Pharma, good for you? good for me?
Everyone and their dog has written about this: primary care physicians and their relationships with the pharmaceutical industry:
Dr. Mintz wrote a bit about saving on prescriptions. While some of it is patient-oriented or US-centric, simple suggestions like pill-splitting are definitely used by Canadian docs who are trying to look after their patients’ pocketbooks. Mr. Medsaver thinks free samples are a big problem, but according to Canadian Medical Association data, about 70% of docs entertain visits from pharma reps for the purposes of obtaining samples.
As much as I read, I haven’t decided what will be best for me and my patients. There are a number of ways to be involved with the ‘bad guys,’ including consulting, doing clinical trials, going to pharma talks/lunches, taking free gifts from the rep who comes to visit, speaking at a conference sponsored by big pharma, etc. but so far I’ve really not seen half of it.
With various placements, I’ve found myself in a spot where I either had to accompany a preceptor to a pharma-sponsored lunch or dinner, or awkwardly bow out and possibly jeopardize my connection with a person who would be teaching and evaluating me. The benefits of free food, pens, and information about a possibly useful medication (and opportunity to ask questions of an expert in the drug) have to be weighed against the risk of becoming biased in prescribing, and contributing to the inflated costs of pharmaceuticals. The one I attended in Cambodia was out of sheer curiousity; how could I pass up the opportunity to see how different marketing was in a developing country? (The big selling feature of the drug in question was that it had been re-formulated to have a longer shelf-life in hot and humid countries, not really a trait we look for in Oh Canada).
On the few occasions that I’ve partaken, I did learn a bit about a drug and all kinds of new statistical miracles for massaging the numbers, collected my free pen or lunch, and maybe asked a question. In Cambodia, I asked about “Number Needed to Treat” because it is a statistical concept that is relatively new to me and something I find extremely helpful for understanding just how GOOD a drug really is. Yah, the Cambodian rep had no idea what I was talking about. At a rep-visit in a BC Family Practice office, I remember saying, when asked what my understanding of the drug was, “well, I know it’s one of the alternates for high cholesterol, and would be used when statins aren’t effective or aren’t tolerated. I also remember that one of the side-effects is anal leakage. I mean, that’s really a problem isn’t it? I wouldn’t expect any of my patients to want to use it…”
Unless there is some major humour involved, I usually promptly forgot about the name of the drug and get on with my day. But does that mean a part of me doesn’t remember? A part of me that will say, “oh, yah, I know a good anti-depressent for you! this brand is great because…” And if I do prescribe a particular drug because I know it better than another, or I think it superior to another, will it matter?
Perhaps there will be deadly consequences. An MP who feels they were personally affected by the negative aspects of the industry-prescriber relationship is vehemently pursuing changing the relationship Health Canada has with the pharmaceutical industry. However, over-prescribing in general may be more secondary to our general quick-fix, brand-name culture than to direct physician-pharma interactions.
I want to give my patients the best of the advantages, but I’m afraid of falling in too deep in terms of a connection with the pharma industry. My bias in prescribing a certain brand, or my tendency to reach for the prescription pad will likely be influenced by that rep who remembers my dog’s name and brings grub from the best caterer in town.
There really is no free lunch.