I always make it a point never to meet with drug detail sales people.  Don't get me wrong.  They are very nice people.  In fact, too nice and too persuasive.  I am willing to take their samples, but I didn't want to be influenced by them.  I also buy my own samples of generic medications to have available for patients who needed them.  I think I owed it to my patients to base my therapy not on the unconscious influences of a sharp sales rep, but to base treatment on good, honest scientific research.  Of course, a lot of the research out there is not good and honest.  Pharmaceutical companies do their best to hide studies not showing their drugs in a good light.  The studies are often designed to make the expensive brandnames look better than they really are.  And the doctors getting rich doing the studies for the drug companies often write in glowing and dishonest terms about the results of their research. (A psychiatrist can almost double his or her rate of pay by working on drug company studies.  Academic psychiatrists are much more likely to get industry funding if they write more favorably about brandname drugs.)

I have recently been shocked as I go around interviewing trying to find a job.  In most offices, I saw numerous drug company ads in the form of free soap dispensers, free magnetic file cabinet clips, free large framed health information posters that were 35% filled with advertising, free calendars, free notepads, free pens, free this, and free that.  One mental health center had just had a free lunch brought by the sales rep for the entire office comprising of 10 staff.  One office had at least fifteen cards prominently posted of different sales reps. 

The cabinets at the private and mental health center offices are often very well stocked with the expensive brandname medicines and yet totally devoid of samples of inexpensive generic medicines.  Drug companies don't give those samples out because they are trying to be kind or thoughtful.  The only reason they are given out is to increase the prescribing of those medicines above what would otherwise occur and thus increase their profit margins.

One otherwise excellent psychiatrist told me that I could get free meals and a chance to make a little extra money by going to the local drug company dinner meetings for area psychiatrists.  Apparently, it has become routine to for drug companies to pay psychiatrists on a pretty much rotating basis $500 or more to speak on some subject on which he or she considers him- or herself expert.  Everyone is happy except whoever is paying the huge bills for all of the brandname medications that unnecessarily dominate modern medicine.  If you wonder who is paying the bill, go to the bathroom and look in the mirror.

Of course, the massive direct to consumer advertising on TV, the radio, and in print is also troubling.  The drug companies do this only to get consumers, who have little knowledge of the research, to pressure their doctors to prescribe medications that the doctor would not have prescribed in the first place.  It's an immense waste of money and not the way medical treatment should be decided.  And then there are all the advertising from hospitals and HMO groups promoting their services in the most glowing terms.  The medical field has become a dog-eat-dog world aimed not at delivering cost-effective medical care, but at maximizing a profit.

I always find the American Psychiatric Association's (APA) annual convention more than a little embarrassing.  The drug companies spend huge amounts of money on very fancy exhibits to promote their drugs in the most favorable light.  Their advertising is extremely biased.  This is not how physicians should be learning their medicine.  Still, the exhibits are very popular and apparently make money for the APA as well.  Many, probably most, doctors try to plan their morning and evening hours to take advantage of the very fancy and free meals offered by the drug companies.  These meals are accompanied by big named speakers who always seem to say favorable things about the drugs being produced by the companies funding the meals and paying the speaker fee. 

Although the APA now requires speakers to reveal all of the companies from which they have received funds in the past year, a fair number of the speakers make fun of the APA regulation and trivialize the funding.  Of course, if it is of so little importance, why don't they just stop taking the drug company monies.  I was happy to see that there was a small amount of discussion at the APA this year on the issue of the impact of pharmaceutical freebies and advertising on medical care. 

Sadly, this year the APA discontinued the one book of up-to-date research briefs of the many scientific studies being presented at sessions not funded by the drug companies.  Instead, the briefs were jammed on CDs that are virtually worthless since it is very hard to find what you want compared to the traditional soft-cover book.  I always looked forward to getting a copy of that book and now they are no more.  Thanks to PubMed and the internet, I am not sure that I will bother with the APA convention in the future.  As a small town psychiatrist, I never felt very welcome there in the first place.

Advertising Saturates Almost All Psychiatric Journals: I did my own tabulation on one psychiatric journal.  I found 61 full pages of ads in color and on higher quality thicker paper than the rest of the journal.  The thicker pages seem to be designed so that the journal is more likely to open up to the advertising. J Clin Psychiatry 5/03 had 61 color pages of ads vs. 109 pages of original articles, all in black and white.  This is typical and corrupt.  Medical decisions should be based on science, not advertising.  However, in 40 years of practicing medicine, I can guarantee you that the vast majority of the psychiatrists I have known have followed to where the drug companies want them to go.

Three Cheers for the National Institute of Health: The US National Institutes of Health has asked all investigators who receive federal funds to make their results freely available to the public. Dr Robert Steinbrook of the New England Journal of Medicine predicts that some journal editors and publishers will be "riled" (BMJ 2005;352:1739). Dr Zerhouni of the NIH has asked researchers whose work was supported by public funding to voluntarily submit an electronic copy of their manuscripts, when they are accepted for publication, to PubMed Central, a free internet service. A similar initiative in the United Kingdom led to controversy recently when some editors and publishers said that free online dissemination of research articles might cause some medical journals to "go broke and close" (BMJ 2005;330:923, 23 Apr). Dr Michael Wilkes, vice dean for medical education and professor of medicine at the University of California School of Medicine at Davis, reacted to the charge that some medical journals might be forced to close by asking, "So what?" He said, "How is the world going to be any poorer if [some journals] go out of business? Publicly funded studies belong to the public. I don't think there should be a system where a middleman makes a profit at the public▓s expense. If journals are going to survive, they have to have added value."

State College, Pennsylvania, Prison Nurses Offered Free Bar Drinks by Anti-Psychotic Drug Rep: In a typical America drug bribe, nurses at SCI-Rockview Pennsylvania state prison on April 27, 2005, were offered free drinks after work at a local bar after a presentation for Geodon at the prison on the psychiatric unit. The nurses happily accepted. Every month, local State College psychiatrists are treated to free drinks and a $25/head meal by other local drug reps with no presentation at all, just schmoozing with the drug reps. AstraZeneca, manufacturer of Seroquel, has been censured by the UK watchdog, the Prescription Medicines Code of Practice Authority, for offering nurses excessive hospitality at educational meetings located in luxury hotels. The meeting, which AstraZeneca cancelled after a complaint from a local GP, was due to be held at the 4-star Cameron House Hotel in Loch Lomond. Nurses who were due to attend the meeting were scheduled to have three hours of talks on asthma during a stay of nearly 24 hours at the hotel, which included dinner, bed and breakfast, and lunch.  AstraZeneca was also reprimanded for giving nurses a free meal at another four-star hotel followed by a brief 45-minute drug talk. BMJ 330:984 4/30/05. Ed: Such bribes are routine, standard, and effective across the U.S.