Saints, Sinners, and Bringers of Dinner

Gienna Shaw, for HealthLeaders Media, January 30, 2008
In last week's column, I praised the SMDC Health System in Duluth, MN, which banned all pharmaceutical promotional products--from pens to whiteboards to squishy stress balls from their halls. I thought it was well worth the estimated $100,000 it would cost them to buy their own supplies to avoid the impression--true or not--that drug company reps could buy them with cheap trinkets. A reader who said he used to work in the pharmaceutical industry and now works with drug companies as a consultant, begged to differ. "I would hate for people to go into their doctor's office and start to think badly of their doctor because they see a Viagra pen," he wrote.

In his e-mail, the consultant suggested doctors deserve more credit than I gave them.

    What a silly article. When I go to my doctor's office, the last thing I think about is that my doctor is being influenced by a pen that a drug rep gave them. I know firsthand, so no, I'm not being naive. Give your doctor more credit than that.

    Managed care has squeezed doctors' margins enough. So what if some office supplies are given to them by a drug rep? I wonder how SMDC passed along the extra $100,000 they are spending on office supplies? I'd rather have my doctor using the Internet to search Medscape for best clinical studies and articles instead of and looking for the cheapest pen. I worry more about the quality of the interactions between patient and doctor as the doctor cattles more patients through the office due to managed care pressures.

    The reality is that a pen or clipboard won't influence a doctor's prescribing. In the '80s or even early '90s, drug companies could more easily unduly influence a doctor's prescribing with larger incentives like trips mentioned in your article. Trips and other major incentives are just not prevalent anymore. Today, many honorable drug companies and reps can truly partner with a physician to improve the patient experience.

In an e-mail response, however, another reader took a different view, saying that drug advertising--not the cost of office supplies--has contributed to increased healthcare costs.
    I thoroughly enjoyed your article. I have been involved in healthcare for more than 30 years. Many if not most changes are for the good. However, I would like to see an analysis of the sudden increase in cost of healthcare, the portion of that increase that is pharmaceuticals, and its association to the public advertising of prescription drugs that has opened up in the last 10 years.

    My surgeons say that since the approval of public advertising of prescription drugs, they are being constantly badgered by their patients for drugs they don't need. However, if the surgeon consistently refuses to prescribe, the patient will leave and seek a surgeon that will. Therefore, it is the opinion of many surgeons that, if the requested drug is not harmful, they will go ahead and prescribe it in order to keep their patient.
    Carolyn E. Skaff, CEO
    ASC Durango at Mercy Regional Medical Center

And an on-line commenter painted a vivid picture of the "invasion" of drug reps and the physicians who encourage them.
    Your article was "spot on!" In my previous position as COO of a large, multi-specialty clinic (70 physicians, two large office complexes about 5 miles apart), the drug reps were everywhere, and during the lunch hour it was almost like an invasion.

    Tons of freebies throughout the facility, and different vendors were actually scheduled on a rotating basis to bring lunch on different days of the week to each of the different clinics. When food arrived, the aroma permeated the air, and made patients wonder what the priority was . . . lunch or their care, as staff members would disappear, reappear, then disappear again . . . some shoving food in their mouths before resuming duties, or bringing plates of food back to their work areas, in view of the patients.

    One time, when there was an obvious schedule mix up, and one clinic did not have anyone bring them lunch, the physician director of that clinic called the drug rep he thought should have been there and told him in no uncertain terms that no lunch meant no further visits. Lunch arrived about 45 minutes later.

    One provider even gave the building security access code to one of the drug reps so she could get in and out of the back door of the clinic more easily with food, without disrupting the clinic operations. Although senior management (non-physicians) were able to make some changes, the physician-owned group called the shots, and they were not about to give up their lunches. It was absolutely ridiculous to see the anger or foul words generated over schedule mix-ups or food that was not as good as the next clinic had.

    Congratulations for bringing this issue forward. I think it is a long overdue lesson for everyone.

So what do you think? Was I spot-on, or did I miss the mark? Do drug reps improve the patient experience? Or just fill up physicians' tummies? You know what I think--now I want to hear what you think. Leave a comment on the site (just click on the button at the bottom or top of this column) and maybe I'll send you a HealthLeaders Media pen.
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at
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