Why do doctors still think pharma doesn’t influence them?

Why do so many doctors still think they are invincible to the influence of the pharmaceutical industry?

Attractive, well-dressed, charismatic drug reps with pearly smiles and shiny flow charts still wait in waiting rooms. Lectures and conferences still occur where lunch is paid for by the pharmaceutical industry. Research studies are still published where investigators receive grants from drug companies and unfavourable results are still buried. Hospitals and medical clinics are still awash in brochures, pens, notepads and coffee mugs sporting names like Pfizer and Lipitor. This doesn’t even include free drug samples lining backroom shelves.

How can all this still be permitted given that patients come to their doctors expecting to be offered unbiased health advice?

From the pharmaceutical industry’s perspective, this makes perfect sense. The bottom line for any for-profit company is to sell their product, and since they can’t sell drugs directly to patients, they convince doctors to prescribe them. The more a doctor sees or hears the name of a drug, whether through drug reps, brochures or seeing the name on stationery, the more likely the drug is to be prescribed.

Knowing that doctors turn to published literature and lectures to make their decisions, pharma provides grants to researchers and funds conferences. Accepting free drug samples is one of the more contested issues among doctors. While doctors may see this as an act of charity by drug companies, which will benefit their patients living in poverty, it is actually just another way of increasing familiarity with drugs. When a doctor gives a patient a drug sample, she has to learn the name, dosing and side effects of the drug. Even though the sample is free at first, once a patient’s condition is well-controlled with this medication, the doctor is more likely to keep using this drug since it “already works for the patient.” She is also then more likely to prescribe it to other patients because she remembers the details of the drug. In a market where the newest drugs are usually just slight variations on existing products, this type of familiarity is essential to pharmaceutical sales.

So it makes sense why the companies would do this, but why would doctors not resist these practices? In 2007, a national survey of doctors in the US found that 94% had some form of relationship with the drug industry. While 28% reported directly receiving payment for consulting, lecturing or enrolling patients in a study, a striking 78% reported receiving drug samples and 83% reported receiving food in their workplaces.

When considering the impact of these relationships, two-thirds of medical school department chairs in the US felt a relationship with the industry had no impact on professional activities (and almost two-thirds reported having such a relationship).

It is then perhaps unsurprising to note that medical school provides substantial contact to students with pharmaceutical companies, and the more contact they have, the more likely they are to think that such contact does not influence their prescribing behaviour. In a study of medical residents, 61% felt their prescribing behaviour was immune from drug promotions but interestingly, only 16% felt this way about the prescribing of other physicians. This means that doctors think they can’t be influenced, but obviously acknowledge that others can.

When it comes to the research, there is no question that doctors are in fact influenced. A review from 2010 finds that information provided by drug companies (drug reps, journal ads, pharma-sponsored events, participating in pharma-funded clinical trials and more) all led to an increase in prescribing the promoted drug.

An earlier review also found that after meeting with pharma reps, doctors were more likely to ask their hospital to add the company’s drug to the formulary. When it comes to the influence on research, a systematic review looking at studies funded by pharmaceutical companies found that these were less likely to be published, meaning less transparency, and if they were published, they were more likely to have outcomes favouring the sponsor than were studies with other sponsors. At the end of the day, whether or not doctors recognize that their prescribing behaviour is influenced by the presence of the pharmaceutical industry, it is the patient that suffers by receiving biased advice, and both the patient and the broader system that pays for unnecessarily expensive newer drugs when often cheap generic alternatives may work just as well.

Canada has banned the use of TV, print and radio advertising of drugs directly to consumers because we recognize that this information should come from unbiased sources. While we unfortunately continue to receive some such exposure from cross-border broadcasts, why would we explicitly allow drug promotion to physicians? As a medical community, we have to say no to pharmaceutical influences on our practice — this means banning drug reps from our offices, samples and promotional products and avoiding lectures and conferences funded by pharma.

We have to work to make our medical schools “PharmFree” following the lead of the American Medical Student Association. We have to support and fund independent bodies that review medical literature untouched by pharma such as the BC Therapeutics Initiative and support educational events that strive to be pharma-free like the BC College of Family Physicians’ Annual Conference.

We have to work to require all clinical trials to be published so we are aware of all the evidence, not just some of it. As doctors, we have to do this for our patients, and as patients, we have to demand this of our doctors. And if ever we find ourselves feeling skeptical about the impact of the pharmaceutical industry’s efforts on physician prescribing behaviour, we have to remind ourselves, they wouldn’t pay for it if it didn’t work.


This blog post was originally published on Huffington Post Canada.

The comments section is closed.

  • Dr Shah says:

    Stupidest argument I have read in some time. The close ties between physicians and pharmaceutical companies are essential to the well being of the business that is Health Cafe. If pharmaceutical companies are not profitable, good luck in getting new medications on the market. It’s funny seeing patients whine and complain about nothing new and then have this same mindset.

  • Dianne Guthrie says:

    I applaud your conclusion that we need to make medical schools free of influence from pharmaceutical companies. My MD very rarely gives any alternatives for health concerns other than to provide a prescription. Many times the issue was better controlled or cured through lifestyle changes or referral to other practitioners such as physio therapists or massage therapists. While perhaps appearing to be quick fixes most pharmaceuticals do nothing to cure disease, they merely mask symptoms.

  • Liz says:

    How do you recommend that Physicians stay current on R&D, new to market products, and published research?

  • Alun Edwards says:

    I agree completely and in this age of increasing specialization in nursing practice and multidisciplinary team care, Pharma have been quick to realize the influence that seemingly educated team members can have on busy general physician prescribers.
    Continuing clinical education programs for the allied professions are frequently delivered by Pharma and it seems the training programs for pharmacists, dietitians and nurses do not emphasize critical appraisal, analysis of evidence or the potential for conflict of interest.
    The effect of a communication by a pharmacist or nurse to a physician (I think your patient should be on new drug X) or to the patient (tell your doctor that you will have better ‘control’ on drug Y) is pervasive and targeted by Pharma.

  • Jackie A. says:

    People are sold to every day. Everything we touch, use, enjoy was sold to us by someone. The characterization of industry as well-dressed pearly smiling, is insulting on so many levels. Many pharma reps have nursing degrees, teaching degrees, MBAs, M. Ed.’s and a myriad of other qualifications that make them credible resources for physicians. Nothing in life is unbiased and all things being equal a doctor isn’t going to use an inferior treatment simply because they had a meeting with a drug rep. The idea is insulting. Reps are highly educated by their companies and are continuously educated on the science of their products as well as other products in the class. What physician has time to keep up with all the changes in medications and why shouldn’t they be encouraged to get the most up to date data and information from industry…after all it’s the pharmaceutical industry that spends vastly more of it’s money on research and development! It bothers me to no end that the medical community wants to pain the drug industry as a bunch of money grubbing individuals when what they do each and every day is save lives. Lives that physicians could save without the billions of dollars the drug industry spends to bring those drugs to market.

