No Free Pens

There's a great article in the last NYT of 2008 about the new "restrictions" that the pharmaceutical industry is imposing on itself. No mugs, no pens, no trinkety free goodies.

Sounds great, right? Pharma is policing itself.

Well, first of all, these restrictions are all voluntary, which means no penalty for breaking the rules. Which is one reason we have laws.

Then, if we read a little further, the fine print comes, down in grafs eleven and fourteen:

The guidelines, for example, still permit drug makers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations.

The industry code also permits drug makers to pay doctors as consultants “based on fair market value” — which critics say means that companies can continue to pay individual doctors tens of thousands of dollars or more a year.

Cutting out the pens but leaving the rest is like going on a diet where you only eat Big Macs. They've cut out the cheapest and least effective part of their marketing campaigns, while doing nothing about the most expensive and deviously influential elements.

Drug reps can still buy lunches for doctors in their offices; they can still take docs out to dinners, as long as there is some educational component. (I went on one of these "educational dinners" long ago... the talk lasted 5 minutes and then we ate for two hours...) Also, the companies can still pay "consulting fees" that generally run in the tens of thousands.

Some of these consultancies are real. But do you think most of the doctors who receive these consulting payments would continue to get them if those doctors banned drug reps from their offices, banned all lunches and dinners, and stopped prescribing the manufacturer's drug?

Which leads me to the main point of this blog: drug companies should not be allowed to track in precise detail exactly which doctors are prescribing their medicines. They can know the rough outlines --- by zip code, for example --- but allowing them to buy databases with the exact number of prescriptions each doctor has given out for each medicine. . . . there's too much potential for an unspoken quid pro quo to exist between doctors and drug reps.

I am heartened by one aspect of this: the fact that Pharma is imposing these restrictions voluntarily means that they see the writing on the wall. They are trying desperately to prevent the kinds of laws that New Hampshire passed from spreading across the country. They want to give opponents of reform some ammunition, something to let them point to and say "See? The drug companies have cleaned up their act! Everything is fine now!"

Except in four or five years, when we're paying attention to something else, the pens and mugs will come creeping back. They'll come back slowly, a trickle at a time, without the big press release and glowing article in the New York Times.

The time has come to reject the hidden intrusion of Pharma into our lives. Prescriptions belong to doctors and patients, no one else.