Pharma pen, pad bans demean "boots on the ground" doctors

Regarding "Drug industry: No more free pens, pads or mugs" (Article, July 28): The new guidelines attacking the integrity of practicing doctors in their relations with the drug industry may have negative, unintended consequences.

It is clear that pharmaceutical representatives with degrees in marketing and not in science are not sources of information but simply sales representatives. They are no different from a Ford salesman talking about an Explorer or a Toyota salesman talking about a Prius. No one walking into an auto showroom expects salesmen to be objective. They are there to sell cars. A Ford salesman is not likely to extol the virtues of a Toyota.

In fact, whenever specific questions about a medication arise that require referral to the pharmaceutical "educational department" we simply receive variations on the FDA-approved package insert.

The reason physicians prescribe medications is that some well-known academic, supported with thousands of dollars of pharmaceutical company money, has written a paper promoting a drug's advantages. The sales representatives simply echo these articles. The whole picture is not more complicated than that. Except as a reminder of a drug's existence, drug company pens and coffee mugs have nothing to do with prescribing options.

At the same time, practicing physicians are struggling to meet overhead and keep their head above water financially. The cascade of bureaucratic regulations that do not improve medical practice simply act to humiliate and further demoralize practicing physicians.

Many of these naïve recommendations start from the very same academic institutions that take millions of dollars from pharmaceutical companies, not just 25-cent pens. Practicing physicians are left with the impression that these academicians, their actions to the contrary, believe they are brilliant and altruistic and the "boots on the ground medical grunts" are stupid and venal.

The effect of this kind of disrespect is to emphasize that in reality, medicine is just a declining business and hardly a profession respected by society. It is not surprising in this climate that practicing physicians primarily seek "quality of life." The changes are often subtle, mostly involving nonavailability. Altruism and compassion cannot be legislated. They can only be encouraged and rewarded. Punitive measures will not work.

Phillip Mendell, MD, Stuart, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/09/22/edlt0922.htm.