Physician urges colleagues to steer clear of drug reps

A university physician has argued that doctors who spend time listening to the spiels of pharmaceutical representatives may be, at best, wasting their valuable time, or, at worst, jeopardizing the health and safety of their patients.

In an essay published recently in the Annals of Family Medicine, Howard Brody said empirical data suggest that "interactions with 'reps' increase the chances that the physician will act contrary to duties owed the patient."

It's not uncommon, he pointed out, for pharmaceutical representatives to leave, in addition to free samples of the drugs they are selling, an assortment of gifts, including everything from pens, pads of paper and coffee mugs all the way to vacation trips.

In his paper, Brody, a practicing physician and professor of family practice in the Department of Family Practice and Center for Ethics and Humanities in the Life Sciences at Michigan State University, said that pharmaceutical representatives aren't evil, but do have a different objective than doctors.

"The goal of the pharmaceutical industry is to maximize its profits," he wrote. "The existence of a potential conflict of interest with the physician of integrity need not imply that the drug industry is acting wrongly, merely that its goals are at least different from the goals of the ethical medical practice."

Brody pointed out that published papers, including a recent one in the Journal of the American Medical Association, suggest that doctors who meet often with drug representatives sometimes don't act in the best interest of the patient.

"Systematic reviews of the literature confirmed that there is a direct relationship between the frequency of contact with reps and the likelihood that physicians will behave in ways favorable to the pharmaceutical industry," he wrote. "Physicians who spend more time with reps are less likely to prescribe rationally."

While some MDs may argue that accepting free samples from reps is actually looking out for their patients, as the samples are given to low‑income patients thus saving them the cost of purchasing the drugs, Brody questioned this argument. Often, for example, the samples either go to well‑off patients or even home with the doctor and his or her staff.

"In addition," he said, "if the average primary care group set out to stock the sample cupboard with generic drugs that dealt with the most frequently encountered problems in their practice, the cost of the drugs would be well within their means to pay for out of practice or personal funds."

In a perfect world, observed Brody, physicians would have the time to meet with the reps, assess and then confirm their claims using outside, non‑partisan sources.

"To spend time with them in a manner that preserves professional integrity would require both refusing to accept their gifts, and also spending a great deal of valuable time double checking their information. I propose that the vast majority of physicians could spend their time in better ways," he said.

Brody said health care providers now have many more tools at their disposal to help them gather the information they need on the latest pharmaceuticals.

"Through the Internet and with palm‑top computers, as well as in print, we have a number of services that organize the latest medical facts and present it to us in easy‑to‑use form," he said. "There's no longer any excuse for relying on the drug industry to educate us."

SOURCE: "The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives." Howard Brody, MD, PhD, Ann. Fam. Med, Jan 2005; 3:82‑85.