The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Monday, January 30, 2006

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 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?


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Blogger Charmsy said...

Well written! It's interesting to hear about this from a doctor's point of view.

The Wyeth drug reps that blow through our town provide lunch four times a year so that the GPs can consult with the Psychiatrist who comes out once a month. Us lowly mental health folks are privy to these sessions and the free food. On one hand it is a great opportunity to network with the Psychiatrist and the GPs and discuss our common cases. On the other hand, there is something vaguely disturbing about Wyeth picking up the tab. Fortunately our Psychiatrist is awesome at putting his patients' needs first.

2:26 PM

Anonymous Vally said...

It's funny, my sister is a pharma rep. She's got the SUV, the laptop computer, the cell phone, the free drugs, she's got it all. The weird thing is that she really and truly believes that she's pushing a product that works. She really really wants to educate MD's about her new drugs. In that way, she's very honest. However, you know how she sneaks into doctor's offices, how she gets past all of their staff? She bribes them with home-baked goods.


10:52 PM

Blogger Fitchick said...

I'd like some free expensive drugs please. Its weak, but its the wittiest comment I've got. At least they're not asking you to do their laundry for your or accusing you of not telling them things you PROVIDED FOR THEM IN PRINT. Yes I'm having a high stress monday. Pass my a tranquilizer.

2:39 AM

Blogger ArizonaDB said...

Its a shame what's come of medicine in this respect. Expensive dinners and free goodies in exchange for pushing the company's "new drug", whatever that may be. Be strong, doc, and go with your gut. You know when you are reaching your own personal line regarding drug rep handouts.

Its too bad money and medicine have to be so tightly woven together in healthcare today. It takes a lot of the objectivity out of the "science" of medicine.


PS great blog, your writing is a pleasure to read.

12:04 AM

Blogger Leah said...

Hey, a girl's gotta eat. :)

1:08 AM

Blogger Foxy said...

Hm, it seems to me after a gazillion years of school and an ethical strategy that requires them to put a patient's needs first, doctors are fully capable of seeing the difference between the blonde bimbo and that babe who's there to stay. I know that somebody will always be susceptible to bribery, etc., but for the most part, if you trust yourself (which I'm certain you do!), you should be able to enjoy the benefits while continuing to make decisions the way you always have: for the patient, not the cash.

12:26 PM

Blogger Charity Doc said...

Ah...what I would give to be a resident again. It was the greatest 4 years of my life. I worked like a dog, slept very little, made about $2.50/hr. Rented a tiny apartment but spent more time at the hospitals than anywhere else. Moonlighted like crazy just to make the car payments and pay back student loans. Survived on hospital cafeteria food and drug rep sponsored lunches/dinners. Wore nothing but scrubs. But it was the happiest 4 years of my life!

Enjoy your residency. You, too, will look fondly back at it years from now and reminesce that they were the greatest years of your life.

As to big pharma...go 'head, eat their free food and use their free pens. But do what's best for the patients. Remember, generic drugs still works. Beta-blockers and diuretics are still considered first line therapy for HTN and are still the only ones that significantly reduce morbidity and mortality. No need to get fancy. Add an ACE inhibitor for those with CHF. ARB are way too expensive. Doxycycline, Tetracycline and Bactrim DS are very effective agains MRSA, where as the more expensive "gorillamycins" are not.

Check out my blog when you get a chance:

1:35 AM

Anonymous Danny Haszard said...

Appreciate your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard

4:30 PM


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