The influence of pharmaceutical companies
To the editor:
In the September 2000 issue of JFP, Dr. Westfall1 provides another voice suggesting that there is something inappropriate in pharmaceutical companies’ methods of advertising to physicians. He is one of many over the years who has expressed concern that physicians’ prescribing decisions are influenced by pharmaceutical company gifts.
I have followed this debate since 1973 when some of my fellow first-year medical students refused to be “bought by drug companies” that wanted to give us black bags (some people still used them then), ophthalmoscopes, and stethoscopes. I wondered how anything we thought about a particular drug at that point would mean anything. I did not believe that in a few years I would wait for the first opportunity to pay back their generosity by prescribing one of their products.
If physicians prescribe a product in return for consideration from a pharmaceutical company rather than because they believe it is the appropriate medication, then the fault lies with our choice of candidates for medical education. If a physician is so naive as to believe everything a pharmaceutical representative says just because of a trip to a show or a nice dinner, that physician is to be pitied.
Of course I realize that pharmaceutical representatives would like to influence our prescribing behavior. That is the purpose of advertising. Will we allow pharmaceutical companies freedom to advertise as other business concerns in America do? Is there something special about advertising speech because pharmaceuticals are used for a noble purpose compared with, for example, beer?
If we allow pharmaceutical manufacturers the same freedom of speech as other companies in America, we cannot condemn gifts as a means of advertising. My day is spent caring for patients. Since I do not have the time to have more than a superficial conversation with a pharmaceutical representative between patients; they make an appointment. I allow one 15-minute visit per day unless I call the representative to provide some specific information. If the representative wishes to bring lunch for the office, he or she is free to do so. If prescribing a particular product is expected in exchange, they will never be allowed to return.
When an extended time is requested for a detailed presentation, providing entertainment or meals is an accepted means of marketing in many businesses. I do not see the logic in an a priori rejection of this method for physicians.
Rather than condemn advertising speech, I believe it would be better to train our physicians to be more discerning in what they believe. We tend to accept what people tell us because we know we would not intentionally deceive. We must realize the purpose of the pharmaceutical representative’s visit and handle it professionally. I resent anyone telling me that I may not receive information as I choose because I am not capable of acting responsibly on it. That is censorship at its worst.
John J. Messmer, MD
Palmyra, Pennsylvania
- Westfall JM. Physicians, pharmaceutical representatives, and patients: who really benefits? J Fam Pract 2000; 49:817-19.
To the editor:
Dr Westfall makes a convincing case of the often troubling relationship between clinicians and pharmaceutical companies as epitomized by the use of drug samples. However, I believe he has underestimated the value of drug samples in the care of medically indigent patients.
The high cost of prescription medications, especially for the poor, has become a major obstacle to providing high-quality care to patients. In one study,1 more than 50% of African American households with incomes less than 185% of the federal poverty level reported that they could not afford prescription medications. The strategies employed by those households to cope with this problem include borrowing money to buy medications, rationing medications so that they last longer, or simply not filling the prescription (we often refer to these strategies as “noncompliance”). For the poor elderly this issue has become the subject of a national policy debate on the Medicare medication benefit.
Dr Westfall correctly acknowledges the availability of the pharmaceutical industry’s patient assistance programs that provide medications at no cost to qualifying medically indigent patients. In addition to the Web site noted in the editorial (Pharmaceutical Research and Manufacturers of America), other sites are attempting to increase access to this useful service (rxassist.org, needymeds.com, rxhope.com). Some institutions that serve a large number of medically indigent patients have been able to provide a nearly full formulary using these programs. For example, this has been successfully accomplished at the medical center with which I am associated, the University of Colorado Hospital.
