Healthy Skepticism Library item: 20035

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Magazine

Fogarty J
Your patients' health worth more than an umbrella
Australian Doctor 2006 Nov 1326

Full text:

A well-dressed woman sits patiently in your waiting room. She doesn’t have an appointment. Outside there are blue skies and the country is in the grip of a record-breaking drought, yet in her hand she carries an umbrella. Why?

No, this is not some lateral-thinking brain teaser. She is a pharmaceutical rep, and the branded umbrella is her gift to you.

The real brain teaser is why pharma companies choose to spend money on such gifts at all, and how such gift-giving affects us as GPs.

If you listen to the debate from both sides, the answers are not clear. If a $10 umbrella, or a dinner out, or the occasional weekend by the sea can impart such a sense of obligation that the GP’s only capacity to reciprocate is to use, or at least consider using, the products promoted by the gift-giver, then this reflects poorly on both ourselves and pharmaceutical companies.

On the other hand, if the brollies and toys have no impact on our prescribing habits, as many GPs claim, then pharmaceutical companies are wasting time and resources.

The ritualistic gift-giving represents a microcosm of the often unsatisfactory relationship that exists between GPs and pharma reps.

While some GPs are happy enough with the present model, finding reps a useful source of the latest information and remaining confident their clinical practice is not clouded by such hospitality, other have closed their doors to reps in response to manipulative sales techniques and numeric distortion of statistics.
I count myself among the latter; those who now say “no more”.

In my view, a fundamental problem of this gift-giving is that it involves a third, unknowing and vulnerable party; a person not informed of the GP/rep relationship, but affected by it.

The person is, of course, the patient. Patients will, within reason, trust the advice of the doctor and trust that the doctor will act in their best interests. They should reasonably expect that the pharmaceutical information we provide them with is based on scientific rigour and statistical independence, not a dodgy graph served with mudcake. After all, we have many accessible and independent sources of pharmaceutical information, perhaps led by the National Prescribing Service with its Radar and associated publications.

For pharmaceutical companies too, the present relationship with GPs must be unsatisfactory. Some complain of the “knife and fork brigade” – those GPs who are regular attenders of functions but who are not clinically engaged – while many other GPs have switched off and are now inacessible.

Isn’t it time for a change?
For GPs the problem with pharmaceutical companies is not the product but the process. For there to be a worthwhile relationship, pharmaceutical companies need to bring to the table less glitz and glamour, less smoke and mirrors, and more transparency and intellectual rigour.

Despite their power and glory, pharma companies remain vulnerable to GPs, who have the option of closing their doors, seeking alternate sources of information, exercising caution in the rush to prescribe the latest and greatest, and demanding higher standards of information.

As GPs we have the power and the responsibility to demand what is best for our patients, and that clearly includes accurate and independent pharmaceutical information.

Perhaps by this action a new relationship will develop with benefits to all involved, especially the main player – the patient.

What is at stake is the fiduciary relationship of general practice – and that is worth much more than an umbrella.