Most doctors think they are way too smart to be influenced by drug companies. Physicians believe that they choose the best medicine for their patients based on science, not bribery.
Although almost all doctors in America accept free lunches for staff, pens, pads coffee mugs and other doodads, these gifts are considered so trivial that they have no impact.
Yet several recent reports suggest that drug company sales representatives do shape prescribing patterns. AstraZeneca recently fired one of its managers after his motivational comments to the sales force were leaked to the public.
Mike Zubillaga was a regional sales director for cancer drugs. In an internal company newsletter he was quoted as saying: “There is a big bucket of money sitting in every [doctor’s] office. Every time you go in, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money."
Less controversial was Mr. Zubillaga’s exhortation to use doctors to spread the drug company’s message to other doctors through speaker programs. This is a common tactic within the industry.
A survey of 1,662 physicians published in The New England Journal of Medicine (April 26, 2007) revealed that 94 percent “reported some type of relationship with the pharmaceutical industry.” Over three fourths acknowledged accepting free food or drug samples. One third of the doctors surveyed were reimbursed for expenses, “including the costs of travel, time, meals, lodging or other personal expenses for attending meetings and free or subsidized admission to meetings…”
Most alarming of all, more than one fourth of the doctors in this survey were paid by drug companies for services such as consulting, lecturing or signing up patients for clinical trials. Influential doctors are more likely to receive large honoraria or consulting fees.
It is these “thought leaders” who end up writing guidelines about best medical practices. Powerful physicians can sway their peers to select certain medications over others to treat conditions like high blood pressure, depression, diabetes or heart disease.
Despite protests to the contrary, it is hard to imagine that a cardiologist who receives more than $100,000 from a pharmaceutical company will not favor that company’s cholesterol-lowering medicine.
What is particularly worrisome about all the free food and gifts, not to mention the outright payments, is that they appear to be increasing. In 2002 pharmaceutical manufacturers adopted a new code of conduct. It was supposed to limit the freebies and guarantee that physician-industry interactions “should primarily benefit patients and enhance the practice of medicine.”
The new study suggests that over the last few years Big Pharma has intensified its outreach to doctors. Whether this effort has enhanced the practice of medicine is anyone’s guess. What is clear, however, is that the cost of medications keeps going up. When doctors prescribe the most expensive drugs the pharmaceutical companies take their big buckets of money to the bank.