  • mark macleod says:

    %featured%This is a fascinating discussion, not because of the yea/nay, mudslinging, heperbole etc. It’s a fascianting discussion because it represents the confluence of forces that occur in health care.%featured% Drug companies want to sell, they are not in the business of charity. There is a dearth of real, thoughtful, usable information and non-conflicted information for providers to access and use in a efficient, effective manner. New products are available and being peddled all of the time. Patients have opinions, sometime informed, sometimes not. Physicians have great incentive to keep looking after patients but few effective mechanisms for effective efficient learning. So is anyone surprised at the behaviors, the potential influences, and the conflicts?

    The hallmark of a good system as Andreas has said is a transparent one. We will NEVER eliminate conflict of interest but it is our obligation to recognize and manage it. It is my personal belief that every pharma company and every device/product company in the health care field should produce annually a list of donations, payments, sponsorships – to know those monies went, the amounts, and for what. Knowing that as a first step would help. Secondly, every study should be registered at outset and the results made public – not so that I as a physician can know, but that smarter people can look at them and ask the right questions.

    We still play games in health care with allusions to altruism and honour. I don’t think these are universally true by any group in the game. Let’s have a reality check

  • Anonymous says:

    I am anonymous because my pharma company may frown on me writing opinion rather than an approved response. The legal fees involved could cause the cost of our drug to go up. The result of many CIA’s is from a few reps using off label promotion not the company directive. Interesting that when doctors see the latest drug go generic they begin to prescribe it heavily. So, if given the drug as a low cost option they prefer the results and fewer side effects of the latest drug du jour. (That’s all the French I know). Also, keep in mind that many new formulations are the result of better delivery systems so you can take an antibiotic QD VS qid which leads to greater compliance and better outcomes. In addition, there are many articles that demonstrate that cost is not the motivating factor in patients taking their medicine, but the coaching, follow up, and results that drive their compliance. After hearing of the extremely long wait for medical care and the number of Canadiens that cross the border to be treated before the grave has been dug I would think you would be very appreciative of the value of new drugs. I used to work in textiles and they could run a process to dye fabric in 12 hours with no chemicals and in 4 hours with chemicals. In other words, I am sure that doctors can treat many patient cases with diet, exercise, and good habits. What has been your success rate there? People are living longer, happier lives due in part to good medicines. What cost do you place on that? Medicines are simply tools to help accomplish the goal of the physician effectively. Use that bulbous brain (and ego) of yours and weigh the information coming from the reps skeptically. We expect you to do that because I readily admit that doctors have a lot on their plate and are very capable people. As a matter of fact, the most interesting conversations I have with my accounts are those that challenge my data so I can represent the data and medicine in a more practical and honest way. If you will take a few seconds to receive the information in the good faith that it is being presented I think you will find most reps and pharma companies are trying to specify the best patient for their medication. You can spot data manipulation just like you can spot a drug seeker/abuser. Discuss the options with your patients and see if they would prefer to pay for a better medicine. Many times the cost of generic vs branded is the same for commercial insurance if using one of the rebate cards provided by the manufacturer. (Probably not an option in Canada because govt restricts their use)
    Also, how many patient education resources do generic companies provide? Any patient assistance departments for low income people? Community outreach programs? Staff and patient training services? (Again, probably not available in Canada because they govt disallows). Remember those govt services are not free. They come with a high tax burden.
    Did you know that If you want to hear a specific speaker with no bias you can take the time to request a grant from a manufacturer? This allows you to choose a speaker not even on the manufacturers list to speak about the disease state for CE credits. This can provide disease state education of the awareness of the problems and their treatment options and even better the sales reps must be completely removed from the process. As well, consider DTC (direct to consumer) ads a benefit for you. These ads increase patient awareness of possible problems and always direct the patient to their doctor for advice and education. Maybe a little more homework will provide you with even better cost options for your patients but I am sure you have been too busy to hear the rep tell you about these benefits.
    Last, all doctors graduate from med school with a degree but some have better grades and results than others. Do you provide fair balance to your patients about your success vs your failures so they can decide whether your outcomes are worth their money or not? Are your services free? are you being paid more or less than you are worth relative to your time and results? Who would you trust your care with, a physician that stays current and integrates information from all available resources or doctors that accept only one type of information say from the government whose only concern is cost savings across the population vs specific targeted results?

    • mel says:

      Dear Anonymous,

      It is clear you know little about the Canadian health care system — as such, perhaps refraining from comment altogether would have been prudent.

    • *-* says:

      Can people really expect laws and rules to regulate anything and everything ?
      Are not educated people generally conscious and having a minimum of morality ?
      Are they many people studying medicine with the intention of spoiling health and life of patients ?
      Did you ever wonder why bad products have never been best sellers ?
      In Countries where population is unable to maintain any viable social system, can’t we reasonably expect the same to pay for the development of drugs, research, clinical trials … ?
      In 34 years in the Pharma industry I NEVER saw any professional prescribing a product he/she is not convinced it is good if her/his patient.
      Are people not tired to take Medical Professionals for stupid and Pharma for more clever ?
      In the meantime, one should be more attentive to the fact that without real competition between Pharma companies, soon, medical treatments will be such a luxury that only a small minority of the population will be able to afford it. (this is already on track).

  • SR says:

    Some of the assertions made hear may still be true in Canada but in the US. Practices such as leave behinds (mugs, pens, pads) are not allowed. Sample distribution is much more restricted (a big negative for patients but more about that in a moment) as are meals and payments to doctors.

    About those samples. It says that the author works with marginalized populations (though I thought that Canadian healthcare solved that problem). I began my pharma career as a rep in the impoverished areas of the South Side of Chicago. Many of the patients fell between the cracks of insurance and medicaid. It was widely known and openly discussed by our doctors that they would not just give a few samples to each patient they started on a medication. Instead they gave none to many patients and would save the samples to give to patients that had no coverage for their meds. Now those patients are left in the lurch. One doctor who ran an indigent care clinic let it be known that he would sign for any samples that were short dated, meaning they were going to expire soon. Since it is well known that most drugs are good for at least one year beyond the expiration date, he used these samples to help his patients.

    While off label promotion can and does occur it is not widespread and reps in the company I worked for were sternly warned against it. I can say this with absolute authority because I created training for some of the largest groups of reps in the US. Legal and Regulatory colleagues were quite exacting in making sure our training emphasized fair balance and approved promotion. Individuals may have chosen to stray from the path but we were very serious about making sure they promoted products appropriately.

    Early in my career when I asked about getting my product on a hospital formulary the head of pharmacy at the hospital said it would help if we donated a fax machine. I was twenty something and still wet behind the ears. I asked my boss about this kind of donation and he nearly jumped through the phone explaining that we didn’t pay bribes and that he would rather lose the sales than play ball on this kind of corruption.

    A good example of the distortions around promotion is evidenced by the film “Love and Other Drugs”. The outlandish training practices depicted in the film did not occur. I know this because I was one of the ones who designed the training. There were never any scantily clad dancers at launch meetings. The legal team would have blown a gasket if it were ever even suggested. Not to mention that a huge portion of the marketing ranks were filled with strong independent women who would never allow that (that said, it’s not something the men would allow either).

    Our company had a strict no Las Vegas policy for meetings just to ensure that the abuses that could occur there didn’t happen. Despite the fact that Vegas has ideal space for big meetings it could not even be considered as a location.

