Why I take handouts from drug companies.

Health and medicine explained.
Dec. 12 2006 12:02 PM

Dr. Shameless

Why I take handouts from drug companies.

My drug-company habit started innocently enough—a pen here, a lunch there. But soon I hit the harder stuff: a trip to Italy in exchange for attending a symposium, tickets to a Mets game for my sons and me (and a chatty drug rep). Et cetera. There's a moment when each of us knows we have gone over the edge. For me, it was a trip to California where I met with a pharmacist for 30 minutes to talk about antifungal medication. 

And so now I am in recovery. I have not taken money or meals or pens or trips or any of it for about a year. It is hard, but every day I wake up and tell myself, today I will not take money from a drug company. Today I will stay clean.

Advertisement

There remains one problem—I don't feel that much shame for my former behavior, at least the money-grubbing part. I just don't think that the financial hanky-panky between drug companies and doctors constitutes the central crisis in American medicine or, for that matter, the most corrosive aspect of the entire messy doctor-drug relationship. They need us; we need them. We do the studies they can't do because they aren't doctors. They invent the drugs that we can't invent because we aren't chemists. It's pretty straightforward, really. A symbiosis.

Which isn't to say either side is particularly admirable. Estimates are that pharma spends $8,000 to $13,000 per doctor marketing its various products. Most of the promoting is done in the name of physician education. Yet, like the trip to Italy, it is generally a faintly camouflaged bribe, offered with a wink and a promise of more to come. In exchange for the business-class tickets, the doctor indicates (unofficially, of course) that he will prescribe more of product A, which is made by the crowd that paid for the Italian adventure, than drug B, which is made by a company that hasn't ponied up (yet).

It's a sleazy proposition all the way around. But as Calvin Coolidge once said, the business of America is business. Successful businesses want to sell as much as they can, as fast as they can. So doctors end up with meals and pens and trips and bogus advisory-board positions and, of course, the hordes of fine-looking well-perfumed young men and women—some literally cheerleaders—who hustle their way through physicians' offices.

Despite its successes, the pharma business model does have a problem. The drug reps, foot soldiers in the mercantile crusade, don't know what they are talking about. Unlike a shoe salesman or the guy who sold you your laptop, the drug rep is 100 percent lost. Imagine buying a car from someone who's never had a driver's license—that's how the doctor-drug relationship plays out. None of the people trying to convince me to prescribe product A ever has prescribed product A—or product B or product C for that matter. None has ever experienced the elaborate mess that is routine patient care. The freebies seek to redress this imbalance by making the exchange seem worthwhile.

And so does the drug-company tactic that, unlike meals and frequent-flier miles, poses a real if subtle danger. In place of expertise, the drug reps offer flattery—and with it, a revival of the old cosmology that puts the doctor at the center of the universe, as infallible as he was in the good old days. 

Alas, we doctors are easy targets. We feel unappreciated by our patients and by the public. The way we see it, we're just a bunch of blue-collar Joes with a degree, traveling through rain and sleet and snow trying to keep people healthy. Like the president, we think it's hard work and, also like Mr. Bush, we are genuinely shocked that everyone doesn't love us.

Enter the drug reps. Those guys love me; they really love me. I have my own personal troupe of professional grovelers who are paid to laugh at my jokes. You should join me when a few are in my office. It is a laugh riot. And you should hear the compliments I get after giving a paid lecture. My back is patted. I receive countless business cards and compliments.

All of this upsets the physician's internal balance. Doctors make countless decisions every day, and lots of them are wrong. Rethinking the errant judgment is a crucial private exercise. But once the tune of the drug-rep marching band gets going, it drums out reflection. The lonely, monotonous routine of doctoring gives way to the cheap thrill of low-grade celebrity. 

So don't bother attacking the freebies. Instead, take aim at the root of the problem—your doctor's insatiable quivering ego. It's not our fault, really. We've been working in a drug-company haze for far too long.

TODAY IN SLATE

Politics

Don’t Worry, Obama Isn’t Sending U.S. Troops to Fight ISIS

But the next president might. 

The Extraordinary Amicus Brief That Attempts to Explain the Wu-Tang Clan to the Supreme Court Justices

Amazon Is Officially a Gadget Company. Here Are Its Six New Devices.

The Human Need to Find Connections in Everything

It’s the source of creativity and delusions. It can harm us more than it helps us.

How Much Should You Loathe NFL Commissioner Roger Goodell?

Here are the facts.

Altered State

The Plight of the Pre-Legalization Marijuana Offender

What should happen to weed users and dealers busted before the stuff was legal?

Surprise! The Women Hired to Fix the NFL Think the NFL Is Just Great.

You Shouldn’t Spank Anyone but Your Consensual Sex Partner

Moneybox
Sept. 17 2014 5:10 PM The Most Awkward Scenario in Which a Man Can Hold a Door for a Woman
  News & Politics
Altered State
Sept. 17 2014 11:51 PM The Plight of the Pre-Legalization Marijuana Offender What should happen to weed users and dealers busted before the stuff was legal?
  Business
Business Insider
Sept. 17 2014 1:36 PM Nate Silver Versus Princeton Professor: Who Has the Right Models?
  Life
Outward
Sept. 17 2014 6:53 PM LGBTQ Luminaries Honored With MacArthur “Genius” Fellowships
  Double X
The XX Factor
Sept. 17 2014 6:14 PM Today in Gender Gaps: Biking
  Slate Plus
Slate Fare
Sept. 17 2014 9:37 AM Is Slate Too Liberal?  A members-only open thread.
  Arts
Brow Beat
Sept. 17 2014 8:25 PM A New Song and Music Video From Angel Olsen, Indie’s Next Big Thing
  Technology
Future Tense
Sept. 17 2014 9:00 PM Amazon Is Now a Gadget Company
  Health & Science
Medical Examiner
Sept. 17 2014 11:48 PM Spanking Is Great for Sex Which is why it’s grotesque for parenting.
  Sports
Sports Nut
Sept. 17 2014 3:51 PM NFL Jerk Watch: Roger Goodell How much should you loathe the pro football commissioner?