Sunday, November 25, 2007

Doctors are Human Too

How much influence does the pharmaceutical industry have over your doctor's prescribing habits?

Not only are we (patients) supposed to ask our doctors about such-and-such drug for such-and-such condition, drug reps are attempting to convince your doctor to prescribe such-and-such drug for such-and-such condition because it is supposedly more effective than the other such-and-such drug commonly used.

Today's New York Times Magazine has a wonderful article, "Dr. Drug Rep," written by Dr. Daniel Carlat. During a year of being paid to give talks to doctors about an antidepressant, a psychiatrist comes to terms with the fact that taking pharmaceutical money can cloud your judgment.
(via Over My Med Body!)

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression.
How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.
Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep.
One of my most uncomfortable moments came when I gave a presentation to a large group of psychiatrists. I was in the midst of wrapping up my talk with some information about Effexor and blood pressure. Referring to a large study paid for by Wyeth, I reported that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 milligrams per day.

“Really?” one psychiatrist in the room said. “I’ve seen hypertension at lower doses in my patients.”

“I suppose it can happen, but it’s rare at doses that are commonly used for depression.”

He looked at me, frowned and shook his head. “That hasn’t been my experience.”

I felt rattled. That psychiatrist’s frown stayed with me — a mixture of skepticism and contempt. I wondered if he saw me for what I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.
I still allow drug reps to visit my office and give me their pitches. While these visits are short on useful medical information, they do allow me to keep up with trends in drug marketing.

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