Sentimientos "enfrentados" ante la Visita Médica...

Mixed feelings on drug reps

Personally, I have mixed feelings about my profession's relationship with pharmaceutical companies. I must admit something gnawed at me during my stay at the Ritz 10 years ago. The "consultants' meeting" turned out to be a group of 25 doctors who were led through a slide presentation on the benefits of the drug being promoted. I realized that I was not in the company of "thought leaders" at all, but rather in a group of ordinary doctors who, like me, wanted a fun -- and free -- weekend in Washington.

I tried to convince myself that the trip and other perks I'd gotten before from drug companies, such as free tickets to Tigers' basketball games, did not influence my prescribing practices. Such rationalization is probably common. A 2000 study in the Journal of the American Medical Association found that the more gifts doctors received, the less likely they were to think that their prescribing behavior was being influenced.

.../...

But for me, something changed five years ago. One drug representative, a tall fellow with blond hair who carried an open laptop, politely but pointedly asked why I wasn't prescribing his company's HIV medicine. He was hinting that he knew what prescriptions I wrote. (I was unaware at the time that drug reps can access doctors' weekly prescribing patterns through a purchasable database.)

For a few seconds, I felt a little guilty about not ordering his product. But guilt was quickly replaced by a feeling I was being manipulated -- and in a way, violated. I asked him to leave my office and not come back. That afternoon I told my secretary to cancel all my appointments with drug reps and not to schedule any more.

My decision came with a price. I no longer have access to the free sample medications that I once gave to my low-income patients. Also, I am not updated regularly on new medications, as I had been through talks sponsored by the drug companies. A year ago, when a pulmonologist asked me about a new anti-fungal medication, I felt embarrassed that I knew little about the drug. A drug rep had briefed him in a visit, but not me.

With thousands of journal articles published each year, and with new drugs and new indications for old drugs regularly being approved by the Food and Drug Administration, it's almost impossible for a busy practitioner to keep up on his own. Doctors often rely on drug company reps to filter information -- a valuable service, but one that can pose its own problems.

Take the case of Vioxx, the painkiller made by Merck. In 2001, a study in the New England Journal of Medicine showed that patients on Vioxx were more likely to have a heart attack than those taking a generic pain medicine. According to a 2005 commentary in Slate, Merck's sales reps continued to market Vioxx and doctors continued to prescribe it until the company voluntarily pulled it from the market in 2004.

Ver

Big pharma and patient care

Doctors' interaction with drug reps is slippery slope, Memphis physician says The Commercial Appeal