My Ongoing Moral Dilemma.

We were warned early.

"Beware, young medical students. Beware the evils of big pharma."

We were naive, didn't understand. Why worry? We already knew that the big pharmaceutical companies had deep pockets. Heck, our clinical education centre, with its state-of-the-art examining rooms all interconnected by closed-circuit television was partially funded, and thus named after, one of the biggest. Big pharma wasn't politically correct. We were told to avoid it, to tell those drug companies to keep their pens and notepads... we weren't interested. We were directed to sources of information such as www.nofreelunch.org which reminded us that accepting a pen emblazoned with the name of a drug company was akin to whoring their products on street corners. *shiver*

But then I started to wonder... says who? We should be educated enough to be able to make treatment decisions based on the interests of the patient rather than the drug rep, right? Ah, the drug rep. The interchangable shiny, happy people that are sent out in legions by big pharma to woo physicians into pushing their products on unsuspecting patients. They are all well-groomed, well-dressed, attractive and just friendly and personable enough to be engaging without seeming slimy. Armed with the latest statistics proving the superiority of their drug over the competition, a shiny SUV and a case full of free samples, they are common in medical circles. You can often see them congregating in small herds at the local Starbucks wearing well-tailored suits, chatting on their cell phones, typing on their tablet computers and downing 5$ lattes between visits to doctor's offices.

Back to the subject at hand. Is big pharma truly evil? My only exposure to them through medical school was during my family medicine rotation. I was in a small town, deep in the Ottawa Valley, and I met the rep for Lipitor. I was particularly interested at the time as it was a drug that my father had been on for many years. She had articles comparing Lipitor to the other statins (newbie note: the statins are a class of drug that decreases your cholesterol levels, thus reducing your risk for heart disease) in terms of effectiveness and relevant clinical outcomes. She could easily site the latest statistics, and made a convincing argument for the superiority of her product over the other statins. I wasn't completely naive... I knew that there was a considerable amount of bias in the presentation of the information. All you had to do was consider the source to realize that it should be taken with a grain of salt.

Gone are the days when drug companies were allowed to wine and dine doctors in style. New government legislation prevents many of the golf junkets and resort weekends that used to be the norm. Now the most you can hope for is a fancy dinner followed by a presentation, hidden under the guise of "Continuing Medical Education". For doctors who are outside of an academic centre, one could argue that these dinners are helpful in keeping physicians up to date on new research and new drugs. One could also argue that it simply puts us in a pleasant post-prandial state to soften us up for the barrage of propaganda that is sure to follow.

The recent book entitled "The Truth About the Drug Companies" is a compelling read. Written by the former editor of the New England Journal of Medicine, it talks about all the very things I've mentioned. It addresses the myth of "research and development costs" as a justification for exorbitantly high drug costs, the manipulations of the patent system to help protect brand-name drugs and prevent the affordable generics from coming to market, and most relevant to me, the marketing of drugs under the heading "education". Hmm. So even if I don't think that listening to a drug rep schpiel will affect what drugs I perscribe to my patients, research has shown time and time again that it will. Of course it will. Otherwise, why would big pharma sink so much money into it?

The doctor I work with currently meets with 2-3 drug reps a week. They often bring us lunch. They always bring samples of the latest, costly drugs. They often leave us with educational materials, some bearing the name and logo of their drug or company, some not. Where am I supposed to draw the line?

Sigh.