A friend of mine works as an office manager and oversees the HR department for her company. Recently, we were discussing a phenomenon she says is becoming all too typical with the people she oversees.
While I don't usually watch television (I find time spent watching TV is inversely proportional to spending time on things that are more important), I do take a few minutes occasionally to catch up on the soccer scores or watch part of an old movie. When I do, I can't help but notice the incredible number of ads for drugs and cosmetic surgeries. Not only is the frequency increasing, but the intensity of the sales messages is also getting stronger. The ads have gone from "Ask your doctor about" to making all kinds of direct and indirect promises of health and happiness.
Sadly, this is just the tip of the iceberg. A couple of days ago, I had a chance to read an article by an emergency medicine resident at the Johns Hopkins University School of Medicine.1 In the article, the author discussed her first day working at a family medicine clinic as a "dutiful medical student." What she discovered is a world where tens of billions of dollars are spent every year by pharmaceutical companies in efforts to influence medical doctors. Her observations are well worth the read. Among her more startling discoveries were the following:
- "I was stunned to find myself surrounded on four sides with brightly colored, attractively packaged free drug samples in all shapes and sizes reaching from floor to ceiling. In addition to the samples, there were various bins full of other 'freebies' - pens, clipboards, penlights, and other useful gadgets. There also were a number of coupons providing discounts on prescription drugs."
- "A medical technician pointed me to food in the break room. Not only was there food, there was an abundance of food - gourmet sandwiches, salads, and cookies - more than enough for all of the doctors and all of the office personnel, even a newly arrived medical student. One of the techs confirmed my immediate suspicion: The lunch had been provided by a pharmaceutical company representative."
- "Pharmaceutical companies know that drug samples are commonly judged to be strikingly influential on prescribing practices. The samples often influence physicians to prescribe the most expensive, newest versions of drugs available - drugs for which data on superiority over much cheaper generic versions sometimes aren't available."
- "Each day, of course, was punctuated by as many as a dozen drug reps bearing free drug samples for doctors and gifts for patients."
- "Furthermore, studies demonstrating the long-term safety of these new brand-name drugs might not yet be available, leaving patients potentially vulnerable. This was infamously demonstrated in the case of Vioxx, where initial data indicating increased risk of heart attack and stroke were downplayed by the manufacturer; later, when more comprehensive data found significantly increased risk of heart attack and stroke, the drug was recalled."
- "The multitude of free lunches and other gifts I observed during my medical rotation were also troubling. According to the 2008 paper by Gagnon and Lexchin, pharmaceutical company marketing expenditures totaled as much as $61,000 per physician, and approximately 80 percent of all pharmaceutical marketing expenditures were targeted specifically to physicians. A 2004 survey in The New England Journal of Medicine revealed that 94 percent of physicians had some type of relationship with pharmaceutical companies in which the companies provide them with food and beverages, drug samples, and other gifts."
- "My medical student experiences with pharmaceutical companies weren't limited to this single family practice clinic. A number of similar incidents happened throughout my clinical experience, from the lunches provided at my first psychiatry rotation (where, thankfully, my preceptor showed the pharmaceutical representatives out the door, and then protested their presence at that hospital) to daily noon conferences on my internal medicine rotation - mandatory for all students - that were always preceded by a sales pitch from a drug rep. A research adviser whom I greatly respect invited students to drug company-funded dinners at expensive restaurants; additionally, at all of the academic conferences I've attended so far, lavishly catered continuing medical education events sponsored by pharmaceutical companies have been ubiquitous."1
Needless to say, "Big Pharma" is doing an excellent job convincing millions of people that drugs and elective surgery are the path to a better life. They have the advertising budget and the infrastructure through the medical profession to make it happen.
The question that immediately comes to mind is: What can we do to stem this trend? In my view, the answer is simple: Share our chiropractic philosophy! People make decisions based upon what they believe to be true and right. The medical intern who wrote this article was apparently the only one in the family medicine clinic upset by the influence the drug representatives were having on the practice. This was not based upon her naivete; it was based upon what she believed to be the ethical way to practice medicine.
The more we share our wellness philosophy, the more people will understand that health doesn't come from a pill. The more they understand, the better chance they have to choose a non-drug, non-surgery path to health.
We have an obligation to share what we know to be true. Your patients will listen and many of them will understand. Those who do have an opportunity to live clear-headed, healthier lives.
- Morton M. "Buying Lunch ... and What Else?" Health Affairs, 2009;28(2):540-45.
A small number of medical doctors (including medical resident Dr. Melinda Morton) have taken a pledge created by an organization called "No Free Lunch" (www.nofreelunch.org/pledge.htm). They have pledged not to accept free lunches or other gifts from pharmaceutical companies.
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