This morning I opened the door to my waiting room for a scheduled patient and found three people sitting there. I ushered in my patient and even before she could enter the office one of the two other women jumped up and asked if I had any time to meet with them.
I have made it a point, since I was in Medical School to avoid taking gifts from the Drug company representatives. I decided that I did not want to be influenced, as far as possible, by marketing campaigns, in my usage of medications. Although Psychoanalysts tend not to use much medication in their treatment, I also spend about half of my time doing general Psychiatry, much of which involves using medications to help people gain or regain better functioning. While on rare occasions I have taken some pens, and my first stethoscope was supplied by a Drug company, in general I have managed all these years to avoid meeting the Drug Reps and taking gifts.
That being said, I have noticed in the last few years the reps have become more aggressive. They come into my waiting room unannounced and unasked; the companies send me all sorts of gifts (ranging from pens to clocks to note pads) without my requesting or desiring such gifts. I receive two to four phone calls and several letters everyday asking me to dinners in fancy restaurants to discuss medications, often with the offer of an honorarium. The phone calls I do not return, the letters I throw out, but the Drug Rep in the Waiting Room is a different problem.
My initial reaction was annoyance at the intrusion. I try very hard to keep up with the Medication literature, and I think I do a pretty good job of it, and I do not want to hear the drug company's description of their newest medication as the greatest advance since the invention of fire. Yet, even beyond the fact that I do not like to be rude (but was given little choice this morning; my schedule does not have much elasticity in it), it is not such a simple situation.
Drug companies are easy targets for demagogic politicians and "activists". They make a lot of money and sell their drugs for much more than it costs to manufacture them. Of course, the demagogues always seem to forget half the story. The Drug companies have to spend somewhere around $1 Billion to bring a medication from laboratory to market and while we have some wonderful medicines that represent highly significant advances over past treatment options, we still need much better medications for the treatment of all sorts of psychiatric and medical disorders.
First, a cautionary tale: When I first entered practice, one of the newest wonder drugs was Xanax (Alprazolam). It was in the same class as Valium (Benzodiazepines) but early testing showed none of the difficulties with Xanax we had seen with Valium. It was very safe, short acting, excellent for treating all sorts of anxiety states, with no apparent serious side effects. People were even beginning to use it in high doses for treating severe psychiatric illnesses, with ht hopeful thought that it might be a replacement for some of our dangerous anti-depressants and anti-psychotics. I almost never prescribe a new medicine until it has been on the market for at east a year (there are always multiple treatment emergent side effects not noticed when testing the drug on 2000 people, but obvious when the drug is taken by 2,000,000 people.) Not surprisingly, after Xanax had been on the market for a couple of years, we discovered it had a very serious problem; among all the medications in the Valium group, it is just about the most likely to produce dependency, even among people who do not have a history of drug abuse. Today, most Psychiatrists avoid it; it has a significant street value, and is commonly abused.
This then is the balancing act all Psychiatrists, and all Doctors, have to deal with: We have many drugs that are useful, none are perfect. We have many conditions that cry out for better medication options and when a new drug comes on the market that addresses a problem that nothing else adequately treats, there is tremendous pressure to use it... which has to be balanced with the concern of the dreaded treatment emergent side effects, which can be worse than the original disease. Add in the worry about lawyers suing us if we get it wrong (getting it wrong is usually synonymous with a poor outcome whether we actually commit malpractice or not and when lawyers sue, they sue everyone who might have money, doctors and drug companies alike; perhaps the recent tort reform will help matters, but we will have to wait and see.) The drug companies want to make money (their share holders demand it) and need to make a lot of money to continue doing the research that will lead to new wonder drugs (aka drugs which make a lot of money) and they need to do a lot of marketing to make doctors aware of their drugs and get us to think of them when we are prescribing.
It is worth considering these things when you next ask your doctor for a new drug that was just advertised on TV and seems to fit all your symptoms.