence would be better for everyone involved, but we should not be foolish enough to think that the practice of medicine will ever be objective. Conflicts of interests and human nature will always be there. The best thing we can do is accept those facts, and work with them. Understand your biases, and those of your patients. Only then can we even approach rational, albeit not objective, medicine.


1 Response to “Doctors and drug companies”

  1. 1 Bekah April 26, 2007 at 10:04 pm

    Public drug advertising has always seemed silly, but never as blatantly offensive as the advertising since the advent of Viagra, et al. It seems it would be well within the purvue of the FDA to curtail drug advertising. This is not exactly a free market we’re talking about, since these medecines require a prescription.

    Oh, other ads that really toast me are those for contraceptives. Nothing like depicting the good life as child-free! Sick.

    Sorry, I got a little off topic. This is really one of my tv-viewing pet peeves.

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