I worked in a print shop for 14 yrs and we had several drug reps as customers. They told me things I never would've believed doctors did, until I saw the proof. Doctors would tell them that they couldn't get in to see them if they didn't buy them an expensive medical book, pay for the design and printing of fancy letterhead and envelopes, lunchs for the staff, etc. One doctor even called a drug rep in the middle of the night to have her deliver samples of the new antibiotic she was marketing, because his child was sick. He was either too cheap or too lazy to go to a pharmacy himself! This kind of behavior is what helps drive up the cost of medicines in this country. It's all about the money.
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Will more companies move in the direction Eli Lilly has taken? Do you think industry-doctor relationships are going to become more transparent, and will this come from both sides?
I haven't seen Eli Lilly's full proposal, so I don't know for sure. There are a couple of rationales for why this is happening; one could argue that hospitals, states and federal government are moving at breakneck speed toward having publicly available data on this. They may just see the writing on the wall and try to get ahead. Others have argued that [transparency] is a way to stem off legislation: "Oh, we're doing it ourselves, there's no need to regulate us." But there's no way to know that what's being told is true, if everything is being told. I applaud Lilly for getting ahead of this, but in the end it may just be that they see the writing on the wall. What's coming—if it doesn't come on the federal front, it'll come on the state front, and if it doesn't come on the state front it'll come on the institutional front. I think the bottom line is, the marketing model of giving doctors stuff to get them to prescribe is over. That doesn't exist anymore because institutions are going to stop it. [Drug companies] are going to have to do something else to get access to doctors to try and move their products.
How should it work?
I'm not against interactions between doctors and drug companies. I think interactions between them can be good. What I am against is the providing of inducements for those interactions. Don't take them up on lunch, don't meet them at a fancy restaurant, don't go down to Florida for four days to meet with them. And if you do do those things, pay for them yourself. Don't pass the costs of those things on to the American public in the form of higher drug prices.
© 2008
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