Defending the drug man.(GUEST EDITORIAL)

 
"The fault, dear Brutus, is not in our stars, But in ourselves, that we 
are underlings...." 
 
Cassius in Julius Caesar, Act I, Sc. 2, Line 145 
--William Shakespeare 

Over the past several years, the pharmaceutical industry has replaced managed care as the Bad Boys of Health Care. Public opinion, government oversight, and litigation pressures have obliged the industry to adopt a litany of mea culpa declarations.

No one condones the rare instances of physicians accepting cash or extravagant gifts specifically in exchange for prescribing particular medicines. I, too, am outraged by reports of withheld data during drug testing. I am very concerned about the increasing costs of medications, while noting large company profits and obscene bonuses to corporate executives. Nevertheless, the draconian restrictions placed on the communication between physicians and the pharmaceutical industry are beginning to hurt our patients.

Three years ago, in an effort to constrain the rising tide of criticism, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued industrywide recommendations limiting contacts between pharmaceutical salesmen and doctors. These guidelines were quickly encrusted by the Office of the Inspector General, thus converting suggested limitations into mandated restrictions, with the threat of severe fines for violations. The leadership of the American Medical Association and American Psychiatric Association quickly endorsed these guidelines. This position is elitist, offensive, and, ultimately, detrimental to our patients.

Most of the physician support for these restrictions comes from academic and administrative doctors. Pharmaceutical funds are a primary support for academic centers, medical meetings, and publications. It is presumed that these leaders and educators are able to accept pharmaceutical contributions, yet preserve their purity and lack of bias, while feckless doctors in clinical practice are too easily misled.

I resent this insinuation that some select physicians can withstand the insidious seductions of pharmaceutical companies, while I, when presented with a free meal and a pen, am led blindly into the void. Most doctors are neither naive nor easily enticed by factors other than attempting to provide the best care for our patients. We do indeed accept that company-supported information may prompt interest, but that interest will not change our treatment--if the data are not supported by patient response.

Contrary to what those who support these restrictions might believe, my greater concern is not for the lost take-out dinner for my family or the missed free seat at the ball game. I'm concerned about how these limitations hurt our patients. An embarrassing truth for physicians is that pharmaceutical representatives can supply useful information. This is particularly the case for primary care doctors, who can never possibly keep abreast of the constant refinements in medical treatment. Severe limits on the venues at which educational programs can be presented have discouraged doctors from attending. After a long day ...