Here’s one of those “duh, of course that’s true” sort of stories: The Washington Post has an article exploring a piece in the Journal of the American Medical Association that suggests the drug industry is exerting too much influence on doctors and diagnosis. The article’s entitled Distance Sought Between Doctors and Drug Industry and here are some of the highlights:
“Declaring that the pervasive influence of drug industry money is distorting doctors’ treatment decisions and scientific findings, a prestigious panel of medical experts called on their colleagues yesterday to adopt far-reaching new conflict-of-interest policies.
“In an article in the Journal of the American Medical Association, the group said that voluntary efforts to limit corporate inducements have failed, resulting in the overprescribing of some medications and the withholding of negative discoveries about others. Highly publicized cases involving the anti-inflammatory drug Vioxx, antidepressants for children and spinal implants made by Medtronic — all occurring while voluntary guidelines were in place — highlight the need for stricter measures, they said.”
Here’s the line I really like:
“My mother told me never to accept gifts from strangers. If a stranger wants to give you a gift, it’s very likely they want something in return,” said Jordan J. Cohen, president of the Association of American Medical Colleges and a co-author of the new proposal. “We’ve become overly dependent on these kinds of blandishments to support our core activities, and that is jeopardizing public trust and scientific integrity.
“The panel … urged the nation’s 400 teaching hospitals to impose stringent measures, including a ban on accepting gifts, meals and drug samples and tight restrictions on outside income.”
But it should be no surprise that doctors are vehemently decrying this finding (since a significant income stream would be throttled) and coming up with sometimes bizarre rationalizations about why everything’s just peachy as-is:
“Spokesmen for the pharmaceutical industry said the extra steps are unnecessary and could deprive physicians of valuable information.”
Not to mention valuable income: “Some physicians have been paid lucrative consulting retainers for no specific work; others are paid to put their names on articles ghostwritten by industry employees. One congressional inquiry cited in the report found that pharmaceutical executives steer research grants to doctors and schools that promote their firms’ drugs.”
It certainly helps clear up why doctors have candy bowls full of drug samples on their counters, pharmaceutical pens, pads, clipboards, posters, office supplies, briefcases, and much more, doesn’t it?
If doctors actually bothered to read the terrific book Influence: The Psychology of Persuasion (highly recommended) they would completely understand this comment instead of denying it:
“There is solid evidence it isn’t the size of the gift, it’s the gifting itself that creates a sense of loyalty and indebtedness,” said Sharon Levine, associate executive director of Kaiser Permanente’s Northern California group practice. The 6,000-doctor practice and the Yale University School of Medicine are among the only institutions in the nation to implement policies similar to those outlined in JAMA.
“The industry is spending $13 billion per year on direct-to-physician promotion,” she continued. “That wouldn’t be happening if it weren’t resulting in changing patterns of utilization. It doesn’t necessarily mean patients are getting bad care, but it does mean their influence is out there.”
Another astonishing tidbit:
“Drug companies spend $13,000 per physician annually,” said co-author David J. Rothman, a professor of social medicine at Columbia University Medical Center. “Those marketing tactics are very, very effective at getting physicians to do what each drug company wants — to prescribe their product.”
And I’ll wrap up with a beautiful example of the problem with quoting so-called experts without doing a bit of background checking:
“I subscribe to the crazy view that more information is better,” said Daniel Troy, former chief counsel of the Food and Drug Administration. “This very sweeping proposed ban would really choke off an important flow of information to physicians.”
Sadly, though, it doesn’t take much Google work to find pithy quotes like “While in public office [at the FDA], Troy betrayed the public trust by siding with the pharmaceutical industry and against the American public he was entrusted to protect.” [src] and “Daniel Troy is instead making it the agency’s mission to protect the drug companies from being held accountable when their products do serious harm.” [src]
Certainly doesn’t make him seem like a good source to have an unbiased opinion about the relationship between doctors and the pharmaceutical industry, does it?
Bah! This all makes me want to concoct my own remedies and skip the doctors entirely…