From the “I Thought I’d Heard Everything” Department

By  |  October 16, 2007 | 

The pharmaceutical industry’s influence in clinical care is increasingly being viewed under a high-powered microscope, and the result is tightening restrictions on what pharma can do with/for/to doctors. Having lived through the era of sun-baked golf and beach “conferences” (with the invited physicians paid handsomely as “consultants”), this extra scrutiny has been long overdue.

And the changes are real. In my hospital, for example, pharmaceutical company representatives, who used to be ubiquitous (you could always tell who they were, since they were the most attractive people in the building), have been all-but-banished – able to see docs only by appointment, and no longer permitted to buy a even a soggy burrito for the residents.

Some states have really tightened these screws. An article in last week’s New York Times described a new Minnesota regulation that limits pharma reps to spending less than $50 per doctor per year on freebies. Up until the new regulation, some reps bought lunch for entire physicians’ offices (docs and staff) every single day. Now that they can’t, one hapless caterer located near a medical office building lamented that his business had tanked – down by two-thirds!

So what’s a pharma rep to do, now that he or she can’t spend lunch money on the docs? More and more, according to the Times, they are still hosting conferences at fancy restaurants – except now these aren’t for physicians, they are for nurses and even front office staff.  

I read that and scratched my head. Do the companies really believe that an office nurse or secretary is  going to influence a doctor’s choice of antibiotic or statin? Seems farfetched. But I’ve learned to never underestimate pharma’s marketing mojo. So I read on, and learned that the audience members were props – it was all about the speaker:

Those delivering the talks get training that involves learning drug makers’ most important marketing messages. And they receive anywhere from $500 to $5,000 for each talk they give, with some doctors earning more than $100,000 annually. 

‘This is the companies way of thanking high prescribers,’ said David J. Rothman, president of the Institute on Medicine as a Profession at Columbia University. ‘Drug companies don’t really care who’s in the audience.’

Just think about that one for a second. Even if you are disgusted by this new variation on the “money will always find its way” theme (see “The Saga of Campaign Finance Reform” if you want to learn the entire sorry song), you certainly have to give the companies an E for effort and a C for chutzpah.

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About the Author: Bob Wachter

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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