The New York Times reported that small gifts from drug manufacturers can positively influence doctors.  The suggestion of course is that the making of small gifts can influence how doctors go about practicing medicine and in particular their prescription patterns.

A study titled  "Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences" was recently published in the Archives of Internal Medicine and the conclusion in the abstract states:

^{Subtle exposure to small pharmaceutical promotional items influences implicit attitudes toward marketed products among medical students. We observed a reversal of this effect in the setting of restrictive policies and more negative school-level attitudes toward marketing.}

So the question becomes whether this is good or bad practice - ethical or unethical.  Should drug companies be allowed to attempt to influence the prescription practices at all?  Is it good business or bad?  These are tough questions.

First and foremost, I think we all have to realize that medicine is a business.  Physicians and health care facilities want to make the consumer of health care believe that health care is about that - caring.  What we all need to know however is that health care is a business - first and foremost.  I was a nurse for a long time and I cared for people - people who suffered horrific injury as a result of being burned.  Yes - I cared - really cared for those people.  However, I also wanted to get paid a fair wage to render that care.  Every person and entity involved in health care is in it to make money.  Is that a bad thing - absolutely not.  Is the interest in making money directly paradoxical to caring - absolutely not.  What we need to understand is that the caring professions (doctors and nurses etc.) and the entities that have been developed to facilitate care (hospitals and long term care facilities for example) are there to make money. Drug companies are no different in that they need and want to make money.  Money after all is what makes the world go around.  It is the model of the American Health Care Industry.

Drug companies make money based on the drugs they sell.  They complain that millions of dollars are spent on research and development for drugs that will never be commercially viable and when a drug is developed that is commercially viable they need to reap the benefit (profit) to fill their coffers for more research and development.  The never-ending circle of profit - research and development - selling all go hand in hand.  The drug companies are competitive with each other at least to a point and they need to market their product just like anyone else.  Should they be restricted to not giving gifts that influence the prescription practices of doctors?  This question infers that doctors, because they have been given repeated small gifts, may prescribe to you one drug versus another because they feel soem empathy toward the drug company from which they received gifts.  That has far-reaching consequences and infers that the drug prescribed may not be as good for the patient versus some other drug.  This study does not say that.

Often we hear of educational institutions being awarded money grants by private companies to R&D their drugs - does that have an undue influence?  In my opinion the answer is obviously yes.  Should this private company funding be allowed - what are the alternatives - would the government need to spend more in R&D - tough questions for sure.  I do not have the answers - all I know is that when a doctor sits in front of me with a clip board that has drug X named on it and he proceeds to prescribe drug X to me I wonder - is that the right drug for me or is the doctor prescribing it because the drug manufacturer of drug X bought my doctor lunch.

This is a challenging area of ethics and one that the medical community has been unable to cope with internally.  I would think that the American Medical Association or other like bodies, either nationally or state leverl, would address this issue.  Maybe the money is too good.

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