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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Saturday, August 02, 2008
    Stock Up on Those Pens

    I first heard the news a couple of weeks ago as I was leaving a restaurant. I had been a guest at a dinner sponsored by a pharmaceutical company (a.k.a. "drug dinner") with an informational speaker. As we headed toward the door, the representative ("rep") who had invited me mentioned that in the future pharmaceutical companies would be instituting new restrictions on promotional events like dinners, and then added, "And they won't even let us give you guys pens any more, either!"

    "What?" I responded.

    "As of 2009, no more pens."

    "You can have my drug pen when you pry it from my cold, dead fingers!" I responded dramatically.

    Then I came across this article confirming the sad news. No more baseball caps or coffee mugs. No more Post-It pads shaped like lungs or kidneys. No more (sob) pens.

    The cold hard truth is that American drug companies spend quite a lot of money on product promotion. They used to spend even more; I recall in the past going to Staples Center once or twice to see the Lakers, courtesy of a friendly drug rep (they can't do stuff like that any more). Are drug companies doing this to influence doctors' prescribing choices? Of course they are. They start early, with medical students getting a free stethoscope and "sponsored" lunches, and escalate their marketing efforts from there.

    My view of drug marketing has always been pretty pragmatic, in case you haven't figured it out by now, but I have to admit I've heard of freespending promotions in the past that gave me pause. I got this attitude from my dad the retired M.D., who never met a drug rep he didn't like. Mostly I feel that the drug companies write all this off as a business expense. As long as they're throwing the dinners, I might as well go. I usually learn something at these functions, as they feature excellent speakers. Whether it's hypertension, cervical cancer or asthma, these docs know what they're talking about and their speeches are quite a bit more than nonstop shilling. (Full disclosure: doctors these days are under a lot of pressure to prescribe generic drugs as well. This pressure comes from insurance companies and - if you are a member of a large practice like The Firm - from the administration. Generic drugs make perfect sense in many, if not most, cases, and I have been assured during my performance reviews that my prescribing habits are not out of line. So doctors are getting pressure from both directions, not just one.)

    Do all doctors agree with me? Definitely not. I've heard of projects such as the pen exchange where docs bring their drug pens to trade for ordinary unlabeled pens. I know some docs who resolutely refuse to talk to drug reps or accept any of their offerings. And that's fine; if you aren't comfortable accepting these things, then don't.

    But I have to admit I'll be sorry to see the tchotchkes go. My all-time favorite was the Levitra pen which slowly unfolded to its full length when the user pushed a release on the side. In case you don't know, Levitra (vardenafil) is used to treat erectile dysfunction. I've heard rumors that these pens were sold on Ebay. I gave mine all away to friends - wonder if I can nab one or two more before the big crackdown?




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