On the last day of the passing year the New York Times published a front-page feature on PhRMA's recent policy to discourage giving swag to doctors: "No Mug? Drug Makers Cut Out Goodies for Doctors".
While many people welcomed this policy I was quite appalled by how easily did PhRMA cave to interest-group pressure, instead of taking a principled stand for healthcare communications. I understand PhRMA has many irons on fire and has to pick its battles. Unfortunately, their decision lends credence to some really rotten arguments used by the supporters of the ban. Someone has to speak up!
So where is the hypocrisy in healthcare marketing restrictions?
The idea that healthcare marketing must be severely restricted, with banning gifts to physicians being just one example, is based on several premises. These premises keep getting cited by the proponents in various forms. Here is my summary of "Top 3" myths and explanation of what is wrong with that line of thinking:
Myth #1: Paid marketing always causes improper influence
I am not going to argue that the goal of any marketing campaign (swag, TV spots, Internet media, etc) is to influence the recipient of the message. The question to ask is what constitutes proper vs. improper influence and why. Of course truly misleading and deceptive practices are indeed a problem. But if a pen or a cup is there to simply *remind* the doctor about that particular brand available, what is wrong with this if the prescribing decision is still made on merits of patient's case? Drug companies make for convenient scapegoats and are far too easy to attack. What we have not seen are *any* credible studies directly linking swag to unsafe prescriptions and demonstrating which marketing tactics are at fault.
Myth #2: Unpaid communication is free of improper influences
The real scandal is that media obsession with little things like cups and pens distracts attention from the real problem: influences are everywhere. Everyone is always influencing everyone else. Physicians interacting with physicians. Patients talking among themselves. Patients-to-physicians and vice versa. Medical journals. Pharma sponsored CMEs. Grants to medical schools. Academic careers staked on this or that concept. Everyone has an agenda and there are far more powerful motivators to do something wrong, that little trinkets. Social and professional pressures could be way stronger than monetary and shifting blame to marketing is an easy cop-out to avoid confronting the real influences.
Myth #3: Marketing is unnecessary and never mixes with health
Newsflash - we are all marketers! When a medical researcher is trying to get a paper published, she is marketing to the journal. When a physician is trying to get patients to comply with his recommended treatment, he is marketing his reputation and education to the patient. When a patient is trying to get a prescription, based on his feedback from a support group, she is marketing her view of her condition to the doctor. We try to influence people around us daily and there is nothing wrong with that. The only difference with *paid* marketing is using money to expand the reach and effectiveness of the message. There is nothing wrong with that as long as the message itself is not improper or deceptive.
The efforts to banish marketing from healthcare remind me of the continuous crusades to get money out of politics. This is a hypocritical game played for the sake of appearances, producing few tangible results and always causing the money and influence to find some other channel to flow through, just like the laws that "prevent members of congress to have lunch with lobbyists sitting down, but they can still have lunch standing up". I find much more honest and truthful the views of California's legendary Assembly Speaker, Jesse Unruh, famous for some colorful quotes about the politics and lobbying:
On money: Money is the mother's milk of politics
On lobbyists: If you can't drink their whiskey, take their money, sleep with their women and still vote against them in the morning, you don't belong in politics
The last quote could easily apply to physicians and drug companies. Physicians who protest the bans on swag rightfully point out that suggestions that they cannot resist influence of a $1 pen imply complete lack of backbone and medical judgement. On the other hand, consider how the *same* kind of influence can flow through "social" or "commercial" channels with dramatically different perception:
About time we confront the hypocrisy head-on. To support the cause, I created a Facebook page and encourage you to join as a fan.