Intended for healthcare professionals

Rapid response to:

Education And Debate

Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1189

Rapid Response:

Freedom of speech vs undue influence

When I was a first year medical student we were given a stethoscope, doctor's bag, reflex hammer and some books and other things. I don't even remember who sponsored the items. Many of my classmates refused the gifts as they said they could not be bought. They would be unable to prescribe for another four years; how could they be bought?

If we are that easily influenced perhaps we do not deserve the trust our patients and the public give us. We all agree that the underlying reason for free lunches, dinners, and other pharmaceutical benefits, including funding of CME and journals, is promotion. I have always made it clear to representatives of pharmaceutical companies that I make the decision based on information from many sources. I have no hesitation to contradict what reps tell me or to demand valid information. I have received information from the medical departments of pharmaceutical companies and disputed the data in discussions with reps.

On the rare occasion when a rep asks me specifically to prescribe the medication being promoted, I tell them I will do so only as appropriate. I have never been told I would receive anything only if I prescribe some product. If I did, that rep would be forbidden to return and I would file a formal complaint with his or her employer.

When I have spoken for pharmaceutical companies, I make it clear the opinions are mine alone. I discuss competing products' benefits including generic products.

Each of us is faced with a multitude of ethical dilemmas daily. We are expected to do what is best for our patients regularly. We give up personal time for them every day. We accept payment, some of us accept huge payments, for our services daily. When an interventional cardiologist recommends angioplasty rather than medical treatment, is it because he or she will be paid much more for the procedure or because it is in the patient's best interest? We choose whether to see patients more or less frequently when paid fee for service knowing full well the more we see them the more we earn. Yet, this is OK, but listening to constitutionally protected free speech is wrong?

Despite my opinion that doctors should be able to receive promotional information objectively and without undue influence, I will agree to refuse all gratuities from the pharmaceutical industry and will encourage the professional societies to which I belong to eschew all pharmaceutical support ONLY when members of Congress refuse all contributions designed to influence their decision making. If it's wrong for us, it is certainly wrong for them.

Competing interests:  
I have served as consultant to and lectured for several pharmaceutical companies.

Competing interests: No competing interests

02 June 2003
John J. Messmer, M.D.
Assistant Professor, Family & Community Medicine
University Physician Group, 941 Park Dr., Palmyra PA 17078