As you might imagine, doctors tend to be relentlessly courted by pharmaceutical companies.
I’m sure you’ve all seen the pens and note pads your doctor uses, emblazoned with the name of some new drug. You might see posters on the walls, clocks, and other items around the office that advertise for one company or another. (I collect such items.)
These items, however, only scratch the surface. Drug companies buy meals for physicians and their offices on a very regular basis. They invite the doctors to lavish dinners at which they talk up their products. Some have held talks on their drugs at a day spa, where the doctor and his/her staff can be pampered while they hear about the products. Companies provide tickets to sporting events and concerts, pay for educational conferences, and basically do anything they can do to get the doctor on their good side. Then, of course, there is the slew of samples provided by the drug reps for use at the doctor’s discretion.
The question–do you think this is a bad thing?
Obviously, such tactics should not entice the doctor to choose a less effective drug over a more effective one. Nor should the doctor ever take information from the companies at face value, without reading the papers and studies themselves.
But let’s say we’re talking about two drugs that do about the same thing and cost about the same amount–Claritin/Allegra/Zyrtec, Pravachol/Zocor/Lipitor, etc. Is it wrong for the companies that make these drugs to court doctors with nice stuff to get him to use their drug over the others? Is it wrong for the doctor to do so?
The usual answer is yes, but I really don’t see why. These companies are advertising a product just like any other. If Claritin and Allegra work about the same*, how should the doctor choose between them? Flipping a coin? Why shouldn’t he support the company that did nice things for him?
Does the “appearance of impropriety” rear its ugly head here? Or would you consider it a genuine ethical breach?
Dr. J
Often one of these drugs works better in a particular patient than the other, but it isn’t something you can predict, and most of the time they work about the same. You’ll still probably use one most of the time, and use the other when the first one doesn’t work.
After that, make money if you want to. You’ll get regulations on this as fast as you’ll see bills pass on campaign finance reform. It ain’t gonna happen. But as long as the doctors STRICTLY adhere to the above, I have no problem with them accepting “bribes.” I think it’s even better if the doctors get perks for choosing a drug they’d already decided on picking anyway.
The problem is that it does work, and works very effectively. People get switched to the newest, “best”, and most expensive drug regimen just because that is what their doctor has heard the most about. This drives the cost of medical care up, and does nothing to raise the quality. It may even lower the quality. Doctors are more comfortable prescribing the new drugs because they have nice pens and pads with dosage information and they have had a nice steak while listening to the side effects. This is more fresh in their minds than the old drug dosing info and side effects/contraindications.
Take blood pressure medicines. The usual person with hypertension gets started on a calcium channel blocker, probably a new beta blocker, and a bunch of other stuff. Depending on the history of the person, none of these have been shown (at least when I was in clinics) to be more effective than a simple diuretic like hydrochlorothiazide. HCTZ is like a nickel per pill. The new CCBs and beta blockers are like a buck a pill (if you are lucky).
And antibiotics. Go into a doctor with a cough. More than likely you are going to get a Z-pack (Zithromax), Cipro, or Augmentin (amox/clavulonic acid I believe). These are all madly expensive, and probably no more effective than either a beta-lactam with some Gram-negative coverage. 80% of all Strep pneumo is still susceptible to penicillin, and most coughs are caused by viral tracheobronchitis…
Nobody is out there advertising for HCTZ or penicillin, so these things fall by the wayside.
You can’t blame all of this on the drug companies. A doctor who subscribes a penicillin drug that works fine 80% of the time will be considered a ‘bad’ doctor by 20% of his patients. I understand all the microbes developing resistance issues, but patients don’t understand or don’t care.
At my hospital (and I assume everywhere else) we have a pharmicist who makes the rounds with the doctors and recommends cheaper meds.
My point was that most coughs are caused by viruses. The minority which actually are bacterial pneumonia or bronchitis are caused by a bug which is by and large sensitive to penicillin, and much more sensitive to extended-spectrum penicillins like amoxicillin or the first generation cephalosporins. Resistant Strep pneumo does not make a beta-lactamase, it carries mutated binding proteins in the peptidoglycan. This means it is often suscpetible to extended spectrum penicillins and such.
But the pharmacist on rounds idea is good. The only problem is that the pharmacist is not usually familiar with the latest studies comparing New Drugacillin to Old Gold Standardamax. These are the multi-center double blinded studies that are needed to determine if, and when, a new drug works better than the old ones.