I started making a simple request to drug reps seeking my time: Instead of providing a meal for my staff, help me access information that would improve my ability to tend to my patients.
It is not uncommon for pharmaceutical representatives to bring meals to physicians' offices, in addition to the latest informational material regarding a particular medication. Typically, this meal is accompanied by pens, notepads, mugs, and-most important-much-needed medication samples. As the economy has slowed, patients' need for samples has increased significantly.
In years gone by, I would often spend a few minutes with the representative, wolfing down my meal and discussing the merits and weaknesses of a particular medication. To their credit, the reps took my reluctance to use a newly released medication-and my occasional criticisms-well. Some would later return with additional peer-reviewed literature to support their position.
But over time, as handheld computers became more powerful and my circumference became larger, I came to a realization: My health and the health of my patients would benefit if I skipped these rushed meals at the office.
There is an ever-growing library of literature available for PDAs, smart phones, and computers. Companies such as Epocrates, Skyscape, Unbound Medicine, and UpToDate provide excellent references at a relatively low cost; many titles are available for less than $100, and most range from $30 to $75. Of significant value is these books' ability to link with other software made by the same publisher. For example, a book on diseases can link to books on medications, drug interactions, and differential diagnoses. Some electronic health records even access these textbooks to assist in clinical-decision support. Many of these textbooks allow you to earn CME credit for looking up the answer to a diagnostic or management question.
Of course, there is a growing movement by organized medicine and government to do away with traditional pharmaceutical representative visits. Five states and the District of Columbia require that all physician gifts from pharmaceutical companies be reported. In Vermont and Minnesota, payment disclosures are publicly available (a 2007 JAMA article, however, notes that there are loopholes and hurdles that make retrieval of information somewhat difficult).
Vermont set a $25 threshold for reporting any gift, and Congress is also considering a $25 threshold, which could supersede state thresholds. Massachusetts recently passed a bill that mandates a state code of conduct for pharmaceutical reps, complete with a $5,000 fine for each violation.
The pharmaceutical industry has responded to criticism with a revised code of its own. Among the changes, pharmaceutical companies are prohibited from the following:
According to a June 2008 survey sponsored by the Prescription Project, a majority of the physicians polled favor ending free office meals and items such as notepads. Respondents seemed split on the custom of leaving free samples at the office. Most were in favor of having clinical experts visit offices to discuss medications, a practice known as "academic detailing." The Independent Drug Education and Outreach Act of 2008 would provide grants or contracts to support such drug-education outreach programs for health-care providers and their patients.
Perhaps the next time a medication detailer pays a visit, he'll "feed" you with a certificate good for an e-book. Like a slice of pizza, it will stick with you. Just in a different way.
Salvatore S. Volpe, MD, is an internist in Staten Island, New York. Send your feedback to firstname.lastname@example.org