Letters to the Editor

The pharmaceutical companies will continue to influence physicians to dispense their brand of medications. The AMA guidelines also allow, unfortunately, a greay area of "moral purity." Hence no physician has to take the uncomfortable stand of rejecting all gifts (bribes?) from drug companies.

The only definitive conclusion is that you no longer have guilt over accepting and using a little black Eli Lilly bag. Could this be interpreted that at one time you had a conscience and now you do not? Is discovery of a lack of conscience what you intedned to communicate? I hope not.

A brother-in-law of mine, a drug detailer, is required to spend several hundred dollars a year on cookies an candies just for medical office staff for each traditional holiday. If he does not, it negatively impacts his appraisal and salary. Additionally, there are lunches to be provided either at the doctor's office or at a local restaurant. These are "small" gifts. Yet they increase the cost of drugs.

Last year, I arranged an appointment with my dad's primary care physician. My sister accompanied me, and we were shown to an exam room to wait. We opened the door after our escort left, figuring we could embarrass Dad's PCP to ber on time if he noticed us waiting.

Instead, he took another 15 minutes to talk with a drug detailer. I would have, too, as she wore a very short skirt and a blouse that showed her ample breasts. She found reason to often bend over or squat down to obtain samples from her cases on the floor. I and the physician got a great show (my sister was reading a magazine and missed it).

Sex sells, too, even if it is only glimpses of a good-looking drug representative's physical charms and some flirting.

Whether for sex or money the goal of the pharmaceutical companies is to create a bias for their products, subliminal or otherwise. Physicians, being human, will still treat the AMA's guidelines as just guidelines. Whenever there is a self-serving opportunity to overlook the guidelines, there will be physicians who will.

Too bad we cannot measure the impact the "little black Eli Lilly bag" had on your prescribing habits. The fact that you still have it may indicate an unrecognized bias. What do you think?

- Bob Speth

The Author Responds
Mr. Speth is correct. The time, energy and money the drug industry spends to influence us phusicians to prescribe their products is impressive and outrageous. Direct-to-consumer advertising, I am sure he would agree, is also very troubling in its content and volume. The reality is, however, that this activity is going to continue and will no doubt become more sophisticated (or obnoxious, depending on your view) as time goes on. Like political lobbying, pharmaceutical advertising is a fait accompli and is not illegal. All physicians, nurses and paramedical personnel are exposed to it. The AMA recognized this and expended a good deal of its time, and some money, to notify all of us of the ethics of the situation.

I wrote the article so our readers would be aware that guidelines are avaialbe. I tried to leaven my words with modest doses of humor and satire. My wife - generally my toughest critic - thought it was one of the best pieces I have written in a long time!

And, yes, I was thankful for the bag, stethoscope and reflex hammer the Eli Lilly rep gave me in 1968. That saved me some money when money was tight, and I do not think I ever prescribed, for example, brand-name Darvon when generic propoxyphene would have done as well.

With the AMA guidelines, we can be more tuned in to the problem, more aware and more circumspect. That was my essential point.

- Jack Ostrich