    It has been an interesting phenomenon to actually be on the inside of events within the industry and observe how from the outside they are totally distorted. Critics do not realize that big pharma companies know the risk of being caught for illegal practices. No one wants to be saddled with a Corporate Integrity Agreement from the government. No the pharma industry is not perfect but rest assured they do not have the cure for cancer sitting in the basement. I have been down there and it is mainly electrical equipment and old conference tables.

  • Gil says:

    It is very obvious that Dr. Goel does not like the Pharmaceutical Industry. At the end of the day, she should look at what the industry has accomplished over the years. The other reality is drugs come out from research and companies spend millions of dollars before approval. Most drugs don’t even make it to the market place. The FDA approval process has been so strict that approval takes years and by the time the drug is out there in the market, the companies have to price it high in order to make up for the lost years and the time Dr. Goel’s favorite generics come in. It is still a business besides being a service. Dr. Goel must have not paid a lot for her medical school, her residency and is highly paid in her practice that business is not a part of her practice. The Pharmaceutical Industry is like any other business that promote to sell their products. The industry cannot be blamed for all the problems that doctors have with their patients. It’s actually the doctors who write the scripts and not the pharmaceutical industry. The industry and the reps do not sue physicians for not writing their products. Doctors have to make that medical decision based on individual patients they see. In fact, most physicians are highly educated compared to the reps that see them. Why can’t they make an intelligent and rational decision based on what they personally think is best for patients. Why blame the reps and the drug companies for their promotional efforts? If something being done is illegal, tell the FDA.
    Can you imagine if everybody stopped drug research because the industry cannot promote the products they produce? We would still be taking aspirin and penicillin. The world looks at the United States as the innovators in medicine. Millions of lives have been saved because of research and promotion. FDA is already regulating what reps can do and cannot do. How about physicians? Somebody has to make some money. Other industries do not get this kind of bad press and some make a lot more profit than the Pharmaceutical Companies. If there is somebody that needs to be regulated, it is the physicians who do not practice medicine the way Dr. Goel envisions it to be. Samples? Dr. Goel should try getting a generic prescription instead of a brand name all the time and still pay premium price.

  • Andreas Laupacis says:

    Ritika points out that pharmaceutical company trials, reports and marketing can be biased, and clinicians must interpret them critically.

    However, industry also funds excellent quality research.%featured% It is important that cynicism engendered by the egregious behaviour by some does not lead to an assumption of poor behaviour by all.%featured%

    A recent paper in the New England Journal of Medicine found that American internists who read identical reports of three hypothetical clinical trials rated the rigor of the reports more poorly if they thought the trials were funded by industry, compared with if they were funded by the NIH (http://www.ncbi.nlm.nih.gov/pubmed/22992075).

    These results worry me. It is likely respondents were aware that industry has previously suppressed results, and therefore they were concerned that the report might be biased. On the other hand, it is more likely that the results were accurately reported, which means that clinicians were minimizing important new research findings generated by pharma.

  • Clay says:

    Since you accuse this industry of bias…which is correct, please make some kind of attempt to be balanced and fair in your article. This is one of the most biased articles I have read in years…in fact probably much worse than the practices you malign

  • Educated says:

    I can understand the concern and believe that some is legitimate; however, we are missing the bigger picture which includes the BENEFITS of these interactions. First point; the large pharmaceutical companies have taken it upon themselves to self-police and strictly abide by the rules. They no longer furnish trips, extravagant meals or even pens and paper to doctors or doctors’ offices anymore. With that said there are still some smaller company’s who don’t follow this practice to date, but change is continuous and we hope they will move to these same practices for the sake of the industry and the patient. Second, how much time does your doctor or your childs pediatrician have to stay abreast of all the new drugs on the market. I can tell you, slim to none. I have had family members put on medicine that is antiquated at best when even I know there are better options out there. I get the impression that the real frustration is that pharmaceutical company’s charge what is considered a high dollar for the medication and that they are profitable. This brings up two issues: if you had a business would you not want it to be profitable? And second, they bear the risk and burden of the exorbitant costs incurred by research and development. They spend billions trying to develop new treatments to make our lives better and longer when the majority never makes it to market. If you are comfortable with the current treatments available and only want to count on the not-for-profit organizations to develop furture treatments you have an argument, but you better open your pocketbook and donate because they only contribute a small percent to the new drug development. And please don’t misconstrue this as a slam against not-for-profits as they are necessary, but they must be funded at the same time. If me, or any of my loved ones, are diagnosed with a serious condition I will want to not only push for continued research but also make sure I have the latest treatment and technology at my disposal. With that said, since I am the only one in charge of my health, I will do my homework and research.

  • Rob Sargeant says:

    I know I’m weighing in late in this discussion, but here goes. As with most ‘Big Pharma’ articles, physicians in this piece come across as mostly hapless, over-worked suckers for spin; at the mercy of attractive sales agents distributing trinkets and free food.%featured% Is it true that we physicians are that naive – or could it be that we are poorly educated and unaccountable?%featured% I would respectively suggest that the problem of medication knowledge and prescribing practice is first and foremost a physician issue that is multifaceted, correctable and has little or nothing to do with the sales pitch – and it starts in medical schools. The current system of learning around drugs is fragmented, experiential-based, and all too dependent on the initiative of the trainee to read up on medication usage, side effects, efficacy and evidence. Basic pharmacology is poorly taught in the undergraduate medical curriculum and is increasingly left to ‘pharmacy’ – to the extent that the majority of students and junior residents I work with on the hospital wards are completely incapable of prescribing even basic medications, including antibiotics. The end result is a lack of confidence in prescribing medication that persists into practice, and as often as not, leads to reliance on specialists to make treatment decisions within narrow fields of interest; with little thought given to how medications will interact with other drugs a patient may (or should) be taking. The second area that is missing is ongoing assessment of routine practice at an individual and institution level to ensure appropriate, evidence-based, cost efficient treatment and outcome. There is little in the way of ongoing assessment of physician knowledge related to the effects and consequences of medication prescription and adverse effects – no oversight, no accountability, no report cards.
    It is easy to point to ‘Big Pharma’ as the villain, but it is doctors who fill out prescriptions. Free lunch or not, we (docs) need to know what the consequences are for each and every prescription we fill, and to be up to date on the newer, cheaper and safer options that are available (a role the pharmaceutical industry DOES help to fill, by the way). To say we are too busy to do this is a cop out; equivalent to suggesting a pilot would not need to learn the controls of a new aircraft prior to flying it. One final point. In Ritika’s otherwise well-referenced article, I couldn’t help but notice the lack of citations backing her claims that Pharma influence at the individual practice level actually impacts physician KNOWLEDGE and patient OUTCOME for better or for ill; the two things that should matter most.

  • Jamil khan pakistan says:

    Yes i fully agree, but in our country the situation is more worse, pharmaceutical companies doing unethical practices and doctors demanding each and every thing even Cash to prescribe drugs,which effect their practice,,,,,,,,,

  • Kultaran says:

    Doctors will be influenced, because they are emotional human beings….

