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3 Drug Companies and Healthcare Professionals: The Ethics Agenda My experience was probably similar to that of many others. I went with a patient to a doctor’s appointment a couple of years ago. As we sat, I began to pay careful attention to what was taking place in the waiting room. Centered in the room was a television featuring a series of short educational programs on health-related topics. e programs were interspersed with commercials, primarily for prescription drugs. My estimate was that, given the normal waiting time that day, patients on average were exposed to about 10 ads for prescription drugs, without their choice. In the time that we waited, three sales representatives, from three different pharmaceutical companies, entered, approached the receptionist, and handed over their business cards as well as several small items that might have been pens. One told the receptionist that he had a “last minute” dinner invitation for the doctor. e other two were carrying bags and took seats in the waiting room. I suspected that they were waiting for the opportunity to meet with the doctor while he took a lunch break, and I guessed [There] is an increasing recognition by both pharmaceutical companies and physicians that, in certain respects, the relationships between drug companies and doctors have become embarrassing to both parties and need to change.1 38 Marketing to Healthcare Professionals that their bags contained copies of studies and other promotional material as well, perhaps, as some samples of medications. I was not in the waiting room long enough to see whether either of the reps was invited in to meet with the doctor. I had two different impressions of what was going on. One impression, reflected in the practice of the sales representatives seeking the doctor’s attention (and using the gifts and invitations to help get it) was of the industry playing up to physicians, where the real power in medicine lies, almost begging for an opportunity to show their wares. e other impression was quite different. e pervasive presence of the pharmaceutical industry that morning, reflected in the waiting room TV’s direct-to-consumer advertising of prescription drugs and in the presence of three sales representatives at the same time, gave the impression of the doctor’s office as an extension of the industry, an extension of the business of selling drugs. An observer might easily conclude that the industry is clearly in the driver’s seat and physicians, knowingly or not, are simply part of the process of selling the company’s products. e relationships that have come to exist between prescribing physicians2 and the companies that manufacture and market medications inevitably affect the nature and quality of the healthcare provided. e nature of that relationship and its impact on healthcare have recently begun to get much more attention. Now, more than ever before, attention is being paid to the risks these interactions pose to the scientific and ethical integrity of physicians and to their ability to act objectively in their patients’ interest. e occasional article of 15–20 years ago has grown to fairly frequent studies and commentaries today.3 Much of the early scrutiny was focused on the issue of gift-giving , especially the ways in which the pharmaceutical companies sometimes “wine and dine” physicians in their efforts to get them to listen to their marketing messages. Questions about the appropriateness of physicians accepting such gifts—expense-paid trips, dinners in expensive restaurants, tickets to entertainment, free lunches, items for personal or professional/office use, and samples of medications—have led to efforts for clarifying ethical standards for the medical profession. e American College of Physicians 39 Drug Companies and Healthcare Professionals published a position paper on “Physicians and the Pharmaceutical Industry” in 19904 and the Council on Ethical and Judicial Affairs of the American Medical Association (AMA), in 1992, published its guidelines on “Gifts to Physicians from Industry.” e introductory paragraph of the AMA document included the statement that “Some gifts that reflect customary practices of industry may not be consistent with the Principles of Medical Ethics.”5 e guidelines were designed to help physicians recognize the kinds of gifts that are appropriate and those that are inappropriate to accept. e ethical guidelines from the early 1990s, however, clearly did not have the effect of reducing or limiting the extent of commercial influence on medicine. Since these guidelines were published, “evidence of industry’s influence on medical practice, research, and education has continued...

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