Уважаемые коллеги,
не могу удержаться от ще одной посылки на английском - это из БМЖ
годичный опыт жизни доктора без встреч с драгрепами. В конце еще письма
читателей
ввв
My year without drug reps
Shane O'Hanlon, specialist registrar, geriatric medicine, Mercy
University Hospital, Cork
sohanlon@gmail.com
It was switching to decaffeinated coffee that started it all. In a flash
of lucidity I realised the dubious ethical basis for drug company
representatives' courtship of doctors. I noticed that my pattern of
prescribing was mostly learnt from observing colleagues, many of whom
sourced drug information primarily from drug representatives. I decided
to take a drug rep holiday to see if I could emancipate myself from this
moral quandary. My aim was to avoid contact with reps, promotional
material, and sponsored sessions. I wondered how I might unsubscribe
from their lists---and how they knew so much about each doctor?
Their calls generally went: "Hi, my name is Alison/Jane from
Something-pharma, and I'm just getting to know the new docs. Would you
have a few minutes to chat about my product?" The friendly and inviting
tone of the first rep during my "holiday" meant I found it difficult to
resist at first. But I had scripted my reply: "Sorry, I don't meet
reps." The brevity of my put-down seemed to stun her. This clearly
hadn't happened before. She floundered momentarily, not having a
suitable response, and apologetically bid farewell. I used the same
strategy effectively with all subsequent callers. Some recovered well
and tried to do a brief plug for their product. Others asked whether
they could leave some literature---I said no, but some did anyway.
None of my colleagues seemed to notice. I wasn't the odd one out, and
the strategy actually seemed quite easy. The reps seemed perplexed, and
a couple called again some time later, possibly to check whether I had
gotten over my principles. But soon the calls almost disappeared.
The next challenge was the weekly departmental meeting---with free lunch.
The rep conveniently had a slot on the agenda. In an attempt to keep
things simple and civilised, I decided to sit outside during the rep's
presentation, like a conscientious objector. But sometimes I missed the
start of the education session or entered too early and had to stay for
the promotional speech. Some reps tried to introduce themselves. It was
difficult to claim that I don't meet reps when I just had. So I began to
keep my head down and walk past. This seemed brusque, so I decided to
say hello but quietly eat my sandwich in the corner while others had hot
Indian takeaways. One rep reassured me that he knew I didn't meet reps
but handed me promotional reading material instead. Worse was when it
was my turn to present and I was alone with a rep for a few awkward
minutes before everyone arrived. I asked colleagues about cutting the
reps, but nobody saw the point.
In the hospital corridors I noticed that some reps approached me then
veered away at the last minute, having seen my name badge. Had I become
blacklisted? I wondered whether they talked about me in the pub, but
perhaps that was paranoia.
I attended some external educational meetings that were sponsored by
drug companies. Generally these were held in luxury hotels, and at one
there was an unfamiliar rep who uncannily knew my name. I walked
purposefully past the fresh cream scones and coffee. The speakers were
excellent but positioned next to large advertising boards. I couldn't
separate the presentations from the sponsorship, so I stopped going.
Avoiding advertising was impossible---most journals and medical newspapers
carried industry promotion. Shunning these educational resources seemed
overzealous. Most medical websites are also littered with pharmaceutical
advertising, and there are hundreds of sponsored patient information
sites. The only objective sites charged fees instead.
Despite my mixed results, I have no regrets. I now research my
prescribing choices and have a healthy scepticism about my colleagues'
recommendations. I realise that it is impossible to avoid
pharmaceuticals promotion completely, but I can minimise its influence.
Unfortunately there remains the possibility of influence by proxy.
A year later I had to decide whether I would return to my old ways or
stay "clean." I had fond memories of the nights out, of being treated on
a company expense account. I saw several colleagues have sponsored trips
abroad, saving them considerable personal outlay, and I missed many
educational meetings with convivial overnight stays.
But I also saw people start to notice what I was doing. They watched,
bemused at my persistence in bringing my own lunch when there was a
beautiful spread. Some considered doing the same, but generally it
didn't catch on---I wasn't promoting it as a life choice. Those who
questioned mostly wondered why. The arguments for and against reps have
been well documented, and the only way to understand the difference is
to stop seeing them. Most people are happy with their current
interactions. I don't judge them, but having altered my practice I feel
more independent.
Becoming more aware of drug company influence may empower people to
decide for themselves how much they wish to engage with it. I don't
intend to force my opinion on people, merely stimulate debate. But my
view now, more than ever, is that in the future the current relationship
with the industry will be seen as unjustifiable.
