Letter

doi:10.1136/bmjusa.03090005

BMJ, doi: 10.1136/bmjusa.03090005, (Published 30 September 2003)

Letter

From BMJ USA 2003;September:475

Dear Editor: The August 2003 issue of BMJ USA, with its discussions of the relationships between physicians, medical journals,and pharmaceutical companies, was outstanding. I have a coupleof thoughts to contribute. First, much of the criticism focuses(understandably) on ethical issues, but often, I believe,misses the point that many of the bemoaned behaviors may beviewed as economically appropriate (and usually legal) activitiesin a free market context. If we all benefit from our freemarket system, it may be a bit disingenuous to overly criticizedrug companies. The honest way to change their behavior would be to change the system. Please note that such excuses donot apply as well to physician behavior. Second, while itmay be true that physicians who see pharmaceutical representativesprescribe differently from those who do not, it does not necessarilyfollow that patients are being harmed. It is widely trumpetedthat many evidence-based treatments are underused, includingstatins, ${beta}$ blockers, and ACE inhibitors. So if drug reps promotethese drugs for appropriate indications, resulting in increaseduse of the same drugs, is that bad? As scientists, let's hopethat the next survey includes a measure of appropriate druguse (besides the question about acceding to patient requests).It is not my intention to be an apologist for any of the involvedparties. I believe the current system should be changed.