Drug rep visits actually improve care for patients

Regarding "Iowa practice draws notice for its 'no-gift' policy" (Article, Feb. 14): In AMNews articles, there is a need for the clinician "street" view of drug company representative detailing.

• Doctors' are not controlled by pharmaceutical "bribes." If patients do well in brief and lucrative visits, the practitioner gains an enhanced reputation, more referrals and the feeling of achievement. What ravioli dinner competes?
• Physician feedback is taken seriously by drug companies, resulting in new dosages, vehicles of administration and instructions. Many adverse effects would go unreported to the Food and Drug Administration without manufacturer persistence in chasing the clinician to complete onerous forms. One type of feedback that is given to pharmaceutical company officials is the aggressive demand for off-label research. They provide insufficient support of costly research to substantiate the use of off-label prescriptions, causing doctors to define the standard of care by clinical experience, rather than by rigorous group data.
• Pharmaceutical dinners result in physician exchanges of experiences. The paid speaker will learn pearls of wisdom from the veteran audience, with a long-term value exceeding any fee to speak. Including annoying travel time, even a modest-income speaker is losing money, compared with providing local patient care. At these dinners, bad-tempered physicians often publicly bash the product and interrogate the speaker, asking about their toughest cases. From a pharmaceutical company perspective, these dinners are a mixed experience. And all dinners and sponsored meetings are counteracted by competitor events. True, generics might be underrepresented, except that members of the audience frequently promote them in comments.
• For five minutes of time listening to a detail rep, a physician will receive $200 to $400 worth of brand-name samples. It is often a choice of these samples or no treatment for uninsured patients.
• Finally, most "propaganda" materials are reprints from the leading journals in medicine. After receiving 20 per month, one is only receiving a wide range of articles that one should be aware of anyway.

Drop the false caricature of physicians as naïve lemmings who are on sale for trinkets. We can eat and say what we think while accepting expensive life-saving samples all at the same time.

David Behar, MD, Bethlehem, Pa.

James L. Schaller, MD, Naples, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/05/23/edlt0523.htm.