LetterBMJ 2003; 327 doi: https://doi.org/10.1136/bmjusa.03090005 (Published 19 November 2003) Cite this as: BMJ 2003;327:E252
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 couple of 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 be viewed as economically appropriate (and usually legal) activities in a free market context. If we all benefit from our free market system, it may be a bit disingenuous to overly criticize drug companies. The honest way to change their behavior would be to change the system. Please note that such excuses do not apply as well to physician behavior. Second, while it may be true that physicians who see pharmaceutical representatives prescribe differently from those who do not, it does not necessarily follow that patients are being harmed. It is widely trumpeted that many evidence-based treatments are underused, including statins, β blockers, and ACE inhibitors. So if drug reps promote these drugs for appropriate indications, resulting in increased use of the same drugs, is that bad? As scientists, let's hope that the next survey includes a measure of appropriate drug use (besides the question about acceding to patient requests). It is not my intention to be an apologist for any of the involved parties. I believe the current system should be changed.