Pharmaceuticals

I attended a talk today on pharmaceutical companies and their practice of using marketing money to get medical types to prescribe their drugs. It was given by a nurse at work who has major issues with this sort of thing. The gist of the talk was that these companies are irresponsible and underhanded in their practices and spend billions of dollars shmoozing prescribers in an effort to get their sales up. The point was that we're being fleeced by these drup reps and their post-it notes and sponsored educational dinners and tickets to conferences in exotic places, and that we shouldn't stand for it because it's insulting and demeaning.

There was a bit of a gap in the logic for me, and I wonder if I'm just missing something. I mean, we as nurses and health professionals are trained to evaluate the quality of any source of information we encounter. Because there is a pharmaceutical company's logo on a fancy, shiny diagram of prostate cancer doesn't necessarily mean, to me, that I should exclude it from my practice out of hand. I can't yet see the conflict if there is no mention of that company's particular drug on the material. We, as professionals, know that there are at least three drugs which do the same thing as Viagra. This nurse's argument is that docs are more likely to prescribe Viagra because it is such a household word, due directly to brand recognition from the advertising, like my diagram.

Anyway, I think my point is that I am sufficiently educated to make the choice which is right for the patient, regardless of the butt-kissing from the drug reps. I acknowledge the influence. But there are some competing factors to consider.

First, the pharmaceutical companies have a responsibility to their shareholders, moreso, some would argue, than to the Greater Good. So they have a right to do what they want to flog their wares. Having said that, sleazy tactics should be recognized for what they are, and practitioners should be sufficently educated to make reasoably unbiased decisions, with the Good of the Patient in mind.

Second, I think that the problem lies not in the bribery, but the irresponsible way in which the pharmaceutical companies spend their money. If there was less money in advertising, maybe the prohibitively expensive drugs would be more economically feasible. Of course the bottom lines may suffer, but the Greater Good would benefit (naive, I know). Trickling the benefit down to the patient means that if a $20,000 drug suddenly costs Health Canada only $10,000, then they may expand indications for use so more people could use it. It would never happen, but the point is that it could. Maybe it ought to.

Thirdly, my institution cannot (or will not) afford to provide pens for its nurses, so why would we ever expect them to provide shiny, pretty diagrams of prostate cancer for us to use? The money is simply not available. And whether we like it or not, the diagrams are useful.

Finally, the drugs benefit the patients, whether we like the company's practices or not. And if they want to enter an $11 billion pissing contest with each other, fine. I maintain that health professionals should be able to evaluate educational material and make an unbiased decision, but even if the reps are influencing prescribing practices, does it really matter, if the treatment is successful? That was more or less a rhetorical question, because I am not sure of the answer. I'll keep thinking about it.

I guess find the issue more with the economics of it all than any kind of general bad-taste-in-the-mouth from the mugs and pens printed with drug labels. I have no particular objection to a moratorium on pharmaceutical sponsorship/gifting, but I think a major component of the problem was not mentioned.

Or, maybe I am naive, and idealistic, and think I can resist all attempts to influence me. Well, I never have been offered sponsorship to a conference in the Carribean... maybe my cognitive dissonance would be more difficult to resolve if the stakes were higher than free lunch.

Well, this was a bit of a stream-of-consciousness thing, because the point of this talk was to make us aware of the subtle and not-so-subtle influences of the drug companies. It was certainly successful in that way. I'm just not convinced yet that the practice, in general, is a horrible thing.