Doctors as drug reps

Fellow ScienceBlogger Abel Pharmboy over at Terra Sig pointed me in the direction of a rather fascinating and disturbing article about physicians being recruited as “thought leaders” by pharmaceutical companies. Abel’s discussion is well worth reading for yourself, but I thought I’d chime in my two cents, as always.

From a surgeon’s perspective, these sorts of “opportunities” are much different, because most of us general surgeons and surgical oncologists only prescribe a rather limited range of drugs. For example, I rarely prescribe anything other than narcotics for postoperative pain relief and antibiotics. And my prescribing needs are generally simple. Nine times out of ten, Percocet is all that I need to prescribe for pain, and a first generation Cephalosporin is fine for most surgical site infections. These are all generally available as generics; so there’s not much in the way of profit to be made getting someone like me to shill for them. Moreover, because I spend more time doing research than doing clinical work, I’m not “busy” enough. Don’t get me wrong; I’m plenty busy, just not in the way that my prospective audience would care about: clinically busy.

Surgeons like me may not be prime candidates for this sort of pharmaceutical company shilling, but we are prime candidates for ethically dubious forms of marketing by other sorts of companies: Device manufacturers. For example, in the specialty of breast surgery, I could if I wished probably agree to give talks for manufacturers of breast core needle biopsy systems or other such devices, such as the Mammosite catheter for delivering radiation therapy. I happen to like the Mammosite catheter, but I view it as still more or less experimental and wouldn’t feel right taking money to give talks on it.

There’s also a downside to becoming a pharmaceutical or device company shill. Believe it or not, other physicians start to view your pronouncements about the company’s products with suspicion. Some physicians will actually look at you as ethically compromised.

And there’s a good possibility that they’d be right.