Announcing NPA's Unbranded Doctor Campaign

I am happy to be asked by my friends in the National Physician's Alliance to let everyone know about the launch of their Unbranded Doctor Campaign: http://unbrandeddoctor.org/

I was at the NPA annual meeting, which they had the great kindness to hold in Houston so it was only an hour's drive, and was able to learn a lot about the launch of this important campaign to start to retrieve medical professionalism from the forces of commercialism.

I have only one small bone to pick with the campaign. I don't see it up live yet on the website, but at the NPA meeting, I was able to see a preview version of the campaign's store, where one can (eventually) purchase T-shirts, backpacks, hats, buttons, and a variety of gizmos to show patients and colleagues that one supports this effort. I believe that there was also an Unbranded wall clock for the heavy hitters. But to my surprise and dismay, I did not see Unbranded coffee mugs or pens!! How better to declare one's independence from the drug industry gravy train? I trust this deficiency will be remedied without delay.

NOTE ADDED 4/2/08: I'm informed by the NPA office that while it is true they do not (as yet anyway) sell pens, they will have mugs available! Sorry for the error.

Kudos to "No Free Lunch" Pioneer, Dr. James Orlowski

The Prescription Project has kindly called our attention to a nice newspaper writeup about Dr. James Orlowski of Tampa:

http://www.sptimes.com/2007/12/27/Business/Doctor_combats_pull_o.shtml

The article credits Dr. Orlowski, a pediatrician, with being the only area physician listed on the "No Free Lunch" website (I assume, for having signed the pledge not to accept any gifts from drug reps).

What they could have said, but didn't, is that Dr. Orlowski did more than get listed on the site; he helped invent the arresting term "No Free Lunch" to describe drug company gifts.

As near as I can determine, the first published use of that phrase was in a paper that Dr. Orlowski co-authored while at the Cleveland Clinic in 1992: "The effects of pharmaceutical firm enticements on physician prescribing patterns. There's no such thing as a free lunch" (with L. Wateska, in Chest, 102:270, July 1992). This classic study looked at 20 staff physicians who attended two junkets at drug company expense, touting expensive drugs, showing that in the months following the junkets, the prescribing of those drugs at Cleveland Clinic shot up far out of proportion to any national trends--while when interviewed, the docs involved steadfastly denied that the junkets had influenced their prescribing.

Looking Over the Shoulders of the Drug Reps: Who Are They?

Some colleagues of mine on the Healthy Skepticism listserv have lately been commenting on some postings on the "Cafe Pharma" blog (warning: it's at least PG-13 if not R):

http://www.cafepharma.com/boards/showthread.php?t=226949

I am not sure just how this changes over time; but when I logged on, the discussion thread had to do with some reps sharing stories of how they had deliberately contaminated the food they brought into physicians' offices to "get even" with various people who gave them a hard time or who did not value their services. Others took issue with such behavior. One resident, who maintains his own blog, wrote to say that now he had yet another reason not to take any food from reps, thereby setting off a torrent of abuse from the reps directed at the resident, replete with suggestions as to with whom his wife was sleeping when he was on duty.

I was guided to this blog one time before by an in-the-know acquaintance, and after 10 minutes of reading gave up in disgust. I chose at that time not to mention this blog or its contents in any of my writing on ethics and the industry, as it seemed way too cheap a shot to take at the reps as a group.

On this occasion as I read the postings I am struck by the range. Some of the reps seem thoughtful and decent and trying to maintain integrity. Others are embarrassingly juvenile, obscene, and just plain mean in their postings.

I have tried hard in my own work never to villainize reps. As I see it, reps have an impossible job. From the company's point of view, they have one function only, to move product. I ask at every opportunity for someone to tell me about a single rep who was ever paid a single bonus for anything other than quantity of drug sales--and no one has ever given me an example.

The other part of their job is to lie about this. They have to lie to two people. First they have to lie to us, because we demand it. We will not easily and comfortably take all the goodies they shove our way, unless they keep repeating over to us the soothing rationalization, "It's education, not marketing." Second they often have to lie to themselves because they can live with themselves much easier if they can see themselves as educators and not as mere salespeople. Or at least they can lie to us more glibly if they lie to themselves first.

In one respect, I can concur completely with the blog postings, as much as I am repulsed by the packaging. If I sort through the obscenities, one basic idea seems to stand out. These reps despise docs and office staff who first scarf up their food and other goodies whenever they get the chance, and then believe that they can turn around the treat the reps who brought the stuff like dirt.

I agree totally. Whether that means it's ethical to deliberately sneeze in their lasagna is an issue we can take up at another time.

Newsweek Reports Fewer Docs Seeing Reps

Newsweek, this week, reports a trend among physicians and medical centers away from talking with reps and accepting company gifts (see the article: http://www.newsweek.com/id/57342). The article, of course, is music to my ears; but it would have been nice had it included just a little bit of data--any data--to back up the assertion that such a trend exists.