This article is about how doctors are influenced by drug companies - but
clearly formula companies work in exactly the same way:

Teresa Pitman
Guelph, Ontario



--------------------------------------------------------------------------

      February 24, 2004
      ESSAY
      When Your Doctor Goes to the Beach, You May Get Burned
      By ABIGAIL ZUGER, M.D.

       doctor I know maintains a fairly typical relationship with the
pharmaceutical industry.

      He deplores its influence on medical practice and worries that his
colleagues' prescribing habits are increasingly swayed by omnipresent drug
advertisements and sales agents pumping new products.

      Regarding his own independence and integrity, though, my friend has no
doubts. He feels that, as a man of science, he is trained to recognize an
advertisement when he sees one, and to file it away in that corner of his
brain reserved for potentially biased information.

      The facts stored there have no influence on his professional judgment,
he believes.

      In fact, he says, it amuses him to take advantage of everything the
drug companies have to offer - the free pens and flashlights, the free
lunches, the expensive dinners, the occasional all-expense-paid jaunt to a
balmy resort to participate in a focus group and depart with a generous
check.

      He shrugs.

      "I need the money," he says. If the drug companies are naïve enough to
imagine that their largess will buy his loyalty, then so be it - it is their
gamble, and their loss.

      In fact, he points out that if a 21st century doctor is too principled
to participate in pharmaceutical-sponsored education, that doctor winds up
without much education at all, since so much of it is now financed by
industry.

      Studies show that most doctors feel the way my friend does, and not
only the ones who are hard up for cash. Travel to any medical meeting and
you will see the most eminent medical minds in the country taking full
advantage of pharmaceutical generosity.

      Some just sip the odd cup of free cappuccino, while others bed down in
free hotel suites. Some influential specialists make a point of accepting
consultant fees and gifts from as many companies as possible, to emphasize
their impartiality. On surveys, almost all doctors affirm that their
clinical judgment is unaffected by such activities.

      But the pharmaceutical industry is not known for its naïveté, and is
unlikely to continue providing their treats without getting something big in
return.

      Relatively few researchers have investigated the question of exactly
what that something big is. Among other considerations, it is one of the few
research topics in medicine that will not attract drug company financing.

      A handful of studies have looked at the common practice of giving
doctors free drug samples and have shown that it unquestionably induces them
to prescribe drugs they would otherwise avoid. The other gifts also appear
to bring a nice return. In one clever 1992 study published in the journal
Chest, Cleveland researchers surreptitiously tracked doctors' use of two
drugs before and after all-expense paid educational jaunts to sunny resorts.
They found that drug prescriptions more than tripled, an effect that
persisted for more than a year, while the use of equivalent drugs remained
stable.

      It is all quite deplorable, my friend says. He used to add routinely
that none of this data was applicable to him, but a recent series of events
may have changed his mind.

      A new AIDS drug was introduced into the marketplace a while ago, with
some interesting features that set it apart from older drugs. For one thing,
it was a new class of drug whose potency was not altogether certain; for
another, it was a long-acting drug that could be taken once a day - a
wonderful and liberating detail for patients otherwise tethered to a twice-
or thrice-daily schedule.

      The drug was released into the marketplace with a minimum of published
information on its success in patients - not an unusual occurrence in these
days of rapid drug approvals. The pharmaceutical company's representatives
outdid themselves, introducing their new product with lunches, dinners and
far-flung focus groups.

      My friend, a little skeptical of the drug, took full advantage of
these opportunities to learn all about it. After many conversations with the
drug representatives, a half-dozen nice meals and a few trips to warm, sandy
beaches, he had plenty of information.

      Time passed. More studies were done. The new drug seemed to perform
somewhat less effectively than had been hoped. Advisory bodies began to warn
that in some situations, the new drug should not be used at all: it was so
ineffective it could get patients into trouble.

      My friend, nothing if not conscientious, went through his list of
patients to identify those with H.I.V. infection who were on the new drug,
so that he could contact them and change their pills.

      The next time I ran into him he was a little subdued, newly conscious
of the power of subliminal advertising.

      "It turns out I had an awful lot of people on that silly drug," he
said. "I honestly can't imagine how that happened."



      Copyright 2004 The New York Times Company | Home | Privacy Policy |
Search | Corrections | Help | Back to Top

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html