The gift trap

This post is about us doctors accepting gifts from drug manufacturers. These gifts range from different size and costs. From pens to microwave ovens to television to diamond pendants to Direct to home set top boxes to laptops to books to exotic vacations…They are very creative. They see to that once you accept it, you feel grateful at least at the sub-conscious level. Each time their representative comes, they ask how we are enjoying their gift, gently reminding us of their favor. Do you think that any of the doctors receiving it cannot afford it? Some people assert themselves saying, if you do not accept it, the representative is going to give it to somebody else and anyway there is no compulsion for us to write the product. Is it so? Once we accept the gift the least that happens is we loose our impartiality in judging what the patient needs. The worse that happens is, we write unnecessary drugs – from multi-vitamins that cost the earth (Otherwise why will there be so many different vitamin preps – especially so when there are very few indications to write it) to expensive, latest, most broad spectrum antibiotic to treat a simple upper respiratory infection (Prescribing Co-amoxi-clauv for common cold is not uncommon. Especially for some consultants, these kinds of antibiotics are the first line treatment for day-to-day fever. The patient is satisfied that he paid a lot of money and assumes that the drug should be great). These not only lead to increased pill burden but contribute to increasing resistance at the community level. It is a vicious cycle, you use powerful antibiotic to kill a common cold, the next time a bacteria strikes, it is usually resistant to that antibiotic. So a more powerful antibiotic is necessary.
Some pharmaceuticals appoint an exclusive person to take care of two or three big shot consultants. They take care of them in everything – including doing mundane things like paying utility bills to helping the consultant in preparing for talks to arranging their travel needs (Both for conferences and personal – of course all expense borne by the company as a service to the doctor). These are usually seen in metros for super-specialists like cardiologist, urologist… They are so nice that they home deliver things like the latest movies for the spouse in the house. You feel you are indebted to them. The least you can do is help their company products. You scratch my back, i scratch yours even better.
Some companies are smarter. They do not spend money in making quality drugs (i even doubt there is any real drug in it. If you see, where they are manufactured, it will be one of the small streets in metros where you know there cannot be any reputable, big manufacturing company) but they offer business deal to the doctor – certain percentage of the total sale (As high as 40% of the maximum retail price). After you make a deal, where is the question of ethics, quality…These doctors earn more from the prescription they write than from consulting fees.
One thing that should be thought of by us (doctors) is, can’t we afford that cheap pen or TV or our tickets to a conference? If we were to get sick and go to a consultant who we know supports a company and if he writes one of those brands, would we believe his judgment – do we really need that drug or is it just a habit, that he wrote to us that all-powerful antibiotic.
Do we need these gifts to trap ourselves into unethical practice?