I have permission to post the following unpublished article by another author.
Medical ethics
I have led a sheltered life. The Army limits business gifts to doctors to such a level that we no longer saw them after 1990. More pertinently, each military hospital has a formulary, so most overtures to advertise a medicine were made to members of the formulary decision making committee rather than the prescribers. (I know because my husband was once on the committee. A man trying to get his product on the formulary offered me a trip to the Bahamas.)
My next several jobs I was either a minor part-time player or trainee, or hidden in a student clinic (although I was told there by a drug company representative that he saw from a database mining regional pharmacy sales that I had not used his drugs, and that he would stop leaving us samples if I did not start doing so- so much for patient privacy!).
Now I am equivalent to (actually salaried by a larger non-profit but I replace a private doctor) a private practice family doctor in a small rural town. I see one of the cadre of fifty or so "drug reps’ or reps from the many home health or health supplies companies about every three hours during my work days. One to two lunches per week, for all my staff, are catered at my practice by some of these advertisers. Our sample closet is full of all the still patented (ie more expensive and profitable) medications. Many of these are unfamiliar to me since the Army moves slowly and the good old inexpensive generics work quite well for most of my patients. (Also my stay in England makes me know them under a different name, if at all.)
Some doctors argue that these salespeople do not influence them. However the companies must believe the billions of dollars they spend on this sort of advertisement pays off or they would not continue it.
My concern, aside from being bribed (subconsciously or not) to prescribe the product advertised to me rather than the one actually best for my patient, is that all this advertising takes money which my patients are eventually paying. I am a well paid doctor. I do not need fancy soaps and socks and free meals as much as many of my poorer patients need medicine and services at the lowest price possible. Nor do I need gifts more than the taxpayers need Medicare and Medicaid money to be spent on actual patient care rather than advertisement of patient care. (The multitude of home health agencies, and the number of sales representatives they send to me, makes me certain that this work is quite profitable for these companies.)
If it were my own practice I would ban these salespeople from my premises. Some doctors argue that even the free drug samples we can use for our poorer patients or to convince our cost conscious patients to pay for a needed drug are not worth the corrupting influence of the sales representatives. My non-profit employer however feels the free medications are a benefit to our patients. Most of my colleagues there have been in private practice all their lives and have never worked with a formulary created to maximize value (patient health) for the money spent on drugs or treatments. I think I will do my research and present to our providers’ quality improvement meeting my findings, and perhaps suggest we accept drug samples but not any other gifts aside from discount coupons for our patients.
There is a second factor in my concern. My staff is used to and enjoys the free lunches and gifts. Some doctors’ offices would have no pens were it not for gifted, advertising pens. The stationery and sticky notes from companies saves us buying much of this for ourselves. My nurses do most of my referrals so if I, having no opinion, do not state which doctor or home health agency to ask to see a patient they decide (and they have said, hopefully in jest, "This agency hasn’t stopped by and given us anything- let’s not send them any patients!"). I expect I will want to provide lunch every week to make up for that loss I cause them. Their salary is not as good as mine to make such a loss -- 50-100 lunches per year- negligible.
Any thoughts or suggestions on how hard (and why) I should work on this, and arguments to persuade my fellow doctors at the company and my staff at my practice, are invited.