The Informed Hospitalist and the Pharmaceutical Industry

4. High Threshold for Rationalization

Most medical professionals, to some degree, rationalize interactions with the pharmaceutical industry. Almost all physicians insist that these interactions do not influence their judgment. The simple fact that the industry spends thousands of dollars per doctor per year indicates that we are wrong. If physicians were not being influenced, the pharmaceutical companies would not be spending such a considerable amount of money marketing to us. Patients trust physicians to make the best decision for them, they depend on researchers to publish impartial studies, and they count on educators to present unbiased truths. The cost of betrayal is paid in human lives. We should learn from the past, as well as the recent coxib debacle.

Conclusion

The interaction between hospitalists and the pharmaceutical industry continues to evolve. With increasing scrutiny from the medical profession and the government, many of the marketing practices that were considered acceptable in the past are now viewed as unacceptable and even criminal. As the relationship evolves, new conflicts are sure to arise as long as the fundamental difference between the medical profession and pharmaceutical industry continues to exist. As medical professionals, we must keep in mind that the pharmaceutical industry is a for-profit industry whose interest lies with its shareholders. It is to be expected that the pharmaceutical industry will try to maximize profits through marketing efforts directed at physicians and patients.

Medical educators must take on the responsibility of preparing medical students, residents, and fellow attendings on how to manage their interactions with the pharmaceutical industry and not just shield them from the issue. In applying the four-point approach of academic detailing, cost sensitivity, three-way transparency, and a high threshold for justification, we can better manage such interactions.

We would like to thank Dr. Anna Headly and Emily Hartsough for their constructive comments in the preparation of the manuscript.

Disclaimer: The content of the article is solely the responsibility of the authors and does not necessarily represent the official view of the Society of Hospital Medicine.

Dr. Rajput can be contacted at [email protected].

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