I refer to the cost-benefit ratio to the manufacturer, of whatever
activities they carry out directed at hospital staff to generate goodwill
for their company.  It is obscene that they can create a positive attitude
with such cheap trinkets and snacks, when they make it back with a hefty
margin of profit, and we just go along with it.

I mentioned that my professional association's local chapter is allowing the
representative for a pharmaceutical company that makes an IV iron
preparation, to buy dinner for attendees at our annual meeting, and the rep
has been given the slot we might otherwise use to have a speaker on some
professional topic of interest to midwives.
About thirty people are likely to show up, and at Norwegian prices this will
cost the rep about ten thousand Norwegian kroner which is about fifteen
hundred US dollars.

The preparation he is pushing costs about one hundred and fifty dollars in
medication alone to treat one patient.  Add to that the cost of IV
equipment, staff time to monitor these infusions, and the lengthened stays
since it must be administered once daily on three consecutive days and many
of our mothers live too far away for outpatient treatment to be practicable.
If he can convince the midwives that this form of treatment is worth the
time and discomfort to the woman, so that we encourage the docs to opt for
IV therapy after a post partum hemorrhage rather than simply advising her to
take dietary iron supplements until she can have a check at her GP's office
six weeks down the line, so that on at least ten occasions during the next
year we choose the IV route instead, he's gotten back what he invested.  

Meanwhile, we are being threatened with loss of staff, but I doubt that
anyone sees a connection, and the personnel budget seems to be completely
separate from the medications budget.

Of course the rep doesn't know that there will be someone present who plans
to press him on this.  Neither do my colleagues, who I hope will have
trouble digesting their dinner after they find out what it REALLY costs.
Obviously we ought to address the issue of why so many women in our unit
suffer significant blood loss in third stage, rather than jump at every new
drug that comes down the road to treat them.

Rachel Myr
Kristiansand, Norway

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