Sunday, November 25, 2007

Doctor Drug Rep

This article in today's New York Times is written by Dr. Carlat, a psychiatrist, who spent a year selling an antidepressant for a major pharmaceutical company. It's a fascinating report of how he suppressed his initial qualms for the easy money, but how over time he felt more and more guilty, eventually quitting. I haven't checked out his website yet, although I'm intrigued by the promise of an "unbiased monthly covering all things psychiatric", which is an enormous claim.

It's a very interesting story. Apparently he was making an extra $30,000 a year doing "drug lunches", talking to primary care physicians about the antidepressant. It's easy to understand, after reading his essay, why doctors get into this kind of thing. It's also rather frightening how much of our "continuing medical education" is actually sponsored by Big Pharma, in that CME doesn't just come in the form of online courses or weekend classes. We continue to evolve our medical practice based in part on the "sponsored" talks, the free lunches with beautiful samples to hand out to patients, and the beautiful, smiling reps, who assure us that "if your patient with X syndrome doesn't improve on our drug, then they've been misdiagnosed."

Also fascinating about this article is his description of how the pharmaceutical companies mine the prescribing information of doctors, aided in part by the AMA's registry of DEA numbers. They then use this information to prod or persuade those doctors who are "heavy prescribers" of certain of their drugs to prescribe more of them--in other words, to dole out medication exactly how the drug company wants them to do so.

Scary. I wonder which company's reps will target me in the future? I wonder what the appropriate stance is to take? I mean, do you reject the free samples that keep some poor patients in their medicine? And who doesn't like free lunch, or shiny new pens? I haven't decided yet how I want to practice, or how much (if any) drug company involvement I want to have. I don't know if I'll go "pharm-free", or if there's a way to compromise without being quite that radical. Or am I compromising my soul that way?

I found this article because Graham at over!my!med!body! found it first. Check it out.


enrico said...

I ranted about this last year, and while I'm a little less "absolute" about it now, I basically still think Pharm-Free is a good idea taken too far. While there is no academically sound benefit to pharma reps dealing w/med students, the reality is they exist and, like firearms, students should learn something more useful than holding a cross and holy water, saying "BACK! BACK!"

Medicine NEEDS BigPharma to innovate/make new drugs and BigPharma needs physicians to prescribe their products. Physician-centric groups should be gathering to find ways to pressure Pharma to do R&D on USEFUL drugs, not yet another ED pill as a cash cow. I'll jump aboard any group that attempts to reorient the drug pipelines to actually make life better for people who are sick. Pharm-Free would stupidly have us ignore everything.

Tiny Shrink said...

Excellent point. We don't practice in a glass box--we will be subjected to sales pitches for office supplies, and medical equipment, in addition to medications. It's a tough call, and I see the Pharm-Free point, but I haven't decided yet where I want to draw the line.