I recently attended my first fancy dinner that was paid for by a pharmaceutical company. Before the dinner, I reminded myself that I was walking into an infomercial. When health care providers are treated to a free meal at an upscale restaurant, it’s because drug reps are going to talk to them about a new pill or product the company is trying to sell. I was determined not to trust anything said any more than I’d trust the claims of those hilarious late-night “male enhancement” commercials that come on after "elimiDATE." I wasn’t in the restaurant longer than 30 seconds before a waiter deposited a glass of Pinot Noir in my surprised little hand. I suddenly thought of a T-shirt I had seen on some grunting guy at the gym: “Drunk girls think I’m hot."This came to me again midway through the dinner, as the waiter filled my wine glass for the third time. Of course it occurred to me that the pharmaceutical company was making me tipsy so that I’d take its new drug home to bed with me. I tried to focus my attention on the presentation, an “educational” talk on a hot pharmaceutical product. The speaker—a pharmacist and professor at a major academic institution—was extolling the virtues of his new drug’s safety profile. As he spoke, presenting graph after graph on the overhead projector, I nodded my head appreciatively, admiring the product’s 50 percent reduction in adverse events as compared to its competitor. Apparently, this excellent safety profile was achieved without sacrificing any of the drug’s effectiveness. Statistics can’t lie, right?The room was starting to wobble a little for me, perhaps because of the currant bouquet, perhaps because of my moronic nodding.Some inebriated people get angry or sleepy, but I happen to be an amorous drunk. I will think you’re hot, so long as you’re not wearing some sort of idiotic T-shirt at the gym. True to form, I had gone into the dinner with my skeptical spectacles on; but like a Girls Gone Wild co-ed who peels off her wet spaghetti-strap top once the cameras arrive, I shed my judgment and traded it in for a pair of beer goggles. The cold, dead spot in my heart I have specially reserved for Big Pharma was warming. I started to question whether I had been too severe with the drug giants in the past. In retrospect, it was arrogant of me to think that I was above the influence of tried-and-true pharmaceutical marketing practices. But my former feeling of immunity to commercial bias isn’t uncommon in health care. In her book Our Daily Meds , former New York Times reporter Melody Petersen warns, “Most doctors believe a gift can’t sway their judgment, that they are somehow different than everyone else. Study after study has shown they are wrong.”Doctors and other providers who prescribe medications aren’t the only ones who fall prey to pharmaceutical marketing. Nurses like me can also become targets, since we influence prescribing practices. A 2010 study—Nurses’ Reported Influence on the Prescription and Use of Medication—out of New Zealand found nurses often recommend the therapies physicians prescribe.Petersen argues that excessive pharmaceutical marketing leads to overprescribing and inappropriate prescribing, which escalates the cost of medicine. It also reinforces the cultural message that a pill—rather than lifestyle modifications or larger social, political and cultural change—can cure our ills. Medication excess harms the environment by contaminating the water and soil with drug metabolites that have been excreted by the bodies of the countless Americans taking prescriptions. A large human toll occurs, too, in the form of unnecessary illness and death due to antibiotic resistance, drug-related automobile accidents and adverse events like falls or heart attacks.Still, free drinks and dinner seem downright innocent compared to some of the more aggressive pharmaceutical marketing practices out there, such as paying academics to author studies or marketing drugs for uses other than what they were tested for. A 2010 report called Confronting Conflict: Addressing Institutional Conflicts of Interest in Academic Medical Centers in the American Journal of Law & Medicine argues that financial ties between academic institutions and pharmaceutical companies are among the most worrisome aspects of the medical system today. The article says these ties represent major institutional conflicts of interest. Academic institutions must remain unbiased in order to provide safe patient care, produce accurate research and educate students. Objectivity is not possible when academic centers rely financially on pharmaceutical companies.The potential harms of these conflicts of interest are not just theoretical. The report argues these conflicts of interest have resulted in patient deaths. The authors recommend regulating interactions between academia and private industry. There is no doubt that drugs save lives. But drugs can only save lives if they are prescribed correctly. In my delightfully boozy state at the pharmaceutical-sponsored dinner, I was in no position to apply lipstick appropriately, much less make choices about how I will care for living, breathing human beings in the future.
Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.Whitny Doyle is a family nurse practitioner grad student.
