Gifts and money influence physician prescribing

It is not a secret that large sums of money have passed from the pharmaceutical and device manufacturers into physicians’ hands.

This money has been paid not only for such socially beneficial pursuits as research and consulting, but also for lavish gifts and junkets. And interestingly, despite disingenuous assertions to the contrary by many a stake holder, these gifts generated a return on investment — surprise! It turns out that the spender companies could count on improving their prescription volumes in return for their magnanimity. Well, of course this is really no surprise. After all, we all know that money talks.

What has been less clear over the years is whether small, almost inconsequential gifts, might also be influential in changing practices. Social sciences provided us with an answer to this: even gifts of small value create fertile soil for payback. OK, then, the answer became clear: remove all manufacturer influence from the day-to-day world of medicine. And so it has happened that pharmaceutical reps are no longer allowed to bring lunch or pens or pads of paper with the name of their wares on them to the hospitals or offices. Only educational gifts of a certain value are accepted. I will refrain from opining on the journals’ and professional societies self-absolution from such rules, as my views on that are beyond the scope of the current post.

Is this removal of potential temptation bad? For someone who can argue each side with equal aplomb, the question is irrelevant: it just is. What interests me a lot more is this: how is it that a 25-cent pen can sway my brethren’s prescribing practices, but $1 million in campaign contributions leaves a politician impartial to the contributor’s cause? Take Senator Lieberman’s claim that $1 million in campaign contributions from the health insurance lobby has not affected how he votes. See for yourselves, in this New York Times‘ piece from December 2009:

Campaign finance advocates have attacked Mr. Lieberman as “an insurance industry puppet,” suggesting that he wants to protect private health insurers from competition because he has received more than $1 million insurance company campaign contributions since 1998.

During his 2006 re-election campaign, Mr. Lieberman ranked second in the Senate in insurance industry contributions. Connecticut is a hub of the insurance business, with about 22,000 jobs specifically in health insurance, according to an industry trade group.

In the interview, Mr. Lieberman dismissed assertions that he was doing the industry’s bidding. “It’s hogwash and it’s weak,” he said, noting that he had often sided against the companies.

Are we really supposed to believe that? What about Blanche Lincoln, when she asserts that $1/2 million in oil money that her campaign has taken has not swayed her legislative priorities, is she for real?

A spokesperson for the Lincoln campaign says that campaign contributions play no role in the senator’s public policy decisions.

“This ad is nothing new, just more lies from another outside group seeking to malign Sen. Lincoln’s record and bully voters into their agenda,” spokeswoman Katie Laning Niebaum told CBS News.

If a 25-cent pen can hijack a doctor’s prescribing practice, how can these sums of money not be hijacking our democracy? And upon whom does the burden of proof fall in this situation?

Here is my solution: less advertising, less mud slinging, less dirty money (a.k.a. special interest contributions). Naïve? Maybe. But totally necessary. Let’s do what medicine has done and, a-la Nancy Reagan’s advice, “Just say ‘NO’!”

It’s time to bring back our democracy.