You must be from Canada?” the friendly well-dressed man behind the counter asked. Surprised, I paused in loading my half-full shopping bag and asked, “How can you tell?”

“We can’t give this stuff away here. I use to be a drug rep in Canada and you guys don’t get anything up there.” I was attending a primary care conference in Spokane, Washington, and on a floor beneath the lecture rooms there was an entire hockey-rink-sized room full of pharmaceutical companies’ booths. I had stocked up on pens, pads, anatomic models, and other items, including a towel, laser pointer, full-sized clock, and even a dirt-filled pot sponsored by an ED drug, which, when watered, grew into a tall plant.

Do you ever wonder how much your prescription writing is influenced by pharmaceutical companies? When faced with starting a patient on a new medication for hypertension, how do we decide? Are our medication choices based on sound, evidence-based medicine? I would like to think that my prescribing practices are immune to outside pressures and based on what is best for the patient. When I first started my general practice, I decided I would not see pharmaceutical detailers in my office because I didn’t want to be influenced by their sales pitches. It’s not that they lie to you; it’s just that they tell you the truth they want you to hear. I remember one of my mentors, when I was an intern, telling me that, on principle, he didn’t see drug reps in his office. However, as the years passed, he found himself pushing past his staff and welcoming the young attractive women in for a chat.

Pharmaceutical influence in medicine is much more ingrained than most of us realize. Starting in medical school, through internship, and into residency, various companies are picking up the tab for lunches and food at rounds and talks. This practice continues into our working lives. Who hasn’t attended a dinner at a nice restaurant or gone to a medical conference and visited the sponsoring booths at the encouragement of the course mediators? In fact, often when conferences are planned, one of the first tasks is to try to secure sponsorship money from pharmaceutical companies.

After years of hearing my colleagues talk about playing golf, going to hockey games, and even traveling courtesy of some drug company, it became clear to me that they were having way more fun and were enjoying their ride on the gravy train. What were my morals getting me? Nothing. That’s it, I decided, I was going to catch a ride on the pharmaceutical ex­press. I started attending some of these events and let the word leak that I liked to play golf. Before I knew it I was inundated with invitations and offers. Here in lies the catch; nothing is free. After playing golf with someone, how can you ignore them when they drop by the office to say hello with their most recent article or handout on their new and improved medication?

It is naive to think that we aren’t influenced. When next writing a script is it possible to forget what the nice drug rep said about how his or her medication is the best? They wouldn’t lie to you—they took you golfing, bought you lunch, gave you samples, and commented on how respected and admired you are in the community. They even liked your new shirt and hair cut. These thoughts all came to me as I read a recent article in the Georgia Straight about a now-retired pharmaceutical detailer and how he was trained to befriend and influence physicians. He mentioned many of the above items—food, drink, activities, hobbies, and more. The article also outlined the enormous amounts of money pharmaceutical companies spend on detailers. If the process of detailing didn’t work, do you think these highly successful companies would continue to invest in it?

Some of you, like me, are immune to these outside pressures, and I compliment you. I’m sure none of you use pens with medication logos on them or have anatomic models, mouse pads, hand outs, and so on with these same logos. I also congratulate you on not eating the food at grand rounds or partaking of the meal at the evening lectures you attend.

Lastly, if any pharmaceutical de­tailers ever read this, I like nice red wine—none of the cheap stuff.

--DRR