This article was taken from the DALLAS TIMES HERALD
Sunday, December 24,1989
By Robin Lichtenstein from Newhouse News Service
DOCTORS, DOLLARS & DRUGS
Is your physician helping the medical industry `push’ pills?
For most people, the idea of pushing drugs conjures visions
of criminals hunkering over piles of cash and illegal white,
But drug pushing – the legal kind – happens every day in a
medical world that’s invisible to patients.
It happens in virtually every doctors’ office through face-
to-face meetings with gift-bearing drug salespeople, during
company-sponsored seminars held in vacation resorts and hotel
conference centers, and whenever a physician opens a medical
journal to page after page of colorful ads espousing the virtues
of prescription medication.
“It’s third-party marketing” to a middleman – the doctor –
whose prescribing behavior helps determine company profits,
according to a drug company salesman who requested anonymity.
“It’s not like getting [a consumer] to sign on the dotted line.”
Industry spokespeople and some doctors say that marketing
efforts generally result in a better-informed physician who is
better able to care for his or her patients.
Other doctors call third-party, or indirect, marketing a
waste of time and money.
Drug industry critics have produced some evidence suggesting
that drug marketing has combined with other factors to prompt
doctors into sometimes prescribing useless or harmful drugs.
Doctors also can be influenced be patient requests for certain
drugs, research suggests.
Ideally, a doctor prescribes a drug because the scientific
evidence shows it will help the patient. To what extent
prescribing decisions are based on science and to what extent on
marketing are issues of considerable debate.
And, with the average prescription cost at about $17.00,
according to a 1988 survey of 1,850 pharmacies nationwide, many
people are asking whether drug companies ought to devote some of
its marketing budget to reducing drug prices.
Robert Wood Johnson Clinical Scholar Dr. Michael S. Wilkes
of the University of California-Los Angeles estimates that drug
companies spent more than $2 billion on indirect marketing on the
country’s 479,000 doctors in 1988.
While in medical school, students on tight budgets are
frequently invited to lunches or dinners sponsored by drug
companies. Many received their first stethoscope, neurological
hammer, penlight and doctor’s black bag from a drug firm.
According to a 1982 study of 85 Boston area physicians,
however, marketing may have a much stronger influence on doctors’
prescribing behavior than doctors realize or admit.
The study, by Dr. Jerry Avorn of the Department of Social
Medicine and Health Policy at Harvard Medical School, found that
the vast majority of doctors surveyed said drug ads and marketing
efforts were “minimally important” factors influencing their
The majority also believed that two heavily advertised drugs,
vasodilators and propoxyphene analgesics (such as Darvon), were
effective treatments for senile dementia and certain kinds of
pain, respectively. Meanwhile, “the clinical literature
overwhelmingly indicates that they are not useful for these
indications,” Avorn and his colleagues wrote in the American
Journal of Medicine.
The most controversial way companies market to doctors is by
sponsoring or underwriting medical education seminars, many of
which offer continuing medical education credits, or CMECs.
Doctors need a certain number of CMECs to maintain their licenses.
Occasionally, the seminars are held in enticing locales such
as Florida or in Colorado during ski season. Wealthier drug
companies may cover air fare and accommodations for doctors whom
they perceive to be opinion leaders in their local medical
In addition to sponsoring seminars and buying advertisements
in medical journals, drug firms hire armies of sales
representatives, also known as “detail personnel,” to conduct
face-to-face sales pitches with any doctor who will listen to
Nearly every doctor’s office sports an array of desk-top
items bearing a drug name or company logo. Personalized
prescription pads, pens and paperweights and other “reminder
items” all come from detail people, doctors say. In addition to
the perks, detail people leave behind medical literature, free
drug samples and patient-educational leaflets.
One potential way to neutralize biased sales pitches is
“academic detailing,” according to Avorn’s research. In academic
detailing, a doctor learns about drugs from a university-based
expert with no allegiance to a drug company. These one-on-one
meetings in the doctor’s office are even more effective when
supplemented by “unadvertisements,” which point out a medication’s
adverse side effects as prominently as its benefits, research
I would suggest two good books to read that give an excellent
perspective view on this subject of drug companies and the medical
1. Murder by Injection; by Eustace Mullins written in 1988
2. 100,000,000 Guinea Pigs, written in the 1930’s
Submitted by Ronald Barker