"U.S. physicians are committed to quality health care. It's part of the oath they take. So, despite what critics say, it's insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary."

It may be insulting, but the truth is often unkind. One of the first things a marketer learns in business school is that by giving people freebies, these people will develop a positive response to your brand name and logo. In psychology, this concept is known as emotional equilibrium. If I do something nice for you, you will want to do something nice for me in return. It's an evolutionary drive present in social mammals like us. It builds social standing and allows the community to stay stable and orderly.

So we can angrily demand to know "how dare someone accuse doctors of being influenced by promotional freebies?!" but that doesn't negate the fact that doctors are human and the rules of evolution and social interaction apply to them too.

A good debate but with no solution. Doctors are human, too, and greed for these freebies applies to them as to any one of us. Moral values are rising, so maybe the conscience of the doctors will govern the issue. Pharma companies are there to make a profit, so whatever it takes to lure doctors, they will do.

To those who support the con perspective, I must respectfully ask you to remove the wool from your eyes. I have been in this industry for 20 years. I have seen many instances where marketing trumped science, and physicians were influenced to prescribe. PhRMA may sponsor ethical guidelines; however, they are left mostly to the physicians and others being "detailed" to enforce. There are many ethical physicians who remain true to their science roots. I suspect this is the minority.

The medical boards of each state should include as part of their ethics statements that doctors cannot accept any gifts or freebies of any kind from drug-company or medical-device representatives. Access to information about drugs and innovative machines should be available to doctors and the public at conferences and in medical journals--but not through marketing or sales campaigns.

It is not wrong or right for physicians to accept these freebies. It is their actions after receiving gifts. Pharmaceutical companies, like ones in other industries, have to advertise their products in the most effective way. Their target is doctors, not ordinary people, who have no right to choice what drugs to use. If we look at the percentage of their spending on advertisements, it may be much lower than in other sectors. Imagine that a marketer visits a doctor for whom time is money. He may refuse to accept. Do you want to spend your precious time for nothing? The drug catalog dropped on his desk will surely be thrown into the bin.

If companies' products cannot sell, they will go bankrupt. No one will do research to produce drugs to cure our diseases. All of us could die prematurely.

Pro, con, that's the issue? The issue is how pharma makes nothing that works and sucks the money out of people. Pharma, tobacco, alcohol, and sugary foods, crap. All crap.

If the freebies didn't influence physicians, would intelligent, sophisticated companies with access to the most advanced marketing research in the world spend so much money on them, year after year after year?

If the freebies don't influence physicians, why do pharma companies resist banning them?

The bottom line is, are America's physicians to be trusted to do the right thing? History shows the vast majority of doctors always put the interests of their patients (and by extension their professional reputations) before any gift they get from drug companies.

And national polls consistently show that the vast majority of Americans (in the 90% range) trust doctors to give them unbiased advice. Let's leave it at that.

Greg Kelly
Editor
Physicians' Financial News

Free? Nothing from Big Pharma is "free." Everyone pays 10 times over for these trinkets and baubles. They also need the money to ensure Congress permits them every method of marketing and pricing abuse, and should their actions become so uproariously outrageous, our government "fines" them a few pieces of silver. And that just goes to Congress to spend, spend, spend. I'm voting against every incumbent come November. It is the only way.

Mr. Kelly, editor of Physician's Financial News, claims, "History shows the vast majority of doctors always put the interests of their patients...before any gift they get from drug companies."

I just searched the most likely databases of publications and found no data and no historical work that demonstrate that the vast majority, a slim majority, or any proportion of doctors always put the interests of their patients before gifts from drug companies.

As an editor, Mr. Kelly would not make a claim that is totally unsubstantiated. Perhaps he could provide a citation for the claim that history shows it.

I agree with Greg Kelly to the extent that "the vast majority of doctors always put the interests of their patients (and by extension their professional reputations) before any gift they get from drug companies." The crux of the issue as I see it is this: Physicians may prescribe a medication that is indeed in the best interest of his/her patient from a medical perspective. I believe it is incumbent upon physicians to be good stewards of our resources as well. This is not to say they should prescribe medications with inferior outcomes. They should simply be objective about reviewing the clinical trials, by removing the bias introduced by PhRMA, and prescribe what is in the best interest of the patient both medically and financially.

Wow, so you are saying most doctors are greedy. I say some are but not the majority. If you spent more time banning tobacco and liquor, the main health concerns for the public, maybe you would not need all those 3-cent pens or $6 pizzas. Maybe ban all computers--that's why the USA kids and adults are lazy. People like you have no clue. People today including you and doctors live at "free will." Do what you want to do to yourself and others, and as long as it is legal--tough break. Sorry, you lose.

