One of his posts mentions the No Free Lunch movement, designed to
"encourage health care practitioners to provide high quality care based on unbiased evidence rather than on biased pharmaceutical promotion." In other words, no free pens, no free pads, no free stethoscopes, no free Chinese dinners, no free trips to "educational" conferences in Fiji... The relationship between the pharmaceutical industry and the medical profession is a stark example of culture failure. Cultures are supposed to reflect the values of the community, and the medical profession values patient care above profit.
The blogger then cites articles here and there that indisputably claim that pharm giveaways affect prescriptions.
I'm haven't really decided which side of the fence I'm on. But I'm always happy to point out that the issue is less clear-cut than people think. And, just as some people work themselves into a tizzy about banning free drug company lunches, well, I tend to be irked by excessive self-righteousness... especially when my lunch is at stake.
The abstracts linked to above show correlations between pharm-company interventions and drug prescriptions. Is this horrible? It would be great if the papers showed something obviously wrong: doctors with Lipitor pens unable to stop prescribing Lipitor to hepatitis patients, for instance. But instead, we're given correlations and a vague warnings that doctors are susceptible to advertising.
They're also susceptible to education. I bet if someone polled students finishing their 3rd year psych clerkships, they'd find we're a lot more comfortable recommending Zyprexa or Remeron than before. No one's clammoring to ban psych clerkships (well, almost no one).
Ah, but medical schools don't have a conflict of interest when teaching about drugs. Or do they? I would argue they have less of a conflict of interest than drug companies, as opposed to zero. Residents feeling the crunch to discharge patients or lower costs, for instance, may prescribe well-tolerated drugs with fewer side effects, rather than the drugs with the best efficacy. And students learn from the residents while helping them out (a "free lunch" scheme if there ever was one).
I think many are opposed to the free pens and free lunches simply because it's unseemly to them. One of my professors suggested that when patients see my Lipitor pen (or something similar), it contributes to the erosion the doctor-patient relationship. Patients sense the conflicts of interest, and wonder if we're really putting their best interests first.
It's a mistake for patients to over-interpret the presence of drug-company paraphernelia given out at these education sessions. Someday I hope my public-university med school diploma will hang in my office -- but since taxpayers helped subsidize my education, should patients assume I'll take the side of the government when it comes to Medicare allocations?
Conflicts of interests are everywhere. Big Pharm advertising campaigns have influence, but so do the studies they tout. Until there's evidence that these free lunches actually hurt patients, save me a seat at the table.