There’s an interesting journal article in this week’s New England Journal of Medicine that reports the results of a recent survey of over 1,600 physicians in six different practice areas, results which found that 94% of the physicians reported some type of a relationship with the pharmaceutical industry. That’s a pretty shockingly high number; even when you look at the numbers for specific relationships, 78% of doctors report receiving free drug samples, and over a third report accepting reimbursement for academic meeting expenses. (On the flip side, merely meeting with a pharm rep is considered to be a “relationship” by the survey, something I feel pretty secure saying is as likely to be totally innocuous as it is to be suspect in nature.)

I consider myself pretty fortunate to be in what appears to be the very small minority of this survey — I trained in a residency which banned pharm reps from having any contact with the residents and in a fellowship which had a similar restriction, and I now work for an entity which has the same proscription in place across the entire organization (as well as a very strict ethics process which even requires me to divest myself of any stock holdings in any part of the health care industry). I can probably count on one hand the few things in my life that came from pharm money — and thinking it through, they were all provided by unrestricted educational grants that were given to national societies like the American Society of Hematology rather than as directed contributions to me or my program.

All that being said, it bears stressing that the NEJM article makes no conclusions about the outcome of the relationships; for example, while there are clearly some doctors whose prescribing practices are altered by the availability of pharm perks, there are others who use free samples (like vaccines) because it’s the only way their patients can afford any kind of treatment whatsoever, and that’s the kind of relationship that some would say might have a positive effect on at least a certain segment of healthcare. I fully expect that these survey results are going to make waves in the press in the coming days, but I also expect that most press coverage will do a piss poor job of making this distinction clear. (I also would love to see the same survey done of a few other industries, making the appropriate substitutions — like of elected Federal officials and the groups they regulate, or of financial services reps and the financial sectors they cover.)


I’m surprised that you’re so surprised by this high number. It seems that EVERY SINGLE TIME I’m in a doctor’s office, at least one pharmaceutical rep is in and out.

• Posted by: Stan Taylor on Apr 26, 2007, 10:08 AM

The pharma companies have massive amounts of money to spend on marketing, considering how ridiculously overpriced most of the meds are these days.

I have a gastroenterologist who was enthusiastically selling me on a new drug called Zegerid, which is really nothing but Prilosec mixed with baking soda and put into a capsule form. If I did not have medical insurance this drug would cost me over $400/month. The profit on this for the pharmaceutical company is likely more than 1000%.

Luckily for the pharma company (AstraZeneca) I have found Zegerid to be gentler on my stomach than taking a cheaper prescription PPIs like Prilosec or OTC stuff like Zantac, so I pay my $55 for 3 months of pills (mail order) and I’m sure my insurance company pays the pharma company a chunk of change as well. With no health insurance, this 3-month supply of pills would be $1000-$1200.

It is no surprise to me that the pharma companies are stretching the ethical boundaries in their marketing tactics. It only bothers me if that then turns into doctors pushing prescriptions for drugs people really don’t need. In my case, it as the right drug for my specific health issue but I can think of many cases where an ovrpriced drug might be pushed by a doctor when a cheaper, generic drug may have been sufficient.

• Posted by: Cameron Barrett on Apr 26, 2007, 4:02 PM
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