Voices: Drug Deals
I put on the paper garments and waited. It had been three years since I planted my feet in the stirrups of the gynecological table and things had changed. These were not the cold stirrups I remembered, these were covered with a clever pharmaceutical company advertising gimmick.
The cushy purple pads were emblazoned with the white letters "Terazol," a prescription treatment for infections manufactured by Ortho-McNeil Pharmaceuticals.
The week before my visit to the midwife, I had a new patient appointment with my primary care physician. I had to stand in line behind a pharmaceutical company sales representative to sign in. She passed promotional travel coffee cups over the counter. The receptionist asked for more than the initial five or so that there would be enough for everyone in the office. "No problem," said the sales woman as she reached down into her endless pit of a duffel bag to produce the remainder of the cups. She then began unloading piles of drug samples on the counter. The doctor made a brief appearance and reported on the number of "patches" - I didn't catch the brand name - that he had just recently given away.
Later, in the examination room I noticed a Prozac dispenser containing orange antibacterial hand soap assured that the soap contained no fluoxetine hydrochloride and a colorful box of tissues displaying the funky retro-style logo of an osteoporosis drug, among several other items.
I wasn't entirely sure why at the time, but I was irked. Unless you're armed with your own pen, you've no choice but to sign in with a pen promoting one drug or another. On the surface such promotions seemed harmless, but were they?
Recent news articles have detailed the unsolicited receipt of Prozac samples via the U.S. Mail. The most notable recipient was perhaps a 16-year-old boy whose name was among others sent to a Florida southern Walgreen's by a local doctor's office. The boy's mother told The Washington Post that the drug sample was accompanied by a letter from a doctor associated with the family's primary care physician suggesting a switch to Prozac. The boy was not and never had been described an anti-depressant medication.
In light of this news, people are suddenly shaking their heads in concern. How dare pharmaceutical company Eli Lily stoop to such careless tactics! Yet the bland-by-comparison brand support promotions I had just witnessed have long been known to affect the prescription choices of physicians. The U.S. Department of Health and Human Services recognized this in the early '90s and organizations such as the American Medical Student Association have been speaking out for years. Even the smallest "gift" the latter insists, is influential and sight of what is in the best interests of a given patient's health can be lost.
The big drug companies continue to assure those concerned by the high cost of prescription drugs that the prices are needed to support research and development (R&D). A report released on July 17, 2002, by consumer advocacy organization Families USA presents data indicating that most of these companies spent more than two-and-a-half times on marketing, advertising and administration than they spent on R&D. Consider that in 2000, Merck spent more money advertising Vioxx ($160 million) than PepsiCo spent pushing Pepsi ($125 million) and Anheuser-Busch spent promoting Budweiser ($146 million).
After my appointment I waited in the lobby for a referral appointment and eavesdropped on three well-dressed, nice looking young men. The large bags they carried gave them away as members of the pharmaceutical sales army. "Do you have an appointment," one asked another. "No," he replied.
I wondered if the doctor would see them. I had to wait over two months for my appointment. Their presence, in such quantity, was an undeniable demonstration of pharmaceutical corporate power. Their unified front was intimidating. Even the most ethical doctor, I thought, must eventually be worn down by such a comprehensive marketing offensive.
-- alicia grega-pikul, 1 August 2002
