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From: B. Harris)
Subject: Re: Pitching pills: How drug salesmen influence doctors, patients
Date: 4 Feb 2000 03:11:00 GMT

In <87baii$q1j$> "John"
<> writes:

>accept a gift, but only 46 percent found it improper for them to accept
>the same gift from a drug company. The frequency of the freebies tends to
>subside as the students enter private practice, yet the impact remains
>real. Exposure to the sales pitches reduced by as much as 66 percent the
>chances of the doctor prescribing the generic equivalent rather than the
>drug company's name-brand product. Accepting free travel to a conference
>resulted in a 4.5- to 10-fold increase in the prescribing rate of the
>salesmen's drugs. Even free samples of a drug can increase prescriptions
>by a third. Add to this troubling relationship the wave of direct
>advertising to consumers. Another recent JAMA study estimated that as
>many as 12.1 million Americans received a drug prescription as a direct
>result of seeing an advertisement. All told, the drug industry spends an
>estimated $11 billion a year promoting and marketing its products.
>Product promotion is part of the background noise in a free-market,
>free-speech society. What is striking about marketing campaigns within
>medicine is how effective they are in altering decisions that many
>mistakenly believe are based strictly on science. If doctors and
>consumers pay more attention to how prone they are to manipulation, pill
>promotions can be swallowed in their appropriate context.

   What makes you think that?  Your last sentence appears only to be a
statement of faith, made without evidence, so that you can avoid the
natural conclusion that medical advertising to doctor and patient
should be outlawed.  Which you'd have a hard time defending, given the
nature of free speech and even commercial speech. Sorry, but the world
doesn't work that way.

   Commercial speech in medical applications is already more highly
regulated than commercial speech in any other sphere of human endevor.
And that's not simply for safety reasons.  Commercial speech in medical
matters is more highly regulated than commercial speech (ie
advertising) on behalf of firearms, aircraft, rock-climbing gear,
sports cars-- you name it.

   By law, until very recently, drug company reps have been prohibited
from making any claim not approved by the FDA, or passing on any
information about a drug not so approved.  The same is true for
drug company advertising to the public.  Recently, drug companies have
been allowed to copy articles in the scientific literature to give to
doctors.  That last was a major battle.

  I'm always amused that the attacks on drug company advertising seem
to come from the same people who complain because doctors don't know
enough about alternative medicine, due to the fact that the FDA and the
government interfere with the advertising efforts of people who sell
herbs, vitamins, and various disease treatments and preventative
preparations, scientifically backed and not. My answer to this is that
sauce for the goose is sauce for the gander. You need to decide whether
society is going to permit this kind of thing or not.  If it is, it is.
Whether the product is a new drug, and old drug, a vitamin, or a new
"magnetic therapy machine," the same scientific standards need to apply
in our judgement of it.  The only question after that, is what kind of
scientific epistemological standards the law needs to enforce.

   For those who answer the last question "none," you need to think
about this a bit more.  A society does not work without laws against
theft, and fraud is merely a kind of theft. If I sell you a bottle of
"whiskey" that contains only colored water, or methanol, there needs to
be a law which stops me.  But the question of whether or not a label
lies, is a scientific one.  It happens to be one on which every
reasonable person would agree, in the case I mentioned.  But the
questions get harder and harder from there, and at some point you begin
to get argument, and discent.  A line must be drawn in law at some
point, and the question is where.  For questions like this in which
there are no clear boundaries, no universally satisfactory answer

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