Cite this as: BMJ 2010;340:c1102
In defence of drug reps 4 March 2010
Next Rapid Response Top
Abdul Jaleel,
Retired NHS consultant
County Durham
Send response to journal:
Re: In defence of drug reps
I am shaken by the author's harsh-sounding policy about seeing the drug
reps on the assumption that this might corrupt his judgment about
prescribing.
The Pharma industry is perfectly capable of defending its operational
policies but my worry is that Dr. O'Hanlon's contribution could be
misconstrued and tar all drug-repophilic doctors with the same brush
about their knowledge of pharmacology. If people fall in this trap, then
let me assure them that in nearly 37 years of NHS service, I failed to
unearth any evidence for such a preposterous misapprehension.
Why not live and let live. Is it not possible to listen the relevant
reps, do your own research on the product and come to a balanced conclusion.
Any wholesale rejection of the apparently vested interest is both unfair
and irrational
Competing interests: None declared
Big Pharma avoidance phobia 5 March 2010
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Dermot Walsh,
Consultant Psychiatrist
Mental Health Commission
Send response to journal:
Re: Big Pharma avoidance phobia
Did your CPD credits suffer?
Competing interests: None declared
Avoiding drug reps 5 March 2010
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Jonathan Belsey,
Managing director, JB Medical Ltd
Old Brickworks, Chapel Lane, Little Cornard, Sudbury, CO10 0PB
Send response to journal:
Re: Avoiding drug reps
Working as I do in England, I am not surprised to hear that Dr O'Hanlon
has survived 12 months without seeing a drug rep - around 50% of doctors
in England manage the same thing. What I find rather more concerning is
that he has reached the level of specialist registrar before realising
that he needs to research his own prescribing choices! In the course of
my career I have had jobs within NHS hospitals, as a general
practitioner, as a health authority prescribing advisor and most
recently within the pharmaceutical sector. In each role, I have found
that prescribing decisions have to be made within the context of a
vested interest, the only difference being which direction that interest
is pushing the prescriber.
As a professional, especially one with direct responsibility for patient
care, the only rational approach is to research your own prescribing
choices. If you feel that the only way you can trust yourself to achieve
that is by hiding in a corner with your own sandwiches, then carry on.
Personally, I'm not convinced that a plate of curry and a pen with a
drug name on is sufficient to corrupt my intellectual abilities, but
maybe I'm deluding myself. Each of us must make our own decision.
Competing interests: I own a consultancy that carries out research and
health economic analyses for the pharmaceutical industry
No such thing as a free lunch 6 March 2010
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Gilly Cooper,
GP
Elgar House, Redditch, Worcs B97 4AB
Send response to journal:
Re: No such thing as a free lunch
For many years now I have taken the same approach as Dr O'Hanlon but as
a GP it's probably easier to avoid drug reps. I never go to meetings
that are organised by drug companies or see reps in the surgery and if I
am at a meeting where there is sponsorship I just ignore the reps. I
fail to understand why doctors continue to believe that they can make
unbiased judgements after being fed biased information from the
pharmaceutical industry. We do ourselves and the profession as a whole a
disservice if we think we are immune from subtle persuasion. Big Pharma
wouldn't bother targeting doctors to peddle their wears if there was no
profit in it! They are in business to make money and a very profitable
business they are. A credit to our country and one of our major
exporters. Neither they nor we should demean ourselves. They are not
selling consumer goods and we should not take part in the charade of
impartiality.
Our time is better spent with pharmacists and reading articles in the
Drug and Therapeutics Bulletin, Bandolier etc.
What a truism "There's no such thing as a free lunch"
Competing interests: None declared
Life is easier after the detox 6 March 2010
Previous Rapid Response Top
Clare Wilkie,
GP
Aberdeen AB16 5UU
Send response to journal:
Re: Life is easier after the detox
I am glad that Dr O'Hanlon has successfully detoxed from the reps. But
it is concerning that interaction with reps is seen to be the norm for
doctors at a personal, departmental and institutional level, so that
ending that interaction is unusual or odd. We should be quite clear why
reps like to feed, accommodate, treat, court and sponsor doctors. They
want us to prescribe and promote their products rather than other
companies' products, or none, and aim to do this by creating a
supposedly cosy mutual dependency and giving the impression of being
interested only in informing and educating. We really don't need this.
We have plenty of independent sources of information about medications
old and new.
And life is so much easier after the detox. Save time and
(mega)embarrassment by not seeing the rep. Eat your own lunch. Holiday
with your family and friends. Avoid cluttering up your workspace with
desk toys. Ask your practice or departmental pharmacist to set up a
meeting about new drugs - quicker, more independent and you can ask
questions. Avoid sponsored educational get togethers or, if you must go,
ask what the reps want out of them.
It's not difficult.
Competing interests: None declared
--
Vasiliy V. Vlassov, MD
e-mail: vlassov[a t]cochrane.ru
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