NEWS - Physicians speak out against seeing drug reps

[Guest guest]

Physicians speak out against seeing drug reps

Rheumawire

Mar 18, 2005

Gandey

East Lansing, MI - An increasing number of physicians are questioning the

role of drug representatives in their practice. In a recent " Reflections "

article in the ls of Family Medicine, practicing physician and ethicist

Dr Brody (Michigan State University, East Lansing) argues that

doctors should refuse to visit with drug reps in the interest of

professional integrity and sensible time management [1]. " The vast majority

of physicians are seeing pharmaceutical reps and there is a strong tendency

to rationalize this behavior, " Brody told rheumawire. " The information

physicians receive during these meetings is clearly biased. We imagine that

we can correct for this bias one-on-one, but all of the data show that, no,

we can't. "

Brody recommends gathering information from evidence-based periodicals over

face-to-face meetings with reps because empirical data suggest that

interactions with pharmaceutical reps increase the chances that physicians

will act contrary to the best interest of the patient. " The evidence

available today seems conclusive on 2 pointsfirst, that we are indeed

heavily influenced by reps and second, that we ourselves are very poor

judges of the extent of that influence, " Brody writes. " To the extent that

we claim to be scientific practitioners, we would seem obligated to take

this evidence into account in deciding upon our proper professional

behavior. "

Brody says the state of medicine has deteriorated to the point that " it is

taken for granted that you can't find experts who aren't on the take. " He

adds, " This is a serious problem that is going to take a while to sort out. "

Commenting online about the article, Dr ( Wood

Medical School, New Brunswick, NJ) says, " Dr Brody's clear and cogent essay

puts the responsibility for physician interaction with pharmaceutical reps

squarely where it belongswith physicians themselves. " comments, " Given

this integration of reps into the very fabric of primary care offices, it is

little wonder that until very recently, the most frequently prescribed drug

for Medicare patients was Vioxx, and that of the fifteen most frequently

prescribed drugs for this population, ten have equally effective, much

cheaper generic alternatives. "

Also commenting on the article, Dr Zweifler (University of California,

San Francisco near Fresno) says that Brody proposes a dramatic shift in how

physicians interact with pharmaceutical representatives. He notes that Brody

cites the medical literature to support his contention that the longstanding

practice of physicians visiting with pharmaceutical representatives in their

offices skews prescribing patterns away from patient's best interests and

disrupts patient flow. " Based on my experience, Dr Brody's observations are

right on target, " he says.

Dr Jerome Hoffman (University of California, Los Angeles) writes, " Brody

also reminds us in his thoughtful essay that most doctors have the wonderful

capacity to delude ourselves into believing that we're above all this, and

impervious to the seductions of industry, no matter what the evidence, and

common sense tell us. My friends and colleagues may be fooledeach of us is

more likely to admitbut not I! "

But not everyone agrees with Brody. Responding to his article, Dr Gordon

Rafool (Gessler Clinic, Winter Haven, FL) comments, " Dr Brody demeans the

intelligence of the physician in private practice. Mostly physicians read on

a daily basis. I, for one, not only read, but participate in CME year round.

If the rep tells me something that is hard to believe, I do not hesitate to

ask for his references on that statement and pursue it. If they have

stretched the truth or frankly lied, they are not welcome in my office

again. "

Rafool continues, " Dr Brody must not practice in the real world. Reps

provide samples that I give to my needy patients and to those whose third

party providers have not delivered their medicines on time. If you do not

see a rep, you do not get samples. Dr Brody needs to come to my office and I

will educate him in the real world. "

In an interview with rheumawire, Brody responded, " I'm surprised that I

didn't receive more negative feedback than I did. Most of the comments were

positive and this was a surprise. " Brody noted that he expected a stronger

backlash to his viewpoint considering most physicians continue to see reps.

Might as well face it, we're addicted to reps?

In his article, Brody compares seeing drug reps to an addiction to alcohol.

He says this " fanciful analogy " helps explain his ethical analysis of the

situation. Brody writes, " Suppose I have an alcohol problem. Overall, I am

making a fairly good recovery, but occasionally I fall off the wagon. " He

explains that every time he slips up, he is in the company of his friend

Judy. He notes that Judy herself seldom drinks to excess, but somehow when

in her company he seems to lose the restraint that otherwise controls his

drinking. Judy is not one of his closest friends and whatever he can do with

Judy, he could easily do with any number of other friends. " Now suppose that

I say that I am deeply committed to remaining free of alcohol, " Brody

writes. " Yet at the same time, I insist that I not give up seeing Judy and

spending time in her company. How seriously do you take my protestations of

yearning for sobriety? " Brody says this analogy may illuminate the ethical

question of whether physicians should spend a portion of their time

interacting with drug reps.

says, " The addiction metaphor is apt. How else could we convince

ourselves that we can rely on reps for information about drugs and not be

influenced to prescribe those drugs? " He adds, " There is only one cure for

addiction, and Dr Brody prescribes it clearlyabstinence. "

" My goal is not to slam industry, " Brody said. " In a capitalist society the

industry has every right to act this way, and pharmaceutical reps are honest

business persons earning their salaries by serving their employers'

interests. The existence of a potential conflict of interest with the

physician of integrity need not imply that the drug industry is acting

wrongly, merely that its goals are at least somewhat different from the

goals of ethical medical practice. "

Brody argues that to spend time with reps in a manner that preserves

professional integrity would require both refusing to accept their gifts and

spending a great deal of valuable time double-checking their information. " I

propose that the vast majority of physicians could spend their time in

better ways. "

Hoffman writes, " Brody knows that the pharmaceutical industry is very

smart, and very successfulit couldn't be the second if it weren't also the

firstand that it would hardly throw away billions of dollars just for the

privilege of playing up to doctors. " Hoffman notes that there is increasing

evidence that these billions spent on 'educating' doctors and patients is

not a series of gifts, or of public service activities, but rather an

investment, with a suitably high rate of return.

Also responding to the article, Dr H Blossom (University of California

San Francisco near Fresno) explains that the pharmaceutical industry invests

significant amounts of money to pay for sophisticated analyses of physician

targets. " Some of the photographic and graphic components of journal

advertisements, for example, have been refined on the basis of recorded

physician eye tracking so that there is no doubt that an 'eye-popping' ad

will draw the attention of the intended targets. The selection and training

of representatives from this industry is just as sophisticated and

thorough, " he argues. " When was the last time you dealt with an unattractive

or irritating rep? " Blossom asks.

Dr , a clinician practicing in Shiloh, IL, also wrote in about

his agreement with the Brody paper. says he saves an hour or two a

day by not having drug reps in the office. " In addition, I choose the drug

that I feel is appropriate for the patient. My former sample closet was a 10

X 9 room that is now a consultation room and extra office for storage. "

Source

Brody H. The company we keep: Why physicians should refuse

to see pharmaceutical representatives. Ann Fam Med 2005; 3:82-85.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org