HEALTH CARE/Joan Retsinas

Influencing Physicians

The next time you write a check at your physician’s office, ask for a pen. It’s an easy guess that the pen will bear the logo of a drug company. If the physician jots down a note, s/he will probably do it on a logo-ed pad. After prescribing a new drug or salve, your physician may well dip into a drawer stuffed with samples to give you a few days’ worth, free, to tide you over until you get to a pharmacy.

Brain circuitry is not yet well-understood. Scientists are grappling with the conundrum of how we humans think. But pharmaceutical companies understand enough about that circuitry to know how to shape cognition. At least they are shaping physicians’ cognition.

The free pens, notepads, and samples constitute a subliminal presence, a bit like the messages for soda that are embedded in movie scenes. But these omnipresent, yet hardly noticed gizmos mark only the first stage of a campaign of influence.

More potent are the free company-sponsored education sessions, sometimes enveloped in week-long cruises, also free, or accompanied by meals at five-star restaurants. How alluring to learn about drug xyz on a cruise to Aruba! Or hear about a new device while munching on pate de foie gras! Even the hospital “grand rounds” lectures may offer free buffet lunches afterward—courtesy of a vendor.

These educational sessions offer useful, current information; and clinicians rely on them to keep up-to-date. Yet the price of staying current is staying open to the influence, even the subtle influence, of the company paying the piper.

Higher up in the arsenal of influence-tools are the paid gigs: the part-time jobs for physicians as consultants to lecture, to write a paper, to discuss research. Even more potent are the research grants, tied to clinical trials of investigational drugs. More powerful yet are the subsidies to the professional panels that draft treatment guidelines.

Outside medicine, conflicts of interest are not uncommon. Legislators vote the lobbyist-way. Mortgage brokers profit at the signing of the contract, regardless of the solvency of the borrower. Investment firms’ researchers tout securities that the firms are selling. The consumer, generally unaware, suffers.

Patients are just as vulnerable. Has a physician recommended drug x because of a persuasive article in a medical journal? If so, did an industry ghost-writer author the article, under the byline of a credentialed specialist? Did industry spokespeople influence the guidelines that suggest what drugs to use, and when? Did the blitz of information on a new medical device drown out the negative reports? Did the vender that sponsored the continuing education seminar skew the presentation? With a drawer of samples, is a physician less likely to prescribe a generic drug? Or no drug?

The Institute of Medicine (Report Brief, April 2009) recently reviewed the infiltration of venders into medical decision-making. The report recommended some actions on the part of physicians, hospitals, and health providers: stop accepting the flood of freebies, from pens to pads to cruises. It recommended that medical journals ask authors to disclose their ties to industry. Most crucially, it recommended that Congress institute a national reporting system, where the three mega-venders—companies that market pharmaceuticals, medical devices, and biotechnology treatments—disclose their funding to the public. We, the patients, should be able to see what company gave what amount to patient advocacy groups, to physicians, to research institutions, to hospitals. Justice Brandeis praised the disinfecting nature of “sunlight” in the public arena. In this era of the internet, the public disclosure of financial ties should be even more disinfecting.

Meanwhile, bring your own pen to the doctor’s office.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, June 15, 2009

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