Drugs and drug reps

I just received an early-morning WhatsApp from a friend praising the actions of David Hambleton and colleagues in defeating the pharmaceutical industry in court – to allow the use of an inexpensive drug (Avastin) to be used to treat a common condition affecting the vision of thousands of people (Age Related Macular Degeneration)(the wet type) instead of the standard medicines which cost 10 or 20 times the price.

Go David and fellows. And thanks Gareth for sharing.

This brings me to an interesting situation. (Dear readers, please let me know your thoughts.)

In my hospital we have lots of meals sponsored by drug companies.

In particular each Friday there is a teaching session, before which a drug rep sells their wares, in turn they buy lunch – M&S if they are trying to impress, Morrisons if on a tight budget (possibly, dependent on the outcome of High Court actions).

Anyway, I usually arrive for the teaching as the rep is ending their talk. I haven’t sat through a whole one yet. Partially this is intentional – I don’t really want to listen to what they have to say and also I am quite a busy guy and I prioritise – teaching beats reps, for example.

I don’t know the effect of these drug-rep interventions although I imagine there must be some cost-benefit return to the companies otherwise they wouldn’t do it; unfortunately, they aren’t allowed to give away pens and little gadgets any more, so they are wholly dependent on their spiel.

So, I don’t listen and arrive at the end.

Is it OK for me to support them providing lunch for the trainee doctors?

That is question one.

The next is the sign-in.

To account to their budget managers, or, perhaps, area managers, they have to get a sign-in sheet, with the names and grades of the different doctors in attendance.

I don’t usually sign. Last week, a drug rep asked me to sign the form despite my not having eaten the food or listened to the talk – in fact, I had asked her to take her presentation down so the teaching could get started.

I refused.

She did not like that.

Now, it would be silly to look a gift-horse in the mouth, as the saying goes. And, these folk are providing our hard working doctors a free lunch. They even get to learn something (although perhaps sometimes with an associated bias) (I don’t believe the reps are allowed to say anything that isn’t true.)

Equally, she has provided food for my doctors, something neither I nor the hospital can afford (not true, but you have to look at where money is best wasted first) (admitting older people unnecessarily to hospital, for example).

Question two, should I have signed?

In many places they manage to pull-off teaching sessions without the food – people bring packed lunches (like I do) – and, it should be the desire to learn, the excitement of the education that draws people, not a chicken and avocado wrap. Yet, who am I fooling.

I am not getting at drug reps themselves; they like the rest of us are trying to get-by. That they work for multinational pharmaceutical giants (if they are lucky) (or small innovative start-ups if less so) is just a fact. I hold no malice towards them.

This is just advertising – and as much as I would love there to be no advertising anywhere, it is an intrinsic part of 21^st Century existence; and, without it the advertisers would be out of jobs too.

I want to be honest and open and do the best for my patients every time I act (which ironically, given the content of this blog, is in stopping medicines predominantly) – the teaching is important, it communicates information, it creates a spirit of learning, education and growth.

The court case I mentioned at the beginning should release 12 million pounds locally to be used in different ways within the NHS; across the country this figure will be in the 100’s of millions.

We should celebrate Davids tackling Goliaths, we need more of them; mostly the system is too complicated to unravel into such a dialogue and, I am sure the pharmas legal team are even now working on a challenge or way around the ruling.

In the meantime, I will go on de-prescribing.