You know that those free samples the doc gives you are from big pharma to encourage you to keep using them. You also probably know that your doc goes on “educational” junkets to exotic locations that rarely consume more than a couple hours a day.

Did you know that psychiatrists are also engaging in the same actions? Do you feel differently because it is a shrink?

Several days after her visit, one of my patients came in complaining of insomnia which had not responded to several hypnotics. He had tried Ambien, Sonata, and Benadryl, but was unable to sleep through the night. Usually, in these situations, I would offer trazodone, which has a long enough half life to last most patients all night long.

Lo and behold, he remembered the Ambien CR rep who had just visited. She (they are always pretty young things) remarked that she hoped the doc would give Ambien CR a try.

He prescribed Ambien CR. He reported that it worked no better than Ambien and the patient ended up on trazadone. This form of marketing is effective, otherwise the big pharma would discontinue the practice. Hiring those pretty young things (PTY) to travel around the countryside handing out free product works.

Does it tick you off that you’ve been waiting for an hour and the PYT comes in with a roller case, chats up the receptionist and is escorted to the inner sanctum? Those docs want the freebies. If you were in their shoes, wouldn’t you?

AMA Guidelines about gifts? They are a farce. Here is the pertinent section:

“(i) May companies invite physicians to a dinner with a speaker and offer them a large number of gifts from which to choose one?
In general, the greater the freedom of choice given to the physician, the more the offer seems like cash. A large number of gifts presented to physicians who attend a dinner would therefore be inappropriate.
There is no precise way of deciding an appropriate upper limit on the amount of choice that is acceptable. However, it is important that a specific limit be chosen to ensure clarity in the guidelines. A limit of eight has been chosen because it permits flexibility but prevents undue freedom of choice. Each of the choices must have a value to the physicians of no more than $100.”

You read that right – your physician can attend a dinner free, at a five star resort, fly first class, and choose up to EIGHT gifts as long as none exceeds a value of $100 individually. $800 in free gifts.

Nice deal, right?

So how did the AMA communicate these “restrictions?” They accepted $600,000 from big pharma to advertise the guidelines.

Could have been worse, I guess. They could have invited doctors to Vail or Pebble Beach and held a fifteen minute seminar on “Keeping the Public’s Trust While Keeping the Loot.”

It’s influence peddling. Pure and simple. It our doctors don’t have the ethical fortitude to refuse these gifts, what’s the answer?