All we had to do in exchange for the free food, gifts, and CMEs was listen to a four- or five-minute sales pitch by this or that drug rep regarding his company’s newest and greatest wonder drug just brought to market. In addition, there were lectures and videos promoting featured drugs.
Frankly, I always came away from these luncheons feeling a little “unclean.” Had we all just been pawns in a big brain-washing scheme, a scheme to get us to prescribe the drugs pitched at the luncheon? My fellow residents all answered this question with a resounding, “No!” They all said their prescribing habits were not in any way influenced by these luncheons. They were just there for the free food and gifts.
But, I wondered: if no one’s drug-prescribing habits were influenced by the free food and gifts, then why were the drug companies spending so much money to put these luncheons on in the first place? Was it simply because they liked us? I suspected the truth was the marketing departments at the drug companies had thoroughly researched the answer to the question, and the answer was a resounding, “Yes! Drug luncheons do influence prescribing behavior.”
Yet, if the luncheons influenced prescribing, was this ethical? Shouldn’t doctors be prescribing medications based what’s best for their patients—rather than on a free lunch and a fountain pen?
I’m certainly not the only one who feels uncomfortable about drug-company-sponsored free food and CMEs. Dr. Marcia Angell, the former editor-in-chief of The New England Journal of Medicine, has been outspoken in her criticism of this practice. Dr. Bernard Lo, a leading medical ethicist at the University of California, has called for an end to drug-company-funded CME conferences. In June of this year, the University of Michigan Medical School announced it would no longer accept drug company money for CME coursework (the first medical school to do so).
According to an article appearing in The New York Times (June 23, 2010), drug companies and medical device manufacturers spend around $1 billion a year to sponsor CME events. The drug companies maintain they offer lectures, information, and courses that are free from bias. Dr. Michael Steinman, a professor of medicine at the San Francisco V.A. Medical Center, disagrees. As quoted in the Times article, Steinman believes: “The course providers have a subtle and probably unconscious incentive to put on courses that are favorable to industry because they know where their bread is buttered.”
Meanwhile, as I wander around the hospital where I work today, I still see the signs of drug company marketing. There are still doctors walking around with drug company pens in her white coats. There are still doctors drinking coffee from mugs etched with the sparkling names of popular antidepressants and erectile dysfunction drugs. There are still doctors who gleefully tell me they’ll be going to a medical conference in Hawaii—meals and CME credits paid for by the drug company sponsoring the event.
I tell my colleagues to have a good time in Hawaii. Rather than mention my discomfort with drug-industry-sponsored CME, I simply shrug my shoulders and say: “Be sure to wear sunscreen.”
Christopher Stookey, MD, is a practicing emergency physician, and he is passionate about medicine and health care. However, his other great interests are literature and writing, and he has steadily published a number of short stories and essays over the past ten years. His most recent essay, “First in My Class,” appears in the book BECOMING A DOCTOR (published by W. W. Norton & Co, March 2010); the essay describes Dr. Stookey’s wrenching involvement in a malpractice lawsuit when he was a new resident, fresh out of medical school. TERMINAL CARE, a medical mystery thriller, is his first novel. The book, set in San Francisco, explores the unsavory world of big-business pharmaceuticals as well as the sad and tragic world of the Alzheimer’s ward at a medical research hospital. Stookey’s other interests include jogging in the greenbelts near his home and surfing (he promises his next novel will feature a surfer as a main character). He lives in Laguna Beach, California with his wife and three dogs.