Doctor education #2… more real-life drama

Posted on October 7, 2008. Filed under: Everything you wanted to know about doctors, medical ethics, Medical marketing, Self-deception |

I got a call from a pharm rep for a company that markets one of the three well-known pills for treating erectile dysfunction one day about five years ago. She lived and worked in the alluvial plain area of the Mississippi delta. If you have never listened to a woman from “the delta”, as they say, you owe it to yourself to call someone in that area. The female version of the accent is melodiously syrupy; a conversation about anything is musical entertainment. “Yankees” seem to think the drawl is an indicator of ignorance or low intelligence. I assure you, that is not the case. There is a reason that William Faulkner spent most of his time in Oxford (Mississippi, not England), and it wasn’t because it was full of “hicks”. 

She sought me out because I was a “consultant” for her company. At the time, I justified that position by using what I now know is “confirmation bias”. I distinguished myself from the “medical whores” I have previously discussed by reasoning that I never consulted for competing products; that I promoted the one I actually used with my patients; and that I truly believed the product was the best in its field. I saw no conflict of interest, because I was only saying what I would have said anyway, pay or no pay. I should have considered things this way (as told by Kenny Tilton):

Once upon a time my sleazebag ward politician buddy and I were cruising the singles bars back when they had such things and he got nicely eviscerated by a woman we were chatting up. My buddy had said something cynical and she had challenged him on it.

“Oh, I have compromised my principles a few times,” he conceded with a sly grin.

“You can only compromise your principles once,” she replied. “After that you don’t have any.”

Since my practice was limited to male sexual medicine, the rep (let’s call her “Sunshine”) was hoping I might have some influence on one of “her doctors”. The mark in question was a male family-practice doctor, and an avid hunter. Sunshine’s company-provided prescribing records showed that he had been the most prolific prescriber of her product in the territory, but recently, he had been prescribing only the competition’s pill. She had already used the low-cut-short-dress-with-FMP’s approach, to no avail. Over an expensive lunch, Marcus Welby had finally revealed the reason for the switch: Sunshine’s competitor had bought for him a Honda Fourtrax ATV, complete with camo finish, double gun rack, and bow carrier. A $7,000 value, as they say on TV. His position: “I’m willing to listen to what your company has to offer.” I’d like to think that since the treatment of erectile dysfunction is basically a recreational issue, and since all three available pills do the job to some extent, he felt there was no involvement of ethics. Of course, I’d be wrong. Even the woman in the singles bar knew that. But Sunshine was relatively new to the pharm game; she was horrified.

Sunshine used her lifelong local contacts to get to the bottom of the story. Medical bribery violates federal Medicare laws, FDA regulations, almost surely IRS statutes, not to mention all the things Momma taught you. Here’s how it was done. Sunshine’s competitor, who was on near-equal footing regarding the physical attributes for the job, had contacted a restaurateur in the doctor’s area. She said, “My company is going to sponsor quite a number of big-ticket dinners for large groups of doctors in the coming year. How would you like for them to be held at your restaurant?” Receiving an “affirmative”, she closed the deal with: “Marcus Welby needs a new ATV, and I’m sure your restaurant would like to buy it for him.” Just a gift from one friend to another. No FDA, no Medicare, no FBI or IRS.

Per Sunshine’s request, I had lunch with the doctor, and discussed the clinical advantages of Sunshine’s product. Last I heard, those advantages were not capable of getting a fully-loaded hunter to and from his deer stand. But I’m no better: I got a new set of golf clubs with my consulting fee.


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    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.


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