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Healthy Skepticism International News

September 2007

Pharma money: the least common denominator

By Tiago Villanueva, GP registrar, Lisbon, Portugal

Imagine the following scenario. You’re a junior doctor starting your residency (specialist training). You’re full of enthusiasm and motivation, and you’re looking forward to making the most out of this intense, but very important stage of your medical career. Postgraduate medical training, among other things, includes attending courses, giving presentantions in conferences, or conducting research. Since attending courses and conferences is often expensive, this translates into a considerable amount of financial effort, that is often greater than the purchasing power of the physicians.

In Portugal, where I work, most General Practice registrars like me often receive sponsorship from the pharmaceutical industry in order to attend courses and conferences. This is due to the fact that there are hardly any other widespread sources of funding available, including the State, who already pays our salaries.

Furthermore, the influence of the Pharmaceutical industry in postgraduate GP training becomes even more considerable because drug companies also take over as the main provider of external training, since the State does not cater for any.

As such, agreeing to be visited by a drug representative is the number one rule of this skewed, convoluted, but necessary game. Every week, I receive invitations from drug representatives to attend courses sponsored by the company they represent. These are often good quality courses (and I am not talking about those that are practically promotional sessions in lavish hotels, which I loathe), with great speakers, who are often well known doctors at regional or national level. Agreeing to visits by drug reps to my eyes, is thus important for two main reasons. The first and by far the most important reason is that without these courses, GP registrars would hardly receive any sort of regular postragraduate training.

Moreover, apart from the biased promotional material they give us, which I normally dump in the bin after the visit, drug reps also often bring in reprints of excellent text books, which are many times not available comercially.

The second reason is that some drug reps may be very willing to sponsor our participation in important courses and conferences, from either their initiative or our own. This is relevant when we’re talking of attending courses and conferences with inherent additional travel, and room and board expenses. On 1800 Euros (gross pay) a month I am not able, for instance, to attend an international conference and make a presentation. I already gave up on the idea of attending the European congress of General Practice (WONCA Europe) this year after I realized that I would spend about a month’s wages during the three days of the conference.

Therefore, it is hard for someone in my position to completely shut the door to the Pharmaceutical industry, even though I am well aware of the potential traps and pitfalls that eventually spring up because of this “promiscuity”. I don’t feel happy at all having to skew my prescription habits towards favouring the drugs of a particular company or the other (in Portugal, doctors in General Practice are empowered to choose the brand of medicine they want to prescribe among dozens of both brand and generic drugs available on the market). I’ve recently had lunch with a drug representative from a generics company, who admitted to me that even though sponsorhip from the drug industry as a rule rather than the exception is not ideal, it is an inevitable part of the reality of the professional life of young doctors like me, and I agree.

What also allows this is the market deregulation. Surely such levels of harassament would not exist if doctors could not have their say on the brand of the drug they prescribe, or if the the number of licensed companies was significantly curtailed so that doctors only had a chance to work with just a handful of different branded or generic drugs.

Finally, I would say that the price to pay for a few books, courses and the odd sponsorhip means opening the flood gates to the daily three drug rep visits, and having to put up with often very boring speeches. For each 20 drug reps, perhaps only one or two actually bring in useful material like books, an invitation for a course, or are willing to sponsor the registrars for a course or a conference.

Is this too much of a price to pay? My tentative answer would be “perhaps”, because the Pharmaceutical industry is far from being the ideal altruistic philanthropist, and I completely acknowledge the ethical dilemnas and the consequences and implications that come with considerable exposure to the Big Pharma influence.

But in medicine, I am not so sure if, like the saying goes, it is prefereable to be alone than in shabby company. It is ultimately the patients who will be affected by our degree of preparedness and competence. And when the Governement does not look after our continuous professional development, I don’t think it is completely wrong for drug companies to fill in the niche, in the absence of a suitable alternative player.

Doctors in training must admit that the educational support of drug companies is not negligible, that drug reps can be important allies in our training, albeit this is a type of support that is not perfect and not the one we would like. And that’s why I say that in the current circumstances, the support from drug companies is the least common denominator to make ends meet for the sake of our patients’ health.



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