Physician Urges Colleagues to Avoid Drug Reps

In an essay published in the February issue of 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, Brody said, 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 professor of family practice and a practicing physician, said that pharmaceutical representatives are not evil, but have different goals than the doctor.

"The goal of the pharmaceutical industry is to maximize its profits," Brody 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 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."

Some physicians 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, however, said there are a number of holes in that argument. For example, he said often the samples either go to well-off patients or even home with the doctor and his or her staff.

"In addition, 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," he said.

In a perfect world, Brody said, 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," Brody said. "I propose that the vast majority of physicians could spend their time in better ways."

He said these days health care providers 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."

For a copy of Brody's essay, visit the Web at http://www.annfammed.org/cgi/content/full/3/1/82