Drug Reps a Double-Edged Sword

Reform bills in the last year have worked to increase scrutiny of lobbyists in Congress, arguing what seems to be no more than common sense: If interest groups lavish attention on politicians, politicians are more likely to be favorably biased toward them.

But what has been described as the “influence trade” doesn’t stop at Capitol Hill. The medical world has lobbyists as well, coming in the form of drug representatives from major pharmaceutical companies. Recent regulations created at Stanford University have aimed to control the problem — but in the complicated world of modern medicine, they may do as much harm as good.

Under a policy that takes effect Oct. 1, pharmaceutical sales reps are prohibited from any gift-giving on school, hospital or clinic grounds; are not allowed in patient areas without an appointment; cannot determine the content of a meeting or lecture course held on campus and are prohibited from engaging in “ghostwriting,” a process in which drug companies write articles for academic researchers who then claim the work as their own.

Philip Pizzo, dean of Stanford University’s medical school, argued that the change was necessary.

“In recent years we have witnessed an erosion of the public trust in the profession of medicine and even in the value of science,” he said. “We were really seeking to do the right thing.”

Certain aspects of this policy seem perfectly reasonable. Few would argue that allowing drug companies to write papers for researchers or permitting drug reps to bother doctors within patient areas without an appointment are ethical practices. But certain prohibitions in this policy are causing a great deal of controversy.

Take Anne Yoshino: she’s practiced medicine for over 23 years, dealing with more than her share of drug companies and their representatives. She admits that she feels a little guilty taking clipboards and pens from drug companies because it is unethical, but dislikes that the ban prohibits free samples of drugs.

“Especially for things like birth control, which affects everyone differently, it is nice to have options,” Yoshino said. For her, and like-minded doctors, free samples of drugs allow doctors to find the best fit for their patient, regardless of brand name.

For drugs like beta-blockers, which are commonly used to treat heart disease and high blood pressure and tend to work the same way no matter who is taking them, pharmaceutical reps are useful in that they are usually well-informed about the products they are selling.

“They are quite willing to tell you exactly how their drug differs from others, whether it has a longer half life or is easier for the patient to take,” Yoshino said. “Although you do have to take what they say with a grain of salt.”

If a doctor is willing to remain objective and listen to representatives from several companies — as well as use their own judgment — drug reps can be a valuable source of information.

Michelle Vaccaro, a former nurse, has a different take: She argues that the drug companies are vital to reducing the cost of continued education for medical professionals, an aspect that applies more to nurses than to doctors. Drug companies are known for sponsoring conferences for medical professionals to discuss the latest news and discoveries in the medical realm, leaving the attendees to pay only for the price of their lodging and transportation.

Furthermore, the Accreditation Council on Continuing Medical Education accredits most conferences and requires them to be unbiased and not controlled by “commercial interests.” So even though the sponsors do get their names emblazoned on all conference materials and can enter the subconscious of attendees, pharmaceutical companies aren’t allowed to overtly manipulate information. Meanwhile, their money does a lot of good improving the medical profession.

Perhaps the biggest problem with the increasingly significant interaction between pharmaceutical companies and hospitals is that the medical profession has in some ways become dependent on drug companies, both for funding and as a source of information. Now that this relationship has been formed, it may prove difficult to break.

There must of course be limits to the access that representatives have to doctors; but even before the official policy, these limits have been enforced by individual offices and hospitals. Both Yoshino and Vaccaro discussed working in situations where pharmaceutical representatives were forced to make appointments with a designated member of the team in order to meet with the rest of the doctors instead of allowing them free reign of the floor.

There must also be limits to what pharmaceutical company reps can gift to individual doctors, though the jury is still out about forbidding even drug samples. However, this is an issue that individual medical organizations will have to decide for themselves. For some, severing the ties may be easy; for others, it may be close to impossible.

But at least they are making an effort.