Mr. Johnson from PhRMA states: "To us, the evidence is compelling: Physicians meeting with well-trained company representatives gain crucial knowledge about side-effect profiles and proper use of medicines." In all my years as a hospital pharmacy supervisor or director, I don't recall being educated by the drug rep on the side effects of the drugs they were marketing. The side effects are downplayed, just as they are downplayed by the industry during clinical trials and post-marketing periods. Just look at the kind of massive public outcry that had to occur to get PhRMA and the FDA to issue suicidal ideation warnings on children and antidepressants.

Let's not forget politicians and lobbyists while we are on the related matter. The decisions politicians make with the same type of implied change in behavior has more far-reaching effects than a doctor's writing an extra prescription for Viagra.

In the last several years while visiting several medical centers, I talked with many pharma reps. None had any science background but held B.A.'s and MBA's in marketing or business. These very pleasant folks could only repeat "co.line" when I asked tech "trick" questions, especially about dominions of related drugs or locus and ethnicity of clinical trials--forget the math. I am the recipient of a recent implant about which I have grave doubts, especially after interface with three company reps.

I just gave a presentation at the university I attend. It was on "Present Day Medicine." As part of the talk, I showed a DVD called Money Talks and also one called Side Effects.

It was on this very subject, and in the film "pharma reps" showed and talked about methods that were used to influence physicians to use the products they were representing. Not all physicians know they are influenced (they do need to find out all about the products represented). However, many of the drug companies told them only part of the story. (The drug companies often locked away reports of adverse affects of the new drugs.)

Often the purpose of introducing a new drug was money alone--in order to be able to charge more than other, older drugs that did the same thing, although often the new one caused dangerous side effects that the older drug usually did not have.

All for financial gain.

Insulting? It's insulting that people of science wouldn't acknowledge the basic law of business: pharma companies wouldn't dump millions of dollars into these programs if they didn't work. The idea of doctors as heroic icons that are immune to the concepts of social marketing is laughable. I should know, I'm related to a doctor and that person is no better than any of us regular folk.

Okay, so let's ban other forms of marketing and promotional gifts for everyone, not just doctors--no business meals, no trips to the Super Bowl for clients, etc.

Otherwise, who are you to single out physicians? You have no right to regulate their behavior in this way. It's a free country and physicians can act as they like.

We are talking about business and with business there will be profit. Who demands profit? Share holders. Who are share holders? The "public" (although the percentage of people who participate in the stock market directly or indirectly is another question).

Every individual has the fundamental right to further his business using fair business practices. A pharma sales rep is as good or as bad as any other advertising channel. Because in the end, if the doctor cares about his reputation, he will be careful to prescribe the medicine he thinks is most effective, irrespective of how many sales reps called on him.

Sometimes we, the general public, are not aware of what a doctor does before prescribing a new medicine. Here are some of the things he or she often does:

1. Talks to his/her peers, his/her seniors, and other personal/professional contacts.
2. Reads about it
3. Attends lectures (yes, paid for by the indsutry), symposiums, etc.

So you have a choice to either trust him or not. If you are not happy with the prescription practices of your doctor, you are free to change. That is the beauty of the system.

Then there are also insurance companies and pharmacies that replace the prescribed medicines with equally effective generics, reducing the costs to the consumer. So if you see the current system as a whole, you will appreciate that it is continously evolving to benefit the consumer.

I worked for Sanofi-Synthelabo {now Sanofi-Aventis} and Sandoz {generic firm of Novartis} as a medical rep in South Africa. I hated having to bribe my way to get scripts and orders by giving gifts and dispensing bonuses and cash backs. It is a use and abuse system where the doctors flock to the latest company offering an 'incentive' and the pharma companies use questionable tactics to get the most business from the doctors. The doctors and pharma both abuse each other for what they want. There is no loyalty or ethics where big profits are concerned.

The saddest thing of all is that the patient always loses out to the corrupt motive for profit by both the doctor and big pharma. I am no longer in the industry and I have come to despise it.

There seems to be a common logical theme: If the lunches and trips and perks didn't influence doctors, then why would Big Pharma spend millions a year on them? If there were no ROI, then why would the money be spent? Further, if doctors really cared about their patients and the general public, then wouldn't they say, "Hey, these drugs are expensive the way it is, let alone with all the extra expenses of trips and dinners, so please don't spend this extra money on trying to bribe me, and just help my patients." But they don't, and instead choose to accept perks and bill like crazy and then point their finger at insurance companies for the raising cost of health care.

Surprise. First we don't want to eat and live healthy. We want more and more prescriptions. Now pharma companies want to take full advantage of your laziness. Lift that fat ugly backside of yours, and start living healthy.