  • Kultaran says:

    Hi all I agree

    The industry is an important part of the Osciety of Doctors, withoutr whom, new reserches and updation or re capturing of knowledge may not be possible. Doctors get very littel time to go through literatures or studies of ALL drugs, hence the Pharma rep ius required to fulfill that need, they may be right in deciding on the drug based on its merits and demerits. Trials, I agree need to be unbiased and trasparent.

  • Mike says:

    Its very simple. Without the pharma industry there would be NO doctors! Period. The doctors find something wrong with you and provide you with a drug. If there was no drug, why would you go to the doctor? Just so he can say something is wrong with you and go on your merry way? But go ahead, alienate the drug companies. They’re the ones who do RD on new products. So forget about a breast cancer drug (stop walking), forget new drugs for anything, for that matter. Have fun with your generics for the next 100 years…..and the same dieases that give you a death sentence today, will still be killing people tomorrow, and the next day, and the next day, and the next day…….

    • stopmakingsense says:

      This is a straw man argument. No one is suggesting drug companies shouldn’t exist, or that their products can be of enormous benefit. %featured%What is at issue is how we should be providing clinicians with information about new treatments. Should that information come from salespeople with a vested interest in promoting their product’s use, or from a dispassionate third party?%featured%

      Few of us think the best way to purchase a car is to listen only to the salesperson, whose job it is to sell their company’s car regardless of the quality. Most of us would pick up Consumer Reports and get some third-party analysis in order to make an informed decision. This isn’t some anit-car salesman position, it’s a pragmatic recognition and response to reality. As a patient, I want my doctor to be deciding what medication I get based on the medical version of Consumer Reports, not based on what the guy at the car lot has to say.

  • Brandon says:

    Wow, I amazed at the lack of understanding that this article was written with. First, Ritika obviously isn’t up to date with the pharmaceutical industry; please allow me to elaborate. Disclaimer, I am a drug rep who has worked in the industry for about 3 years. We do not give away such things as pens, trips, or anything along that nature to doctors; the only thing that we can provide to the physician is a lunch and learn educational meeting. The reason that drug companies will but physicians’ lunch isn’t to influence them but merely to gain time with the physician. That’s it, because without a lunch, the average time with a doctor is 40 seconds; it’s impossible to explain the drug in that time frame… The reason is that doctors are so busy with these extreme patient loads that they are always running behind. Ever been to your doctor’s appointment and been seen on time, probably not. You can blame insurance companies and government programs for that. I could spend all day on this issue alone but let’s move on.

    Second, Rikita, you want med schools to become “Pharma free” as you call it. How then are they to learn about the advances in medicine? Every young resident that I speak with is clueless in terms any branded medicines. They know 3 drugs for hypertension, and they are all generics. Are those the best ways to treat your patient? What about when you have a pat that works on the road, should he take an HCTZ? Or how about a 35 year old with stage 2 hypertension and suffering from edema from the generic HCTZ and CCB that he was given? Just some food for thought, Rikita, it’s not as cut and dry as you make it.

    • stopmakingsense says:

      How is a medical student going to learn about new advances in medicine? How about medical school?

      Honestly the tone here of a junior drug rep presuming to lecture a physician is so revealing about how the industry thinks and operates.

      ps. This is a Canadian website and Canada has its own regulations (independent country, crazy, eh?), so if there’s anyone lacking understanding, it’s you.

    • Joel Wiens says:

      Residents you speak to are clueless about branded medicines? And the pharmaceutical industry is coming to the rescue?

      How are doctors supposed to learn about advances in medicine? There are a lot of ways to learn about advances in medicine in a timely fashion. Doctors know how to do it. Leaning on Pharma sponsored drug talks is, based on quite a lot of research, not a good way to do it. Core competencies in medicine include self learning about medications needed by our patients. Pharma talks is not a component of that competency. Period.

  • Jeremy Petch says:

    Interesting piece in today's Globe and Mail that is very relevant to this discussion:

    Drug sales reps often skip the side effects, doctor survey finds


    • Brandon says:

      Once again, a very misleading article written by people with a bias. I work in the industry and can tell you that docs ask me about the side effects on every sales call. They care about it and so does the rep; it’s simple, if the patient has a bad adverse reaction they will obviously not want the drug and the doctor will not want to use it. That results in a lose-lose situation for the drug rep so they obvioulsy want to avoid that. The best way is to be upfront about possible adverse reactions so if it happens the doctor knows what to expect.

  • Samantha Delabate says:

    Joel Wiens – You clearly have no life. Quit commenting on every post. We get it, you don’t like the pharmaceutical industry. Now go for a run, read a book or do something, anything besides staring at your computer and regurgitating the same view point into 20 different posts. Samantha Delabate – Houston, TX.

  • Jerry Genesio says:

    Dr. Goel, clearly you have struck some very sensitive chords. It’s interesting to note that most of those defending Pharma chose not to provide their names (as required). I have Caller ID, and when the phone rings and it reads “Private Caller” or “800 number”, I ignore it.

    I worked as a drug rep in the U.S. for 20 years and I can tell you the regulations put in place since the 1970s & 1980s were desperately needed and haven’t gone far enough. Even today I know of a cardiologist whose wife reps for a cardiovascular device company. I often wonder whose devices he uses and if I’d want him for my cardiologist.

    Back “in the day”, I knew of pharmacists and physicians who accepted gifts, trips, stock, grants, and very well paid lecture fees at Pharma conferences. I often got into trouble for losing bid contracts to those who played the game because I frequently took my lower bid “upstairs” demanding to know why I lost the contract. Sometimes they’d throw me a bone and give me half of the contract to shut me up, and unfortunately I was often told not to make waves by my own employer, who I’m quite confident also had reps who did play the game.

    I resigned from the company I worked for and left the industry entirely when, during the heat of the HIV/AIDS crisis in the 1980s, I learned that many U.S. blood industry leaders including my own employer had been importing raw human blood plasma from many under-developed countries throughout Latin America and the Caribbean Basin, including Haiti. In some of these nations, Hepatitis C was known to be endemic. In others, HIV/AIDS was endemic. Millions of liters of human blood plasma were being flown to the U.S. mainly because of the huge profit margins.

    Good job, Dr. Goel! You have my gratitude and admiration.

  • Brian Pots says:

    I find that pharma is an easy excuse for people to point the finger on what is wrong with healthcare. The pretty reps and free lunches are all nice and all but really make for an easy target for the woes if the industry. The profits that companies make are held on disdain and many misconceptions exists. If you examine the profit margins that pharma makes in comparison to other industries you might think differently that pharma makes to much to money. Unless of course you believe that all companies make to much which is a completely different topic for a different board. So lets break this down….
    the top 10 combined industry leaders in terms of profit…
    pharma companies made ~75b usd.
    Tobacco 35B
    Healthcare labs 8B
    Auto Makers 93B
    Computer equipment 123B
    Managed healthcare (only 7 companies listed) 14B
    Drug retail (only 4 companies in this category) 8B
    Medical equipment 26B
    Oil and Gas 240B
    Insurance life health investment 73B

    Source Forbes.

    When you look at the top profit margins for companies the highest rated pharma company is number #43 in terms of profit. Not to debate the merits of reps effectiveness but its not like pharma is the prince of profits. In fact they are far from it. I bring this up because so many believe that reps are doing the evil bidding of the mighty pharma companies. They may or may not be but a closer look at the numbers illustrate that pharma is not as all powerful as our colleagues would want us to think. However they are powerful just adding some perspective on corporate power. Sorry for the typos but I did this on my iPhone.

  • Irene Ying says:

    This month’s JGIM: Despite drugs sales reps rarely mentioning serious adverse side effects, 54% of physicians still rated the scientific information provided to be good or excellent

  • Faraz Siddiqui says:

    Great piece, Dr. Goel, this is an important issue and I think you have a clear and strong argument. A fantastic study that I came across analysed the difference in prescription attitudes and behavior at McMaster School of Medicine (Ontario) when they regulated the contact between pharmaceutical company representatives and internal medicine residents (http://www.ncbi.nlm.nih.gov/pubmed/11667936)

  • Rini Ghosh says:

    Any of the people commenting on here who think that Doctors are somehow immune to being influenced by lobbying, Id like to ask why they think so. Perhaps some of them should remember that to Err is Human and Doctors have yet to be proven to be supernatural beings. This sort of "doctors are above all of that" tone needs to change, and doctors should be the first to embrace, I can make mistakes ideology. (You are obviously there, your colleagues needs to catch up).

    No one expects doctors to be faultless, or above mistakes so I am not quite sure why they put that pressure on themselves. You can make mistakes, acknowledge them, make sure it doesn't happen again and then move on. That is all that patient safety asks you to do. It doesn't ask you to be infallible. Similarly, you aren't above normal human tendencies, if you think you are go ahead and do some research and you will see that you aren't. As doctors, as people who should have some kind of working knowledge of the human body and brain should be well equipped to reconcile with these facts.

    I really think Pharma companies everywhere need a complete shake up. They are unethical, profit maximizing entities which have no business making the kind of profits their make off of human beings and their poor health. Stop blocking access to medication to poor countries, stop your evergreening, and let your performance dictate your fate. Direct to consumer advertising should be made illegal in the US, as it is in Canada. And pharma companies don't need to send their reps to try to buy out docs either. They are smart people. If you are making a good product, they can figure it out on their own and will prescribe it to their patients.

    • Rini Ghosh says:

      I just realised that I made a bunch of typos in my post above. I apologize for the tardiness. My adrenaline got the best of me! :D

    • Brandon says:

      I was actually laughing at that comment since you are obviously uneducated and clearly have no factual basis for your comments. I have just one question for you: Since most doctors work 60 plus hour workweeks what percentage of them do you think sit down and read medical journals to stay up to date on the newest medications?

      • Joel Wiens says:

        Whatever percentage it is that you find, you will find that percentage closely tracks with competency. There are lots of resources out there to keep doctors up to date without having to pour through journals, Brandon. Welcome to the information age. It’s about filtering, and guess what, it’s not brain surgery!

  • Jonny Drug Rep says:

    Really? The ethics of a doctor can be bought with a bagel and a cup of coffee? If it were only that easy, I’d have been the best drug rep that ever existed. The food buys time. That’s all. If during that time, a salient and factual clinical arguement is made, then a doctor will consider using a product appropriately. That is how it happens. This article leaves out the nature of the conversations that occur between reps and doctors. It also avoids the most fundamental premise that doctors practice medicine. Writing medications is what they do. That’s what they studied, that’s their job. It is, in my opinion, reckless and irresponsible for a provider to NOT meet with representatives of new products to at least hear their side of the evidence before rendering a verdict on any therapy. This article seems to be very narrow minded, very assumptive and very ill-informed. (might I even add the word “bigotted”?) As with everything in life, balance is key.

    • stopmakingsense says:

      "meet with representatives of new products to at least hear their side of the evidence" I don't think anything the author said could have made the problem more clear than this.

    • Marc-Andre Gagnon says:

      The assumption in this comment is that drug reps do bring an important information that help physicians improve their prescribing habits. This is in fact a very bold statement when compared to the existing literature. A systematic review of the literature on the impact of sales reps on prescribing habits shows that, with rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. It did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, it recommends that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.
      The systematic review can be found here:

      Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, Vitry AI. Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: a systematic review. PLoS Med. 2010 Oct 19;7(10):e1000352.
      Marc-André Gagnon

    • Joel Wiens says:

      The information is on the side of the writer, Jonny. Your pseudonym, by the way, undermines the seriousness of your response. If you can’t put your name behind your comment, I don’t see why your opinions should be engaged seriously in conversation. Observe that when leaving a comment you name is required.

    • always question says:

      Doctors do and should practice medicine. However perscibing a drug should only be a part of that. Reaching for the perscription pad to solve all problems is not good medicine at all. And as a drug rep, if you’re trying to say that you’re not fully invested in pushing your product that’s insane. Doctors should keep learning and evolving, but not from people who have a vested interest in educating them in one direction. No drug rep is going to say that in this case a non drug therapy would be best, please!

    • April Health says:

      “…It also avoids the most fundamental premise that doctors practice medicine. Writing medications is what they do. That’s what they studied, that’s their job.”

      I would certainly hope that is not all they studied, Jonny!

  • Hishab Uddin Ahmed says:

    Hi Ritika,
    You have perfectly identified and express appropriately. As a result of harsh competition among the pharma companies and because of physicians thirst for taking privilege from them, the physician some time make mistakes by prescribing inferior quality drug.

    If the doctors be aware of the drug quality and patient interest then some mistakes may be avoided.

  • Fabio telman says:

    Most physicians have not or would not build a habit or staying up to date with medical evidence or pharmacology through independent sources. Contact with Pharma through reps, advisory boards or industry-sponsored trials is often the only way they maintain some level of knowledge that is up to par with what patients would expect.

    As part of the natural exercise of competition, Pharma companies will highlight their pluses and their competitor’s minuses in an apparently zero-sum game that results in increased awareness to HCPs.
    Ritika is right in saying that “From the Pharmaceutical Industry perspective, this makes perfect sense” since it generates profit.

    However, there is an even more important topic that the article seems to toss to the side: the question of ethics. Are physicians or Pharma acting unethically by maintaining these practices? is the system so perverse that it leaves no room for alternatives for physicians to gain knowledge or for pharma companies to make profit? In my opinion, it used to be that way, but no longer. Today, physicians have quick, convenient and practically free access to relevant scientific information that could enrich their practice without the influence of Pharma. On the other hand, Pharma has come to be more regulated through policies like the Sunshine Act or even self regulating practices like compliance codes.

    The practice of only publishing potitive data is practically erradicated. This item still needs work, however, because pharma can only invest in the science that promises good results, but they must publish whatever outcome. Funding for solid, independent research is scant and no institution or even government is in a position to pour the millions of dollars (American or Canadian) required to develop new drugs, compare old ones to new ones, follow-up with safety trials, etc.

    No doubt, physician-industry relationships can easily become suspect, so all parts must continue to work to defend their reputation and long-term profitability. Simply breaking the bonds between physicians and pharma for the sake of “independence” or “unbiasedness” is an empty promise of benefit to patients.

    • Joel Wiens says:

      The question isn’t really what most physicians currently would or wouldn’t do, the question is are we doing right by our patients. Research suggests that we are failing our patients if we are depending on drug reps for our medication information. If doctors are unable to keep up with medication information with medications that they use on a regular basis, then they are failing a major component of medical practice competency and should improve that competency. If the need to make time to see patients takes precedence over competency in the service provided, there are serious issues to address in the practice.

  • Bob B. says:

    Good discussion above, but I really wish the author had done at least a little bit of homework on what is really going on in the marketplace. Pharma can no longer give out pens, note pads, or coffee mugs. Lunch can no longer be provided except in very limited situations (a very modest in-office meal or snack in conjunction with an educational program), and must be fully disclosed on public websites. Pharma can no longer “bury” a negative study… all are made available on ClinicalTrials.gov. And there is a very strict firewall between research grants and the commercial side of the pharmaceutical business, ensuring that Pharma cannot influence research. The pharmaceutical industry is arguably the most highly regulated industry in existence, and it has radically changed the way Pharma interacts with physicians. Does Pharma influence prescribing? I think so, but not in the ways suggested by the author.

    • Jeremy Petch says:

      Thanks for your comment, Bob. I think some of the discussion about this post is rooted in some differences between Canadian and American law surrounding MD and drug rep interactions. Ritika is a Canadian physician, writing on a Canadian website. This has created some confusion for some American guests who don’t seem to have realized this.

    • Joel Wiens says:

      Thanks Bob – is your last name really B? Just a pet peeve about discussion boards. Pseudonyms indicate a lack of commitment to ideas, a sense that, oh well, I’m just reacting anyway, no one really cares. This is bad for true dialogue. In any case, as fantastic as it is that those laws are in place in some places, regulations are only as good as their implementation and enforcement, as well as in their completeness. ClinicalTrials.gov is fantastic as a start! It is not being participated in universally, however, and it’s usefulness is critically related to the universality of participation. Pharma is just beginning to see an appropriate level of regulation, and it is important to not balk at pushing forward to implement those regulations to the full intention of the spirit of those regulations.

  • dr merrilee fullerton says:

    “As a medical community, we have to say no to pharmaceutical influences on our practice — this means banning drug reps from our offices, samples and promotional products and avoiding lectures and conferences funded by pharma.”

    At the same time that there is clamor for a national pharmacare program (as though putting “national” in front of pharmacare somehow makes it a good thing) some groups and individuals want the medical community to “say no to pharmaceutical influences on our practice” and they want to use evidence that is often incomplete to support more pharmaceutical use.

    Strange but true.

    • Joel Wiens says:

      Merrilee, I don’t understand how you come to the conclusion that anyone believes that putting the word “national” in front of pharmacare somehow makes it a good thing. Your comment really does a disservice to the work being done on this subject by not even engaging the idea. Could you flesh out a little bit better what you object to in the ideas that are being clamoured about?

      I really don’t understand what you are referring to when you say “some groups and individuals want the medical community to “say no to pharmaceutical influences on our practice” and they want to use evidence that is often incomplete to support more pharmaceutical use.” Maybe the syntax is off a little, but I don’t see your point.

    • Brandon says:

      Are you high? Your comment made no sense, please tell me that your not an actual doctor. Wait, I know your not or you would have remembered to capitalize the D.

  • Greg says:

    Forbes magazine last year did a review of the cost of developing pharmaceutical products/devices. They looked at the R&D expenditures of all the major companies over 15 years, adjusted for inflation and divided that number by the number of new products they had approved. Using that methodology, the average cost was about $7 billion per product. Those costs, of necessity, are passed on to the consumer. I think we need to evaluate the constraints and subsequent costs that the pharma industry is saddled with and ask ourselves if they warrant the consumer cost. The FDA is a huge barrier to innovation. It serves a legitimate role, but it is an agency that has gone berzerk with regulatory constraints and needs to be reigned in.

    • Ryan Herriot says:

      These companies spend far, far more on the described marketing activities than they do on R&D. Perhaps if they spent more on R&D and less on marketing, the average cost per product would be a lot more in the public’s favour. In any event, the idea that we need to put up with unhelpful behaviour because these companies develop new drugs is false.

  • Bob Oreiley says:

    Thanks for the article. As a physician practicing for the last dozen years I would say that some of my colleagues are the biggest suckers in the world when it comes to easy influence. They are bright and clever and very intelligent but easy prey for con men (and women) in fancy suits with a free lunch. The Pharma industry does spend resources on research and development and they are pretty good at it but they are Jedi when it comes to selling. If you dissect the financial statement of a large Pharma corp then you will see just exactly how much $ flows to marketing vs. hard science.
    I have found that older physicians are much more easily duped by “research” presented by Pharma reps – perhaps it is their culture or perhaps their poor understanding of stats and epidemiology. I can only hope that physicians in the future can be a bit more skeptical with the claims of those who stand to profit.

    • dr merrilee fullerton says:

      This has not been my experience at all and I have been in practice for 25 years plus, working with all ages of physicians in a variety of settings.

      For the most part, physicians I know will listen to the drug rep (when they occasionally see them leaving samples of Acetaminophen and Ibubrofen for patients on limited budgets) and then consider the information they have been provided with.

      Why is there so much negativity here?
      It is like a doctor/pharma bashing site. Too bad.

      • Joel Wiens says:

        Thanks, Bob – you are so right. I think it is too bad when being self critical (if being critical of one’s profession is being “self” critical) gets dismissed as simply bashing. I don’t think “suckers” is too harsh a word when I look at the results of drug prescribing patterns in our culture. I also think there is less and less of an excuse for it, and I submit that in the past there was some excuse for the poor critical thinking going on in prescribing practices related to underdeveloped education around statistical comprehension and drug development processes – as well as a culture wide love in for corporate product developers as the heroes of our time.

    • Brian says:

      Hi Bob,

      I thought con men (and women) typically were doing illegal things and their goal was to defraud the ‘mark’. You don’t know much about Pharma if you think that is the goal or reps entering an office. Most, if not all, reps truly believe that the product they are promoting is the best choice for the the patients for whom they are promoting it. Physicians have choices when they prescribe. From older, cheaper generics, to newer more expensive generics, to new expensive branded drugs. The goal of pharma is to inform about these options. Not substantially different than a physician explaining treatment options to a patient, from the older, cheaper, and possibly less effective to the cutting edge and expensive.
      Should you choose to challege the “research”, feel free, but that is what the peer review process is all about. Neither the rep nor the company published the study. The company, most likely, provided funding for the study to be done, for if they had not, the drug would never had been studied. The fact that the company paid for the trial does not change the fact that the authors did the study, wrote it up, submitted it to a respected peer reviewed journal, and it was published. That makes it part of the scientific literature. You may disagree with the methods, results, or discussion, but that does not mean that studies provided by pharma are not ‘research.’
      If not Pharma, then who? If pharma does not give a grant for a drug to be studied, then how will the drug be studied? If Pharma does not highlight new theraputic choices, then who will? If physicians are satisfied with the status quo, they will not look for improvements. They will be satisfied with good, even though something better exists for their patients, just without their knowledge.

  • Jaswal Al-Huweid says:

    The existence of the multicentre randomized controlled trial is evidence of pharmas control over medicine. And academic physicians are happy to turn off their brains and accept all results as “evidence based medicine”.

