Thursday, January 25, 2007
Conflict of Interest
Ok, ok. I guess I started this hot button topic. So, I should at least follow through on it. I should preface this post by saying that I am in no way, shape, or form - in a position of power in any health care policy organization. So, don't expect a polished statement. I'm just a peon in this mammoth health care system.
In discussions like this these, three questions always come up: How much does pharmaceutical marketing tactics make you prescribe their drug? Is this fair or unfair for your patient? Is this a conflict of interest?
Of course marketing tactics influence my prescribing habits! There have been many studies done to confirm this fact. This data is used by this medical school to forbid its docs from accepting any freebies from drug reps. This data is also used by this organization to advance its agenda of a zero tolerance policy of any acceptance of drug company free stuff.
Don't get me wrong, these are not the only groups who have this point of view. In every major medical organization in the US, there is a group of docs who want to absolve themselves and all medical organizations (like the American Medical Association) from all pharmaceutical funding - meaning that organizations like the AMA should accept NO FUNDING whatsoever from drug companies - because of conflict of interest.
While I understand these arguments, I disagree with them. (And, no, I'm not on the payroll of any drug company.) I think taking such an extreme point of view is not going to help them achieve their goal. I'll be curious to see follow-up studies at "that medical school" to see if removing drug rep freebies changed prescribing habits.
Drug reps and drug company marketing are always going to be there. There is no avoiding it. A few years ago, drug companies wised up and marketed directly to consumers - taking the doc right out of the loop. So, even if you ban drug reps from your office, patients always come in saying, "I heard on television to ask you about drug X." That's marketing getting at you a different way.
Even though I had my pissy rant yesterday, drug reps definitely do serve a purpose (and not just to give samples of meds). If for anything else, they serve as an information resource for me. Now, this is a biased resource. But, I know that going in. I work 12-14 hour days sometimes. I don't have the time to keep up on the latest medical research. I'm a clinician, not a researcher.
Through my medical school training, I've been taught to question all information that is given to me - whether it's a patient's vital signs, or physical exam, or lab work, or whatever. These skills I use when talking with reps about data they give to me. The pearls of info I receive during these interactions help me to make a more informed decision on prescription drug selection.
Finally, is this fair for patients? Fairness is always in the eye of the beholder. In my opinion, when you boil down the issue to its essence, it just comes down to the strength or weakness of the patient-physician relationship. Not only should the patient feel comfortable enough to express their feelings on this topic, the physician should be ready to listen and explain her/his point of view in a non-judgemental way. I didn't say it was easy, but it is necessary.
at 1:01 AM