Some argue doctors may be choosing your drugs, not on the basis of the best medicine, but the best marketing.
"Reps come up to them and say, 'hey doc, what's the deal? We've been going out to dinner and you're not prescribing my product,'" says Dr. Goodman.
Pharmaceutical companies offer physicians free meals to the tune of 4 million dollars a day. It's all part of a staggering 12 billion dollars they spend each year marketing directly to doctors.
"If you have to know what drug companies are about, you need to know three things: marketing, marketing, marketing," says David Rothman, Ph.D., with The Prescription Project.
Every day, as many as 100,000 drug reps, called detailers, fan out across the country. Each one meets with as many as eight doctors a day.
"I was not compensated for helping doctors help patients, I was compensated for getting the doctors in my territory to write more of my particular pills," says Kathleen Slattery-Moschkau, a former detailer. She says she and most of her colleagues were never trained in medicine.
"Most of us had no business talking to doctors about these drugs that could mean the difference between, sometimes mean the difference between life and death," she says.
The reps are armed with sophisticated information. Using a technique called data-mining, the pharmaceutical companies provide the sales reps with weekly records on exactly what brand of drugs and in what amount each doctor is prescribing.
"So the sales rep goes in, he or she talks to the doctor, pushes a certain product, then the next week, they'll look at the prescribing and see if it worked," explains Susan Chimonas, Ph.D., with The Prescription Project.
The companies counter they play a role in educating doctors about the new medications. Some doctors say it's information they want.
"We're busy in our practice. It's hard to keep up with the most up to date literature, so at times, it's helpful," says Heather Fullerton, M.D., a pediatric neurovascular specialist at the University of California, San Francisco.
And what about those free samples?
"The samples can really help patients who are financially disadvantaged. They don't have health insurance," says Katrina Bramstedt, a clinical ethicist at California Pacific Medical Center in San Francisco. She says considering the patient's need is paramount.
"Patients come first, before making money, before aging, before fame. That's why we go into medicine is to help our patients," says Bramstedt.
Doctors can access unbiased information about medication on the Internet, so depending on the pharmaceutical companies is not necessary. "Information on costs, side effects, interactions with other drugs, place and therapy information that, let's face it, a salesperson is not likely to give you," says Dr. Goodman.
Dr. Rothman says more needs to be done. "Keep the drug reps out of doctors' offices. Abolish gifts. Abolish samples," he says. These are changes he says could be a prescription for better health care.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/.
For more information, please contact:
The Prescription Project
30 Winter Street
Boston, MA 02108
(617) 275-2853
Institute on Medicine as a Profession
Columbia College of Physicians & Surgeons
630 W, 168th Street
Box 11
NY, NY 10032
(212)305-4184