    The biggest tenet of science, reproducibility, cannot be possibly met when a trial costs a billion dollars to run and ten years to complete. What entities, other than pharma corps, have the resources to do such work? None.

    We are owned by pharma, like it or not. I for one welcome the attractive physiques of drug reps that grace my office. The science I consult to treat my patients comes from their companies, or companies like them.

    To criticize the “free pens and lunches” is a short-sighted, easy argument to make. Ultimately, however, it is meaningless. We should be grateful that these corporations are willing to give us, and our patients, things. We’d still be using their drugs anyway if they didn’t.

    • dr merrilee fullerton says:

      Once again, gross generalizations about MDs:

      “academic physicians are happy to turn off their brains and accept all results as “evidence based medicine”.”

      “We are owned by Pharma”.

      Honestly, where do you get this stuff? It is nonsense.

    • Arthur says:

      the problem is how stained that science is that you consult and how much more drugs you may unnecessarily prescribe … the article clearly criticizes much more than free pens and lunches.

  • Robert Glanzman says:

    As a neurologist, who spent 7 years in clinical practice and the last 14 on “the dark side” (in Pharma), I think a few comments need to be made. First; as was previously mentioned, every interaction between an employee of a pharmaceutical company and any health care provider (HCP) in the US is tightly regulated, by the FDA, OIG and individual states. Since the “Sunshine Act” was implemented, nothing of any value can be given by an employee of Pharma to any HCP without full disclosure and the nature of these “gifts” are that they be of nominal value and directed for patient benefit, not for the HCP. Second; with regard to publishing only positive data; this is pervasive throughout all of published science. There are a limited number if Journals and each of these has limited space. Third; simply because a drug has a failed study does not mean that the drug is ineffective. In neuroscience, with “soft” end points, it not uncommon for placebo to have substantial benefit. Even in MS, a disease with relatively “hard endpoints”, patients typically have a 30% reduction in relapse rate, simply by signing informed consent. Ruling out a Type I error, in this setting is never easy. Fourth; I would not be too impressed with cheap generics. Generic companies don’t have research departments, they have lawyers. No significant advancement in the treatment of any disease I am aware of has ever been made by a generic company. The reason branded drugs are so expensive is the horrendous cost of drug development, a very risky business indeed. Many hundreds of very smart people spend their entire careers researching new advances and never have a drug actually come to market. Next; it is unfortunate that the US is the last remaining country who actually pays “retail” for branded drugs. In most countries, including Canada, drug pricing is regulated by the government, with the net result that ~ 50% of all Pharma profits (and hence development reimbursement) comes from the US. This is clearly unsustainable, and I fully expect that 25% of all Pharma profits will disappear over the next decade, as the US begins real drug price control. This will necessitate new, hopefully more efficient, models of drug development to be discovered and implemented, if we are to continue the remarkable advances we have made in treatment of previously intractable diseases. And last; we all need each other! Academia will never have the resources or expertise necessary to implement full development plans, from pre-clinical studies, through Phase I pharmacokinetic studies, into Phase II proof-of-concept studies (generally using a biomarker as a primary endpoint and exploring dose ranging in a selected population) and then large, expensive Phase III confirmatory trials. One program I was recently leading had a total tab of 600 million Swiss francs, just for Phase III. I hope you can begin to see why new drugs are so expensive. On the other hand, it is critical that we, as drug developers be able to have frank and open discussions with our colleagues in academia. Their understanding of basic pathophysiological principles and clinical experience are vital, in ensuring we maximize benefits of novel compounds and minimize risks to patients. So, the next time you hear that researcher “X” had an interaction with Pharma (attended an advisory board, served on a Steering Committee, etc), be thankful, not suspicious.

    • dr merrilee fullerton says:

      Thanks for a sensible comment with reasoned discourse. Much appreciated.

    • Joel Wiens says:

      Dr. Glanzman – While I think it is important to mention the existence of the “Sunshine Act”, I think it is interesting that in this debate it would be important to mention that “things have been done to address this”. The question isn’t whether “anything” has been done, but rather whether that is sufficient. We can all clap our hands and say way to go for doing regulation, but at the end of the day it is a correction to a horrible and very sad initial situation that is a stain on our profession. Physicians are only beginning to be aware of what studies mean and what they are really saying and how they actually work, so I understand why this has taken a long time to get to. But now that we know, we are responsible to our patients get information we can trust about the things we are telling them to do with their bodies for the rest of their lives and with their hard earned money. Keep in mind that the biggest drug burden lands on people with the least expendable cash for the well know reasons of socioeconomic inequality.

      Regarding your statement that publishing only positive data is pervasive in all of published science…it is a remarkable admission, though a belated one, now that that fact is becoming better recognized and spoken about out loud. It is a shameful circumstance for a community that speaks so self righteously about their commitment to truth and how they are being so persecuted by this official or that government. It is self censorship and it hurts patients – that fact needs to be recognized at the very least. The justification that “a product is produced in the end” is insufficient – we don’t know enough about the product! The missing data speaks volumes. The justification that it is hard to make these things is likewise insufficient. Billions of dollars are made by the companies that do this hard work, probably unevenly distributed amongst the shareholders, but nonetheless. I am less impressed by how hard people are working on this stuff then by the safety of their product and by the transparency with which they go about their work. They aren’t making an iPhone – they are making things that people swallow and then hope will improve their experience of life.

    • Ryan Herriot says:

      The argument that we should use certain drugs because, if nothing else, we might be getting some placebo benefit: you can’t be serious. If anything, that’s a reason NOT to use an expensive brand name product. If placebo is what you’re relying on, surely you can think of something cheaper!

      An argument against the marketing influence of branded pharma is not an argument FOR generic drug companies, which of course have their own problems, mostly with regards to pharmacists.

      The argument that because of the money sunk into drug development we are somehow obligated to put up with the marketing activities of drug companies: no we are not.

      American patients do not pay a fair price for drugs…they overpay.

      And finally, do we need each other? Really? There will probably always be a large private role in drug development…but perhaps it doesn’t need to be as large as it is currently. Certainly we ought to re-examine the relationship at all levels. For example, we have a real problem on our hands with a dearth of new antibiotics. These are not profitable to develop, so they are not developed. As long as we rely solely on the profit motive, we are going to be hooped. This motive can line up with what society needs, but of course not always.

  • Swells says:

    You are absolutely correct by stating “they wouldn’t pay for it if it didn’t work”. Neither would I. That’s why I like my physician to afford me a sample of something before I do pay for it. Saves me the laboring trouble of an additional office visit and additional trip to the pharmacy.

  • Phx says:

    What world are you living in? While most of what you say is true, your context is odd. Since the Pharma industry provides no value… I have a few questions for you

    Where did generics come from? (Shhhh… Pharma)
    How many drugs have been developed in your socialized world north of us?
    While Pharma provides no value and are really slick.. How is it that so many smart doctors get “tricked”?
    Maybe it has more to do with their ethics than you want to admit
    You may want to update your research, the pens etc have been long outlawed by most companies
    You are just being silly and mis informing

  • Dr. M says:

    Many of us realize that we are influenced. However, influence is not always negative and given to a negative result. Many of the best clinicians I have had the pleasure to know have had relationships with Pharma. I believe some of your argument is antiquated and stale. Pharma has worked to prove their transparency including the availability of unfavorable data. The physicians that are friendly to Pharma should not be deamonized nor deemed any less effective within their profession. While all of our information should not come from one source I.e. reps , we should not close the doors of exploration and exclude vehicles that may provide useful information for our patients.

