A physician feeling violated and manipulated by pharma

Dr. Manoj Jain, an infectious-disease specialist in Memphis and adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta, published a column in the Washington Post, “More rules are needed to curb drug firms’ attempts to influence physicians.“

He starts off describing being recruited by a drug company as a “thought leader” and being added to the company’s speaker’s bureau.

Excerpts:

“But for me, something changed five years ago. One drug representative, a tall fellow with blond hair carrying an open laptop, politely but pointedly asked why I wasn’t prescribing his company’s HIV medicine. He was hinting that he knew what prescriptions I wrote. (I was unaware that drug reps can access doctors’ weekly prescribing patterns through a purchasable database.)

For a second, I felt a little guilty about not ordering his product. But then I felt violated and manipulated. I asked him to leave my office and not come back. That afternoon I told my secretary to cancel all appointments with drug reps and not to schedule any more.

I am not alone in thinking this way. Columbia University researchers who studied the issue of conflict of interest between marketing and patient care concluded in 2007 that “only the prohibition of [doctor-rep] interactions will be effective” in reducing it.

My decision came with a price. I no longer have access to the free sample medications that I once gave to my low-income patients. Also, I am not updated as I had been on new medications or talks sponsored by drug companies. A year ago, when a pulmonologist asked me about a new copycat antifungal medication, I felt embarrassed. I knew little about the drug. A drug rep had visited him and not me.

With thousands of journal articles published each year, and with new drugs and new indications for old drugs regularly being approved by the Food and Drug Administration, it’s impossible for a busy practitioner to keep up. Doctors often rely on drug reps to filter information, which can pose its own problems.
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The drug industry’s relationship with doctors needs transparency, regulation, enforcement and professionalism. … Under the health-care overhaul, a government Web site will list all doctors who take money from a pharmaceutical company beginning in 2013.

We also need regulations and enforcement to bar doctors from taking excessive and inappropriate gifts and speaker fees.

Lastly, doctors need to seek inner guidance from their sense of professionalism. No matter the source of undue pressure – the pharmaceutical industry, insurance companies or the government – physicians need to remain true to the best interests of their patients.”