You won't need a doctor, medicine, or pharma companies either.

Ban all forms drug advertising on TV and nonmedical magazines. Ban drug rep visits and lunches in doctors' offices. Pharma companies should be allowed to promote their products in regional meetings. All speakers at the meetings should disclose the grants they receive from the drug companies. If a drug rep treats a doctor with a $100 dollar wine and dine, he can influence the doctor's prescription habits.

I wonder why we always expect our doctors to be the saints or priests. They are merely trying to make a living like the rest of us. Ambroise Paré said, "I dressed the wound, and God healed the patient." If our own bodies lose the ability to heal from any injury, how can we recover from a major surgery even with the best medicine?

Just ask Pfizer how much they will pay a doctor to talk to other doctors and side-step the safety issues. Not the average, but the pay for the 10% of their stable that does 90% of the talks. The kind of money they are willing to put in their "experts" pockets to give presentations shows how corrupt the system is.

You can't have it both ways, people. On the one hand, you love the pharmaceutical industry for its innovation and ability to develop cures and prevention of disease. All of which, by the way, costs billions of dollars in R&D. Yet, nobody expects to have to pay for it. The price of pharmaceuticals is based on the value the drug provides and by profit required to drive future innovation, not the cost of goods (the cost to manufacture the pill). People don't understand this concept. They think because a pill contains 10 cents of ingredients, that the price for the prescription should be low. The reality is that for every one drug that makes it to the pharmacy counter, there are 1,000 drugs that never even make it out of clinical trials. All of this costs money. Consumers are paying for the price of development of that drug, and the development of all future drugs that may or may not ever get past the test tube phase of development. If a drug company is not allowed to generate profit to put back into R&D, we may as well kiss this industry good bye. What is a fair profit? That question could be asked of many industries (oil, consumer electronics, furniture, etc.).

I think that it is irresponsible and misleading to frame the question in this way. Many physicians are asked to speak to groups about particular medications or products, and are paid a fee for their time. This is hardly a "gift." I myself have not, but I would not be resistant to giving a lecture about a medication or procedure I believe in.

It was this same sort of irresponsible alarmism that caused patients to eschew Celebrex in favor of older and more dangerous medications, to their ultimate detriment. This shameless, self-serving, and dangerous baiting of those who depend on others to vet their medical information is the worst kind of sham journalism, it is dangerous, and it must end. As far as I can tell, this endless suspicion-mongering has never saved a single human life. There are plenty of real stories to be told--how smoking cessation programs save lives, how the new "evidence-based medicine" journalism rewards negative and overblown side-effect reports more than actual scientific data--but they are not much fun to write or to read.

Want to practice medicine? Do it. I promise you it is not what you believe it to be. Otherwise, let those of us who have taken an oath to help and not to harm do our job in peace without the constant din of negativism and suspicion that has infected our patients without cause or positive effect.

I just read Pfizer's response to BusinessWeek's "Doctors Under the Influence" article in which Pfizer asserts that the article "relies on innuendo and distortion to support empty charges of lack of disclosure about interactions between pharmaceutical companies and physicians," is "odd and troubling," that there "is no failure of transparency here, only a cynical attempt by your magazine to portray it as such....By implying that any paid relationship with an expert is inappropriate, you betray a fundamental lack of understanding of that process....Instead, your magazine published a story reflecting a pronounced anti-industry, anti-physician bias. Your readers deserve better."

First, Jonathan Foulds, PhD, is not a physician. Yes, he has been involved in cessation research but also chose to serve as a member of Pfizer's speakers' bureau, as a paid sales agent for Pfizer. Pfizer knows that Professor Foulds has written a number of online blogs supporting Chantix without advising readers that Pfizer selected him to assist in marketing Chantix.

Pfizer should not need to await federal legislation to demand total financial transparency and disclosure by its paid agents when writing in support of its products. If Pfizer isn't outraged by the non-disclosure in Professor Foulds' Chantix blogs, it should be.

John R. Polito
Nicotine Cessation Educator

I was a pharmaceutical rep. Not only did these "hungry for freebies" S.O.B.s accept the gifts, dinners, grants, trips, tickets, and everything else they could get their greedy hands on, but they were rude and abusive to me as well. Pathetic.

I think doctors are wise enough to recognize the obvious reason a pharmaceutical company's giving them health freebies or free stuff.

Health care it shouldn't be a business. Physicians shouldn't be "selling" pills to patients just because they have a nice dinner after or a relaxing vacation in Hawaii paid by the "gealth" corporations. It's our health and our lives. It's a simple and basic ethical behavior. If they want additional money, just go out and work in Macy's for a salary and commission.