MD Gifts

by Daniel Laury

I am a secret lover of gifts. When industry reps come into the clinic, I secretly pine for the freebie pens and sticky pads. Chocolate is guaranteed to improve my attention to detailing. A luncheon will keep me focused as long as I am masticating. And I have a whole collection of drug mugs in the break room.

I feel mortified since apparently this is unethical and influences my behavior inappropriately.

Studies on medical residents and interns found that they reported not being influenced by drug rep gifts from industry but we don't believe these overworked, underpaid docs who have enormous debts, do we? We feel that they will drop their dedication to patient beneficence in response to a doughnut offering by some drug company. In addition, somehow their behavior can be generalized to attending physicians making ten times as much money.

I live with intense shame since I am made to feel that I am the only one struggling with my inappropriateness. And I appreciate all those good, ethical doctors who make a mad rush to gather the gifts at meetings just to make sure that I don't feel like an outlier. I have to explain to patients that writing notes with a pen from Pfizer, for example, may inexorably lead me to write Viagra instead of Cialis. When they lie on the exam table lined by Ketek emblazoned paper, I divulge to them that subliminally I am being programmed to change my prescribing habits. When I give out samples of Fosamax, I admit to supporting drug gifting. When I do investigation research studies that are supported by the industry, I am really saying that I allow myself the possibility that the outcome will be influenced even though it is a double blind protocol.

Think about how morally low I have fallen when you walk through my office. You are given an Implanon Clipboard and write your information with a Pfizer pen. I then wash my hands with Allegra antibacterial soap while popping a Xopenex breath mint. I have you lie down on a table covered by Ketek paper, look at your throat with a Zithromax penlight, auscultate your heart with a Cozaar stethoscope and test your reflexes with a Viagra hammer. I look up at the Cardizem clock and then send you home with a brochure written by Zoloft. You are given samples of Meridia which we put in a Zyrtec bag for you.

There are those who advise me not to see pharmaceutical reps at all, though many of them are our patients. It makes for uncomfortable situations. And what if I had to prescribe a competitor's drug for them? What then?

I went through 4 years of med school, 4 years of residency, and now I am told that a highlighter will make me forget my primary concern for my patients over a drug company's financial interest. Honestly, I don't feel guilty writing Lexapro with a Prozac pen.

Interestingly, many of the proponents of these changes were older physicians who accepted significant gifts for years, only later to feel that the younger generation should not be similarly abused. So whereas our senior physicians got fishing trips, gear bags full of medications, golf equipment, etc., I am encouraged not to take a phlegm collection device out of the kleenex box that may have a drug company logo on it.

What would our world be without pharmaceutical support? Continuing medical education would be very different. My ability to offer newer medical care would be jeopardized. It's pretty clear that no individual physician can possibly keep up to date about everything in medicine; there are too many new drugs and therapies to learn.

Without industry help, the Merck manual of therapeutics would not be available for referencing diseases, I would not be able to go to a cadaver lab to train for newer surgical techniques, medical magazines would not be able to subsidized, patients would have to buy their first prescriptions without testing them to know if they tolerate or respond to them, and I would no longer be able to go to other communities to give public education talks sponsored by companies. I remember with shame that I once even accepted a laser pointer to help with giving lectures (I have seen better ones on ebay for $5). If I had to pay to subscribe to all my medical journals, pay for every learning experience, and pay for my pens, paper, patient information...guess who would be ultimately paying the extra cost of doing business? More likely, I wouldn't go to new technique training or read more magazines so the quality of medicine would go down.

Ethics committees think that patients hold us so high on the pedestal that they would be crushed to know that we accept free mouse pads on occasion. Truth is that I don't think any less of my own doc if his reflex hammer says Synvisc on it. Do I really think that he will try to sell me a particular drug because they gave him a tongue depressor with some drug logo on it?

I was once going to put competing drug pens in my pocket so I couldn't be called biased. I have considered turning the exam table paper over so that I can't read the drug name. But wait, what if I read it subliminally backwards and prescribe the wrong medication? Ketek obviously thought of this when they named their product palindromically.

So as I sit here transferring my little article to HerOption flashdisk after taking notes with my Zithromax pen on a Ambien notepad, I wonder if maybe we are going overboard with this undue influence bit.

Oh well, I really coveted that Viagra tie.

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