[e-drug] Unanimous Vote Bans Gifts to Doctors in Massachusetts (4)

["Dr.L.Offerhaus" <offerhausl@euronet.nl>]

E-DRUG: Unanimous Vote Bans Gifts to Doctors in Massachusetts (4)
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Dear colleagues,

In the past I have written quite a few articles in the Dutch medical 
press about this subject, and I still don't know any definite answer. 

The problem has many sides: 
(1) Industry whose main interest is selling drugs and making profit like any other industry, and asking attention for their products with any means available within legal limits; 

(2) the goverment with so many political goals in mind as there are ministers and ministries: 
(2a) Education which wants to promote academic research but usually has a desparate shortage of 
funds, and often is more than happy if this financial load is taken off its shoulders and transferred to private partners;
(2b) Economic affairs which is primarily interested in promoting new and existing industries and making (tax) life as easy for them as possible and has to stimulate not only the internal market but possibly export as well; and finally 
(2c)  Public Health which is responsible for health insurance and the cost of drugs - quality of care is too difficult a subject and where the government meddles in such affairs they are often misguided (like linking diagnosis to treatment units, the so-called Diagnosis-Treatment Combinations invented by ignorant Dutch civil servants). 
Then 
(3) physicians, and, to a lesser extent, pharmacists, who 
(3a) , when working in general practice, are often flattered by Rep visits; we can recognize this from Winnie-The-Pooh as the "owl postbox syndrome" . Most of them are overworked and feel undervalued, and they appreciate the suave appraisal methods used by the reps. They rarely know the price of drugs, and if they do the effect this has on insurance premiums paid by the community is pushed away into the subconscious mind. 

More serious is the destructive influence industry has on education,  either directly (drug-oriented meetings) or indirectly (funding of postacademic education, paying travel expenses, paying for clinical trials etc.), and this is where the government is at fault because this sector should be the full responsibility of the government (Education and/or Public Health) - a government which is unwilling to pay for proper education and health care fails in its democratic duty. The weak spot is then the prescribing pattern of the specialist physician, because the GP will copy the pattern if only to avoid conflicts with his colleagues in hospital care. If goverments create gaps others will be more than happy to fill those.

Some 40 years ago there was a slim hope that the growth of academic clinical pharmacology would change this behaviour pattern, but I have become very pessimistic. The discipline had very little influence, and where  there was some impact it was often nipped in the bud by 
all "surrounding" parties, hospital medicine, industry, pharmacy and basic pharmacology. The curious phenomenon is that physicians tend to keep to strict academic protocols in patient care, but as soon as drugs are involved some of them seem to act like charlatans or medieval quacks. 

One hopes that it is a minority, but I am not so certain. The boundaries between "orthodox" drug treatment and alternative approaches are more vague than is often pretended.

I fully understand Valeria's point of view, but where things go really wrong as in the USA political force under the pressure of serious financial restraints is the only way to change attitudes.  In 
politics only power and money count. Ministries will only listen when their purses are empty.

So it is not the occasional ball point or mouse pad, but the much larger problem behind the scenes.

Good luck, best wishes,

Leo Offerhaus
The Netherlands
"Dr.L.Offerhaus" <offerhausl@euronet.nl>

[It is perhaps worth reminding e-druggers of two very useful articles available from PLoS Medicine.
Mansfield P.   Industry-Sponsored Research: A More Comprehensive Alternative.
PLoS Med 2006;3(10): e463
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030463
and
How Drug Reps Make Friends and Influence Doctors by Adriane Fugh-Berman and Shahram Ahari
PLoS Med. 2007 April; 4(4): e150.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17455991
Remember to repair links if broken.  BS]