How the Grinch Stole Medicine

Medical Conflicts of Interest

Image by Mike Licht, via Flickr

When I was young, I often heard my elders say, ‘there ain’t no free lunch.’ It wasn’t until becoming a medical intern and resident that I discovered not only are some lunches free, but also dinners, books, bags, shirts and even trips to wonderful resorts and hotels. That is if you didn’t mind having them paid for by the pharmaceutical industry.

This was in the day of anything goes, between those of us in medicine and companies that derived their profits from the stroke of a physician’s pen. After plying us with food, drinks and trinkets, we listened to their information (“data”) about reported “benefits” our patients received, if—moving us toward when—we prescribed their particular drug. The pharmaceutical companies rolled out legions of our own; physicians who explained the benefits, conducted their own “research” on the drug in question and found it better than older (i.e., competitor’s) drugs. These physicians spoke our language, used real patient anecdotes, crafted a message making us ready to write prescriptions the moment we set foot in our clinics. Representatives brought buckets of samples, knowing we’d dispense them to unwitting patients causing them to come back for the sacred written prescription. It isn’t razors Gillette sells, it’s keeping us coming back for blades. Boy were they good.

It was only later when some of our patients had disappointing results—hopefully, none fatal—that we learned the sleight of hand; manipulation of data show benefits where none—or at least very little, compared to a sugar pill—really existed. We heard daily from insurance companies desperately trying to put a hitch in our prescribing get–a–along, explaining that generic (cheap) medications were just as good as the latest wonder drug and if we didn’t get the message, tried to bury us under an avalanche of faxes demanding us to ‘preauthorize’ (a process only slightly shorter than building the Hoover Dam) for the wonder drug in question.

The drug dinners are still free, but now are “educational.” For the most part free trips are out, but free medical books are still in and physicians rewarded with continuing education credits (CME). Unfortunately, it seems our own medical schools are the last hold out. A recent study exposed the faculty at Stanford University for accepting speaker fees from pharmaceutical companies, when Stanford’s own conflict of interest policy prohibited the practice. Even today, our own local medical schools accept pharmaceutical funds to support their CME programs but carefully craft “conflict of interest” forms for speakers to sign.

It’s time to clear the air and keep pharmaceutical companies out from influencing physician’s prescribing habits: no free lunches, no dinners, no trinkets, no support of physician educational conferences and most of all—no free samples horrors!. Physicians need to go it alone: use peer–reviewed research; prescribe medications affordable by patients, and continuously look for alternative ways to promote and enhance health.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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