    • Joel Wiens says:

      Dr. M – interesting name. The fact that good clinicians have had relationships with Pharma is interesting, but I don’t grasp how it furthers your argument. The fact that the clinician was good at what they did means exactly what about the appropriateness of their relationship? I believe that is a non sequitur. Perhaps even stale.

      Regarding the fact that Pharma has worked to prove their transparency…again, interesting. Why exactly did they do that? I think there may have been a billion dollar lawsuit involved. Interesting.

      Demonization is never a good strategy for implementing change amongst colleagues, I agree. I don’t quite see that in this article, though. Saying that people shouldn’t do something, clearly and with a good argument to back it up, is not demonizing. Saying that they are bad people is different, and that isn’t done in this article.

      It is a good admission that doctors shouldn’t only get their information from reps, and a healthy recognition. I think the information available to us at this point makes this recognition a little bit of an understatement, however. A major part of physician competency is knowing how to identify good information and to be thoroughly knowledgeable about the difference between advertisement and fact in the statistics presented. It has been thoroughly shown that this service is ill provided by industry representatives and I don’t see the utility derived by physicians who seem to depend on them.

  • USA says:

    This may hold true for you folks living in the world of socialized medicine, but here in the US we still value the freedom of choice for our healthcare. A point Rita forgets to mention is that while there may be effective and less costly generic options vs a branded drug, these generic options often carry no indication to be used in the manner that they’re being used…. Use an anti-epilepsy drug to treat your pain because its cheaper and it works right? Wrong. Just because a drug is cheaper doesn’t mean it’s safe or legal to use in place of a branded drug. Also, Rita fails to point out that the generic drug companies producing these cheaper options are held to much lower quality standards, far less consistent with positive patient outcomes, and produced in countries outside the US in facilities with little to no quality measures in place.
    Pharma may seem like the evil in medicine to many people but it is far lesser the evil when compared to the type of physician that believes socialized/standardized medicine is the answer. It’s called paint by numbers, not medicine by numbers. Value your craft or be prepared to franchise medical degrees and practices like McDonalds.

    • Ritika says:

      Thanks for your comment. Most of the time the generic options have been around longer and have much more evidence behind them than the newer brand name drugs, so this isn’t about off-label use at all. A good example is using hydrochlorothiazide for hypertension. Guidelines usually recommend this as the first choice treatment – it’s been around forever, it works AND it’s generic meaning cheaper. For some reason though, I see patients on brand name medications like Coversyl that have never even been tried on the first line treatment and have no specific indication for this medication. Hydrochlorothiazide costs 2 cents per pill (less than a dollar for the month’s medication), while Coversyl costs 65 cents a pill (almost $20 for the month’s medication). Not only is this person getting a more expensive medication, they’re also getting something that has actually been around a much shorter time and therefore has less long term data. The cost is either being paid by the patient, by their employer or by the government – either way, it in an unnecessary expense. Another factor is that of docs wanting to prescribe something ‘new’ in order to appear cutting edge, something that patients sometimes buy into. This is very dangerous as the longer a medication is around, the more likely we are to actually understand its safety profile. This is not about using just any medication for any use – in fact, I would discourage off label use (something often encouraged by pharmaceutical reps to boost sales).

      • Brandon says:

        “off label use (something often encouraged by pharmaceutical reps to boost sales).”

        Seriously, come on please quit stereotyping sales reps, as an educated person you should be able to make a better argument without resorting to that. I work as a Pharma sales rep and have never once done this because I have integrity and passion for my work. That is like saying “most black people like watermelon” or most “Indians own convenience stores.” You seriously lose all basis for your argument when you say things like this.

      • Jeremy Petch says:

        While you are entitled to your viewed, Brandon, please refrain from from insulting the author or the posters here. This is a forum for healthy debate, not to hurl insults and make ridiculous statements, like suggesting that pharmaceutical companies have not promoted *illegally* off-label uses in order to boost sales. This is a matter of legal record. After all, one of the largest criminal fines in US history involved a $2.3 BILLION guilty plea on federal fraud charges by Phizer for (what else?) marketing off-label uses of their medications. That's the tip of the iceberg. You are more than welcome to express your views here, but keep the insults in check.

      • SR says:

        Jeremy, while I agree that civil discourse is sorely lacking on the internet and that insults are inappropriate, I think what Brandon may have meant was this:

        There are many negative stereotypes about pharma reps that I find insulting and are inaccurate. These stereotypes have no more grounding in fact than those promulgated about some ethnic groups. As a pharma professional I am passionate about my work and I and my colleagues take great pride in bringing value to the healthcare system. When A critic of the pharma industry resorts to ungrounded cliches about the industry it undermines there credibility.

        Brandon you may correct me but that’s the gist and I think those points are valid.

      • Jeremy Petch says:

        SR, I appreciate your charitable reinterpretation of Brandon’s words. I do think it’s worth reiterating though that such assertions are not actually ungrounded (again, Phizer’s $2.3 Billion dollar fine for criminal fraud, etc.). One could argue that such activities are in the minority, but to deny such activities completely doesn’t help discourse, and it definitely doesn’t serve to rebuild broken trust.

        I do think that’s what a lot of this discussion is about: broken trust. There is no longer trust between the pharma industry and many physicians. The pharma industry abused the trust that existed (again, this has been carefully documented by the courts, both civil and criminal) and are now experiencing what should be an entirely predictable backlash. Healing any relationship after a betrayal of trust requires, at the very least, an admission of wrongdoing. It seems not everyone is ready to actually to rebuild the relationship, and would prefer just not talk about the past so they can get on with the future. Unfortunately, many physicians obviously don’t feel the same way. Representatives from the industry, particularly the passionate ones, should be paying attention to this and addressing it.

    • Joel Wiens says:

      Interesting…who is this Rita that you speak of?

    • Dean says:

      Tell you what, USA, my ex-wife needed a benign tumour removed from her temporal lobe to cure her epilepsy. Our evil socilaized health care system covered the cost of it with forcing our family into bankruptcy, which would have happened under your fantastic system.

      So maybe you should actually look into things more carefully before condemning them.

  • DrPHealth says:

    Thanks for reminding us of something that was such an engrained part of practice. As physicians have slowly backed away from certain practices with Pharma, companies have increased their detailing marketing to others now providing prescribing, which for some provinces include pharmacists, some nurses, some other professionals.

    Lacking has been the concomitant rhetoric within newer prescribing professionals on guarding against industry influence. Pharmacists have had more experience and provide greater professional direction, but still highly open to potential influence.

    It is an issue that is buffered from prescriptive solutions.


Ritika Goel


Ritika Goel is a family physician at Unity Health Toronto, Inner City Health Associates and Assistant Professor at University of Toronto.

Republish this article

Republish this article on your website under the creative commons licence.

Learn more