Map of life expectancy at birth from Global Education Project.

Tuesday, July 12, 2016

Anybody who isn't paranoid is nuts

One of my research projects was to develop a questionnaire assessing the knowledge and beliefs of people living with HIV about the disease and treatment. I did qualitative interviews first to harvest the kinds of ideas people have and then translated those into structured questions. One of them is:

 "Some doctors are paid by drug companies to prescribe certain HIV medications."
People can call that correct, partly correct, or not at all  correct, but I didn't score this question when I calculated their overall accuracy because it's not exactly true and it's not exactly false.

Susan Chimonas, in the journal Democracy (which I very much commend to you as a most excellent freebie)  uses this recent study in JAMA Internal Medicine as the occasion to write about the problem of pharmaceutical industry influence on prescribers. I say she uses it as the occasion because we already know all this. Even very small gifts can have a substantial influence. They talk about $20 meals but even pens and sticky note pads have been shown to have an effect. My old office at Tufts Medical Center had boxes of office supplies stamped with the pharmaceutical brand names. The drug companies obviously wouldn't waste their money on this if it didn't work.

Now, there isn't any stated quid pro quo. You don't actually have to prescribe Toxovan to get the free lunch or the triangular pen. This is actually a weird trick about human psychology. It's surprising how well it works. Transparency is often touted as the solution -- drug companies should have to disclose their gifts to prescribers, prescribers should have to disclose the gifts they accept. But that doesn't work. The only solution is to ban the practice. Drug companies should not be permitted to give anything to prescribers. The information they need is in the so-called "label" (actually a substantial pamphlet) approved by the FDA. The docs should read it. That is the only interaction between prescribers and drug companies that should be permitted.

No comments: