One of the first posts I wrote was a about how pharmaceutical reps provide lunch for physicians while presenting information about a medication that they are promoting. The post, and others like it, have generated visceral reactions on the part of the public. A similar article to the one that I wrote prompted comments like “Get over yourself and buy your own lunch” and “I’m certainly glad that you are not my doctor.”
The opinions were so strong I was invited to speak on CNN about the topic. In particular, I was asked to speak about all the other extravagant things that physicians get from drug companies. I ultimately did not do the interview on account of me not having any experience with receiving any of the extravagant things they were talking about. It seemed to me that individual physicians receiving lunch was (excuse the pun) small potatoes compared to what happens behind closed doors in the halls of power. While upcoming rules will soon provide the public with a window into the value of goods provided to physicians by drug companies, they will provide little insight about where pharma has its greatest and most effective influence: behind the closed doors of those halls with thought leaders, opinion makers and legislators.
To that point, a story came to my attention recently that reminded me about that fact. The dean of Weill Cornell Medical College, a prestigious and highly regarded medical school, has apparently kept close financial ties with industry, as reported in the the college’s newspaper. The college’s Dean, a highly accomplished and awarded physician researcher, has retained positions with a major pharmaceutical company and a laboratory equipment company. In these roles last year she reportedly received about $260,000 from one of the companies and about $277,000 from the other last year. The Cornell Daily Sun also reports that she has apparently received millions of dollars in compensation from both companies over the years as well as more than a million dollars worth of shares and stock options in the companies.
As dean of a prestigious medical college, she must undoubtedly understand that she has the ability to influence the behaviors of thousands of future physicians, and the power to lead by example. I find it appallingly hypocritical that, while the dean sits on the board of these companies, she is training future physicians who will be discouraged from receiving anything of value from the pharmaceutical industry.
To get a better understanding of the depth of this double standard, take a look at the pharmaceutical vendor policy of the medical college’s affiliated hospital. In an effort to control costs, they have significantly restricted the activities and access that pharmaceutical representatives have in their facility. This is fairly common practice among hospitals, as is the practice of restricting inpatient medications to cheaper generics whenever possible. Hospitals know that the presence of pharma reps increases costs by encouraging physicians to use the more expensive medications. Hospitals thus try to reduce the influence of the reps on physicians both by removing the expensive alternatives from the hospital pharmacy, and by limiting access to pharma reps.
Like many other hospitals, reps here need to be credentialed and registered by the hospital before being allowed access. They must enter the facility through specific entrances designated for reps, and they may enter by appointment only. Furthermore, the hospital’s policy explicitly states that reps are not allowed to meet with medical students on hospital property. Nor do they allow free drug samples to be distributed by pharmaceutical representatives.
By now it should be exceedingly self evident why telling your students on one hand not to speak with pharmaceutical reps, and on the other taking millions of dollars from the same company would be hypocritical. That we should ask more of our medical educators and health care leaders is also self evident. And I could say a lot more, too. I could say how inappropriate this is, and ask that all medical college deans take a pledge to no longer take money from industry. But instead I would like to defer to a simple message which summed up what most people felt about a recent article on drug rep lunches that I think fairly and accurately sums up this situation as well. The comment, directed at the medical community, said simply and emphatically, “Who’s money do you think you’re spending? IT IS IMPROPER BEHAVIOR!”
Deep Ramachandran is a pulmonary and critical care physician who blogs at CaduceusBlog. He can be reached on Twitter @Caduceusblogger.