If you wait around long enough at nearly any doctor's office or hospital, there's a good chance you'll see a pharmaceutical rep hauling in a case of drug samples along with a couple of pizzas for lunch. It's a fact of life for both doctors and drug reps, an understanding that freebies sometimes equal a few minutes of face time with doctors. It's an uneasy relationship that critics say is ripe for conflict of interest, where doctors prescribe drugs from companies they have relationships with. At a recent debate at UT Houston, Dr. Paul Anthony, chief medical officer for Pharmaceutical Researchers and Manufacturers of America, argued that conflict of interest is a fact of life, but has to be managed.
"I don't think it's possible through any set of codes or any kind of policy to eliminate conflict of interest. What we all need to do as physicians is learn to manage conflict of interest, because it's always going to be there and we should make sure that we're aware of what those potential conflicts are when we make a prescribing decision."
Several schools, including Stanford and the University of Pennsylvania, have banned all freebies from drug company reps at their medical schools. Dr. Howard Brody of the University of Texas Medical Branch in Galveston says some doctors are blinded by what he calls "self-deceit," believing they're not influenced by drug company gifts. He says one solution to the conflict of interest problem would be to funnel research money through a neutral agency instead of having it come directly from the drug company to research physicians.
"You could still have new research. You could still have new drugs. The companies could still make a very nice profit but we wouldn't have this problem that we of the control of the information flow being so vested in the hands of the industry."
Drug companies say they would use other ways to market their products if those tactics worked, but have yet to find ways that work better than what they're doing right now. Dr. Eugene Boisaubin is a professor of medicine at UT Houston and says there has to be a balance.
"I guess in the best of all worlds we always will have pharmaceutical companies, we need them for good products, but we'll teach physicians to be more aware of what the influences might be and how to look at a more balanced view and what other sources are they can use besides the pharmaceutical industry to get information that is a little more science-based and not just promotional."
Both sides agree that the bottom line should be patient care, regardless of where the medications are coming from. The pharmaceutical industry has recently instituted what it calls "pharma codes" that loosely regulate freebies given to doctors.