Physicians must realize the true goal of drug company representatives

Regarding "Physicians don't have to want gifts to appreciate the role of drug reps," "Hard to expect residents and fellows to pass on an offer of lunch" and "Questions for critics of honoraria" (Letters, Feb. 13): These letters regarding physicians and pharmaceutical representatives followed an article, "Buy your own lunch" (Article, Jan. 16).

I do not belong to any "anti-pharmaceutical rep group," nor do I know No Free Lunch's founder Bob Goodman, MD. However, I strongly support their goals, and I no longer see pharmaceutical representatives.

I agree with comments regarding the usefulness of samples to allow a patient to see if a medication will work. However, I have a problem with pharmaceutical companies supplying me with only the latest and most expensive medications.

Give me amoxicillin, atenolol, and hydrochlorthiazide samples as well as those medications covered by patents. My patients have as many problems with these medications as they do with the latest and greatest drugs being advertised in the journals and being detailed by pharmaceutical representatives.

Until I can stock a sample cabinet with both older and newer drugs, you cannot convince me that pharmaceutical detailing and samples are anything more than a means to gain more market share.

One letter writer points out that residents and fellows have a hard time passing up meals because of time and cost.

Residents and fellows, despite their long hours (which are now capped), still make at or above the median income of American workers. If they are having trouble feeding themselves they might want to look at their discretionary spending. Also, many programs provide meals for them; mine does.

Regarding the differences between academic physicians and those in private practice, I disagree on some points.

Many academic physicians are not on straight salaries, as one letter implies. They work on a productivity basis, not dissimilar to our private-practice comrades. I took a pay cut when I went into academic medicine. Although I enjoy working in an academic community hospital, it is not always as rosy in academia as one might think.

The prime function of the pharmaceutical representative is to maximize market share for their products. To not realize this is one of the greatest deceptions seen today among members of our profession. Let's wake up and begin to pay our own way.

Charles F. Sturm Jr., MD, Monroeville, Pa.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/03/20/edlt0320.htm.