We’ve known for years that drug companies give gifts to physicians. The gifts have taken many forms – pens, vacations, meals, free samples, etc… Physicians always insisted that these gifts didn’t influence their prescribing practice – that they always prescribed strictly in the best interests of their clients.
Two trends have been exposed in recent years which demonstrate just how depraved this hand-in-glove relationship has become.
Firstly, the “thought leader” ruse. Here’s how it works. A drug rep, usually an attractive young, perfectly groomed female, approaches a physician, usually male, and tells the physician that he has been identified as a thought leader in his area, and that they would like to recruit him to give presentations to groups of physicians and other healthcare workers. The physician, of course, will be paid generously for his time. He says “sure,” and the dance begins. The drug rep arranges the “training” sessions. The drug company provides the script and the refreshments. The mark – I mean the physician – delivers the script, in which the merits of the drug company’s product are lauded to the detriment of competitors. At the end of the session, the physician receives a check and goes away contented. Over the next few months more such sessions will be organized and the physician begins to think of his “speech” checks as regular income. He will also receive “coaching” from the drug rep if his presentation seems to lack the kind of conviction that the drug company feels warranted. (After all, they are paying the piper).
Now – physicians aren’t stupid – and our “thought leader” probably reckons that his speeches are resulting in more business for the drug company – i.e. that the audience he is addressing will prescribe more of the pills in question, and that this is the business rationale for the whole thing. In this he couldn’t be more wrong. The target of the exercise is the “thought leader” himself. It is his prescribing that the drug company is impacting. By getting him to extol the virtues of pill X to others, he comes to prescribe more of it himself. According to an NPR investigative piece, for every $1500 a drug company spends on a thought leader, he writes an extra $100,000 to $200,000 of prescriptions for that company’s product.
There are two dynamics at work. Firstly: gifts engender a sense of obligation to reciprocate. This has been clearly understood for thousands of years, but apparently not by a great many physicians. Secondly: what psychologists call cognitive dissonance. We like to be consistent. So our hapless “thought leader” ruminates: “If I’m pushing this product, then it must be good, therefore, I should be prescribing it myself.”
Now you’re probably wondering how could well-educated people like physicians be so naïve. Don’t they know anything about human interactions and manipulations? Good question. And very pertinent to the real scandal: the specialty that receives the most pharmaceutical money is psychiatry! What can one say?
The second disturbing trend is the hijacking of medical research by pharmaceutical companies. This happens in a number of ways. Pharmaceutical companies hire researchers to “evaluate” their products. If the results are positive, then publish; if negative, then suppress. Or massage the data until a positive result can be demonstrated. This kind of thing got so bad that most reputable journals required their authors to disclose any financial links they had to the products they were purportedly evaluating. But it seems even such strict rules don’t guarantee integrity. See the New York Times article “Medical Industry Ties Often Undisclosed in Journals.” In this article Dr. Marcia Angell, former editor of the New England Journal of Medicine, refers to:
“…the widespread corruption of the medical profession by industry money.”
She then goes on to say:
“The journals’ lax enforcement of disclosure policies probably reflects the fact that journals, too, are dependent on industry support.”
And there it is. The peer-reviewed journals – the point of contact between the practitioner and the research – are in the hands of the drug pushers. Is this a great country or what?
In my view, we have reached the point where all medical research has to be considered suspect until demonstrated otherwise. This is probably true across all specialties, but especially psychiatry.