Should Doctors And Drugmakers Keep Their Distance?
Doctors are obsessed with time.
It comes down to simple math. If I have four hours to see a dozen patients, there simply isn't much time to stray from the main agenda: What ails you?
Frequently harried, I avoid drug company salespeople. Their job is to get face time with me and convince me quickly of the merits of their products.
To sweeten the path in, they bring food for the staff along with free samples of prescription drugs for us to give to our patients.
A typical office visit goes like this: The sales rep catches me in the hallway between patient rooms, or ducks her head in my cubby when I'm furiously typing to keep up on chart notes. She greets me so warmly that human instinct kicks in, and I simply find myself unable to cut her off.
Boom. I'm trapped.
I get a four-minute spiel about her company's newest brand-name drug and why it's superior to similar medicines that have been on the market for years. I want to ask why I should prescribe the new drug when I know the older drug is safe, effective, and at this point cheap because it's generic.
But if I ask a question, I'll get another four-minute lecture. Forget it. I smile and stand to show how busy I am. The sales pitch ends.
The experience leaves me feeling tainted. Marketing isn't medical science, my mentors taught me. I've read the studies showing that drug detailing, as these sales calls are known, works in spite of doctors' skepticism that it influences our prescribing.
But let's be honest: Drugmakers wouldn't spend billions of dollars on sales and marketing without getting a return on their investment.
When I was a medical resident, my training program prohibited drug detailers from calling on me and my colleagues. I understood the rationale. We were being taught to draw our own conclusions about medical science and steer clear of commercialism.
But a part of me felt the ban was too paternalistic – simply banishing industry folks from campus gave us no strategy for handling these inevitable interactions. Plus, I wondered, is there anything worthwhile in the sales pitches? I needed to find out for myself, so when I left the confines of residency and drug detailers came calling, I decided to let them pitch to me.
I quickly became more convinced of the merits of my residency's prohibition on detailers.
But roiling inside academe is a bigger philosophical question: Beyond sales and marketing, is there room for productive and ethical collaboration between doctors and industry in laboratory science, clinical trials and education?
For the most part, the doctrinaire position among many doctors has become one of mistrust toward those aligned with industry, on the basis of presumed conflicts of interest. That's why I was surprised to read a recent set of essays in the New England Journal of Medicine that questioned how our profession arrived at this state of affairs and suggested a re-examination is in order. The Journal has long been known for its stringent standards — both in terms of the science it publishes but also for helping make author disclosures standard operating procedure.
My initial reaction to these essays was similar to that of many critics: How could the Journal dare question this sacred cow? The series even sparked a highfalutin rejoinder from former Journal editors, who took their old home to task in the pages of a rival prestige journal.
This academic kerfuffle prompted me to read the essays more carefully. With enough time for reflection, the essays inspired me to think anew, taking me back to the days when I questioned orthodoxy.
Clearly there have been egregious examples of flawed collaborations with industry, such as the debacle over the painkiller Vioxx. Researchers both inside and outside the company were implicated in minimizing the drug's potential cardiovascular side effects in order to make it more marketable.
Examples like Vioxx understandably make us wary of pharmaceutical firms and those that collaborate with them. Nevertheless, it's wrong to simply assume that any doctor funded by or working with a drug company is corrupt. We should not simply read the number of industry collaborations that a doctor has as a litmus test for virtue.
I still have no interest in being hounded by pharmaceutical detailers, and I will still take note of how studies and researchers are funded. But I no longer will automatically dismiss clinical guidelines written by experts who have industry ties. Why, after all, would we want to automatically prevent the people most knowledgeable about a topic from being engaged with the public simply because industry helped pay for it?
As state and federal research budgets have become pinched, industry funding is a reality that we simply have to come to terms with if we are move to medical science forward.
Therefore it makes sense to me to re-examine how we handle these relationships and set up ground rules valuing transparency and the public good. A good starting point would be clarity on whether such industry funding is used for a researcher's lab and overhead costs — supporting the research effort — or simply funneled into their pocket, which I see as simply payment for marketing.
John Henning Schumann is a writer and doctor in Tulsa, Okla. He serves as interim president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital
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