Bad Medicine


It’s no secret that I speak for pharmaceutics companies from time to time. There, I said it. I’m not embarrassed. Why should I be? It’s perfectly legal, and I am not contradicting my medical ethics. The truth is that I treat HIV+ patients, and the pharmaceutical companies that I speak on behalf of pay me to speak to other providers, patients and educators on my experience treating this disease. We have a contractual agreement that gets reported to the IRS. 

The other day, a pharmaceutical representative I have known for many years visited my office with his new manager. They waited patiently in my waiting room until I had a few moments to spare. I took them into my office. By the looks of their expressions, they had serious business to discuss.

“Dr. Spinelli,” he began. “I just want to let you know that in the coming months my company will have to disclose how much they pay physicians to speak.”

“Okay,” I said. “And…”

“That’s all.”

“Why are you being so weird about it?” I asked.

“Uh, no reason,” he hesitated, and then they looked at each other. “We just wanted you to know.”

Perhaps if this was ten or twenty years earlier my response would have been inappropriate. Back then doctors were treated very differently then they are now. Pharmaceutical companies were notorious for taking doctors away on “business” trips to the Bahamas or Whistler Mountain. They showered them with expensive gifts and sumptuous dinners. Then, of course, there were the quiet kickbacks paid to doctors for using their products and authoring papers to substantiate their studies. There were many odd exchanges between doctors and the pharmaceutical industry, but I don’t want you to think that all doctors back then were greedy. There were, and still are, many physicians who would not even accept a pen with a pharmaceutical logo on it, let alone a fancy dinner and fist full of cash.


When I first began practice 9 years ago, I was taken to dinner with my then boss and mentor. We were invited by an up and coming biotech company to a very posh restaurant. There we were met by another physician who brought his wife. Immediately they proceeded to order food for themselves and then extra meals to go, for their family waiting at home. Then while we sat there feasting on entrees that cost more than my weekly market bill, this physician ordered a different wine for each course. The visibly anxious rep excused herself at one point; and while she was in the restroom, this same doctor ordered a dessert wine that cost $500 a bottle.

“Drink up,” he sneered. “The drug she’s pedaling costs a few grand a month.”

He was disgusting, and I felt ashamed. “I’m not to be had for a cocktail,” I thought to myself. “Like some salted peanut.” No matter how bad things get, I promised that I would never be that kind of doctor. 

Currently, most pharmaceutical companies have agreed to follow the Pharma Guidelines, which impose strict restrictions on how much they can spend on doctors and educational programs. Dinners cannot exceed a modest price and no spouses are allowed. There are no more trips to the Bahamas or Whistler Mountain, and any trip from here on out is considered an advisory board or speaker training. That means doctors spend most of that time in a lecture hall listening to other doctors discuss studies presented at the latest HIV conferences. So you see I am not embarrassed by my contractual agreements with certain pharmaceutical companies. Speaking for them doesn’t mean it influences how I write prescriptions. In fact, it is the other way around. I speak only for the companies that make products that are useful for my patients. Most doctors I know would agree.

What bothers me more than anything about being brought to the back of my office by those pharmaceutical representatives was that I felt as though I was being taken to the principal’s office.

Why were they being so ominous? Do they know doctors that make so much money from pharmaceutical companies that they should feel embarrassed by public disclosure of their earnings? I think so. Sure there are doctors and pharmaceutical companies that “get into bed” with one another. But consider this: my good friend works for a large investment firm. They have a department, which acts as a concierge for clients and provides them with tickets to sporting events, theaters and restaurants. Taking clients out and showing them a good time is all part of their business. I understand that doctors are held to a higher moral ethic, but my time is worth money as well. Maybe doctors should adopt a contemporary view about their self worth. When you call a lawyer, his fee begins when he answers the phone. When you page your doctor at night, he receives no reimbursement for those calls he returns after office hours. So I understand the necessity for pharmaceutical guidelines. However, if medications didn’t cost quite so much in the first place, we wouldn’t need to concern ourselves about doctors’ corporate entanglements.


One Comment

  1. Larry Flick
    Posted February 15, 2009 at 3:09 pm | Permalink

    Absolutely fascinating. And brave of you to share this. I’m duly impressed… as I often am by you.

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