Tabula Rasa

It's getting harder to defend the drug companies. Despite mounting evidence that pharmaceutical company gifts and lunches influence physician prescriptions, I've argued in the past that this is beside the point -- there's no evidence that free lunches harm patients. Besides, there are many financial considerations influencing doctors' decision-making, from Medicare reimbursements to preferred drug lists to the curricula of state-run medical schools. It almost seems like corporations are being unfairly singled out.

But then you hear stories from the Sunday New York Times, like the doctor who received an unsolicited check for 10 grand:

Schering-Plough's tactics, these people said, included paying doctors large sums to prescribe its drug for hepatitis C and to take part in company-sponsored clinical trials that were little more than thinly disguised marketing efforts that required little effort on the doctors' part. Doctors who demonstrated disloyalty by testing other company's drugs, or even talking favorably about them, risked being barred from the Schering-Plough money stream...

...In return for the fees, physicians were supposed to collect data on their patients' progress and pass it along to Schering-Plough, the doctors said. But many physicians were not diligent about their recordkeeping, and the company did little to insist on accurate data, according to Dr. Pappas and the others.

One of the nation's most prominent liver disease specialists, who spoke on condition of anonymity for fear of angering big drug makers, called the trials "purely marketing gimmicks."

...Six specialists in liver disease said Schering-Plough also paid what it called consulting fees to doctors to keep them loyal to the company's products. The letter accompanying a check for $10,000 explained that the money was for consulting services that were detailed on an accompanying "Schedule A," said a doctor who insisted on anonymity. But when the doctor turned to the attached sheet, he said, "Schedule A" were the only words printed on an otherwise blank sheet of paper.

It seems we're getting closer to scenarios from a bad Robin Cook novel (I can't remember which one had the doctors get brainwashed on a pharm-sponsored cruise).

So, this leaves me in a fix. I can either throw out the argument that conflict-of-interest doesn't necessarily mean harm to patients, or I can wait for new evidence that it does. Maybe I can conduct one of those corporate pseudo-studies to find out.

Or maybe all the proof I need is already out there -- written on a sheet of paper marked "Schedule A."

UPDATE: Chase raises a good point (in the comments below and on PoorMedicalStudent: it takes two to tango, so doctors should also be held accountable for taking a bribe. Anjali recently noted that doctors are on trial in Italy for just such an offense. Still, there is such a thing as extortionary pricing, and I think the law -- and ethics -- demands more of rich corporations than of poor medical practitioners.