Not to be missed from today’s Sunday reading is the article, “Dr. Drug Rep,” in today’s NYT Mag — click here. It’s a first person account by Dr. Daniel Carlat, an assistant clinical professor of psychiatry at Tufts School of Medicine, of his year of on-the-side service to Wyeth Pharmaceuticals promoting their depression drug, Effexor XR, to local docs in the Newburyport area. He gave up the side-practice after the ethical conflicts became too much for him. He made an extra $30K over his $140K regular income. Some tidbits:
At the end of the last lecture, we were all handed envelopes as we left the conference room. Inside were checks for $750. It was time to enjoy ourselves in the city.
Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep. Eventually, with an internal wince, I began to introduce myself as “Dr. Carlat, here for the Wyeth lunch.” The drug rep who arranged the lunch was always there, usually an attractive, vivacious woman with platters of gourmet sandwiches in tow. Hungry doctors and their staff of nurses and receptionists would filter into the lunch room, grateful for free food.
At my next Lunch and Learn, I mentioned toward the end of my presentation that data in support of Effexor were mainly short-term, and that there was a possibility that S.S.R.I.’s were just as effective. I felt reckless, but I left the office with a restored sense of integrity. Several days later, I was visited by the same district manager who first offered me the speaking job. Pleasant as always, he said: “My reps told me that you weren’t as enthusiastic about our product at your last talk. I told them that even Dr. Carlat can’t hit a home run every time. Have you been sick?”
HCFA’s cost control legislation includes measures to tighten the ability of drug companies to engage in this influence peddling. As we’re all looking for ways to control rising health care costs, are we willing to take on this unsavory, unethical, and wasteful practice?
“influence peddling”
Isn’t that exactly what your organization does?
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One of the subtle and interesting things in this article was the use of Meta-Analyses and selective data presentations (e.g. remission v. response) to make points or derive conclusions about specific medicines or classes of medicines. These types of analyses have been used groups looking to advance or restrict the use or certain types of medicines. The lesson is that every analysis has limitations, and newer studies can modify or change the conclusions from older ones. Physicians cannot have complete knowledge about a particular medicine, or how it compares to other treatment options, or how an individual patient will react/respond to a specific medicine. They need to try and have as great an understanding as they can about the medicines they use most frequently, and to work with both their patients and pharmacists when there are complicated medication situations.