Bioethics Medicine

Doctors as drug reps

Fellow ScienceBlogger Abel Pharmboy over at Terra Sig pointed me in the direction of a rather fascinating and disturbing article about physicians being recruited as “thought leaders” by pharmaceutical companies. Abel’s discussion is well worth reading for yourself, but I thought I’d chime in my two cents, as always.

From a surgeon’s perspective, these sorts of “opportunities” are much different, because most of us general surgeons and surgical oncologists only prescribe a rather limited range of drugs. For example, I rarely prescribe anything other than narcotics for postoperative pain relief and antibiotics. And my prescribing needs are generally simple. Nine times out of ten, Percocet is all that I need to prescribe for pain, and a first generation Cephalosporin is fine for most surgical site infections. These are all generally available as generics; so there’s not much in the way of profit to be made getting someone like me to shill for them. Moreover, because I spend more time doing research than doing clinical work, I’m not “busy” enough. Don’t get me wrong; I’m plenty busy, just not in the way that my prospective audience would care about: clinically busy.

Surgeons like me may not be prime candidates for this sort of pharmaceutical company shilling, but we are prime candidates for ethically dubious forms of marketing by other sorts of companies: Device manufacturers. For example, in the specialty of breast surgery, I could if I wished probably agree to give talks for manufacturers of breast core needle biopsy systems or other such devices, such as the Mammosite catheter for delivering radiation therapy. I happen to like the Mammosite catheter, but I view it as still more or less experimental and wouldn’t feel right taking money to give talks on it.

There’s also a downside to becoming a pharmaceutical or device company shill. Believe it or not, other physicians start to view your pronouncements about the company’s products with suspicion. Some physicians will actually look at you as ethically compromised.

And there’s a good possibility that they’d be right.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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