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Why doctors believe pharma companies?
Because the information is provided with benefits and perks
Based on the Congressional
testimony of Michael Wilkes, M.D., Ph.D. Vice Dean, Medical
Education Professor of Medicine and Public Health, University of
California, Davis in front of the Committee on Government Reform
with respect to safety of Vioxx.
My research has shown that the courtship between Pharma and doctors in training
starts early in medical school. Medical students are poor, overworked, and want
to feel important. Drug companies sponsor mixers and “liver rounds”
(aka parties), provides free pens, books, and medical equipment and even free
prescription drugs all intended to appeal to the desires of medical students
(relaxation, entitlement, and kindness). |
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All of this is provided early and often
through the medical school years without any expectation of directly impacting on
prescribing; after all students are several steps removed from the actual writing of
prescriptions – at least for the time being. However, the goal is to curry favor and
prepare a fertile soil for the future. Sandberg found that students given textbooks
by pharmaceutical sales representatives are unlikely to remember the name of the
company or its products. However, the gift establishes habits, e.g. a willingness to
receive gifts and the development of positive attitudes towards drug companies.
This is the medical equivalent of feeding the bears in the National Parks. After
just a few time of compassionate feeding the bears learn to keep coming back. In
fact, they forget how to find food on their own. Doctors have become the health
care system’s educational “bears”.
Once students graduate and they can prescribe drugs research shows promotional
material is highly effective at altering prescribing patterns. Yet despite a large
amount of research that documents a profound effect of promotion on doctor’s
prescribing habits doctors commonly deny that their prescribing decisions are in
any way influenced by promotional material. Why? Because they want the
lunches and they feel entitled.
What role has organized medicine and academic medicine taken to limit physician – Pharma interactions?
In recent years the pharmaceutical industry’s marketing tactics have come to the public’s
attention. Books by Angell, Kassirer, Avorn, and others have received national attention.
Conflicts of interest at the NIH and other academic institutions have made national
headlines. In response some organizations including the AMA and the
ACP have
introduced new guidelines to limit real and perceived conflicts of interest. In 2002 the
Pharmaceutical Manufacturers Association reissued its own strengthened guidelines to
cut back on bribery. But for the most part all these guidelines are window dressing
intended to get the public and policy makers off their backs. Because these organizations
have come to depend on industry money for their life blood there is little chance of
meaningful change without strict new policies and federal oversight. Recall the example
mentioned above involving the 2005 annual ACP meeting and its relationship with Pharma.
On the one hand the organization issues strict rules about doctors relations with drug
companies but on the other hand it promotes and courts that same money. The same
conflicts of interest exist at JAMA, the
NEJM,
UCLA,
NYU, Harvard and nearly every
other American medical school.
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