A Atlantic Monthly de abril traz o artigo The Drug Pushers, por Carl Elliot. O autor expõe as táticas usadas pelos representantes farmacêuticos para influenciar médicos, a troca de presentes por receitas, os médicos que são pagos para "educarem" outros médicos, e como estas relações comerciais afetam o cuidado do pacientes.
I have heard reps talk about scoring sports tickets for their favorite doctors, buying televisions for waiting rooms, and arranging junkets to tropical resorts. (…) A former rep told me about a colleague who somehow managed to persuade a pharmacist to let him secretly write the prescribing protocol for antibiotic use at a local hospital. (…) Carbona arranged a $35,000 “unrestricted educational grant” for a doctor who wanted a swimming pool in his back yard. (…) When Oldani found a pharmacist who liked to play the market, he gave him stock options. When he wanted to see a resistant oncologist, he talked to the doctor’s nurse and then gave the oncologist a $100 bottle of his favorite cognac. Reidy put the point nicely when he told me, “You are absolutely buying love.”
As farmacêuticas também criaram mecanismos para que os médicos façam aquilo que os representantes são proibidos de fazer:
The case of Neurontin is especially instructive. In 1996 a whistle-blower named David Franklin, a medical-science liaison with Parke-Davis (now a division of Pfizer), filed suit against the company over its off-label promotion of this drug. Neurontin was approved for the treatment of epilepsy, but according to the lawsuit, Parke-Davis was promoting it for other conditions—including bipolar disorder, migraines, and restless legs syndrome—for which there was little or no scientific evidence that it worked. To do so the company employed a variety of schemes, most involving a combination of rep ingenuity and payments to doctors. Some doctors signed ghostwritten journal articles. One received more than $300,000 to speak about Neurontin at conferences. Others were paid just to listen. Simply having some of your thought leaders in attendance at a meeting is valuable, Kathleen Slattery-Moschkau explains, because they will often bring up off-label uses of a drug without having to be prompted. “You can’t get a better selling situation than that,” she says. In such circumstances all she had to do was pour the wine and make sure everyone was happy.
Naturalmente, nem todo médico é nojento, e o artigo descreve como outros médicos resistem às constantes tentativas de suborno. Mas a transição de paciente para consumidor de serviços de saúde, e de médico para provedor de serviço, é pervasiva.
Many doctors seem resigned to this shift. They see themselves as a beleaguered group whose lives are made miserable by third-party payers, personal-injury attorneys, and hospital bureaucrats. Whatever idealism they may have had about the practice of medicine is being pushed aside by the concrete realities of hustling in the new medical marketplace. Many academic physicians seem cowed by the power of the drug companies, upon whom some depend for research funding. For some, it’s not so much a question of whether medicine has become a business as what kind of business it has become. When I talked recently to a gastroenterologist at an Ivy League medical school about his work as a thought leader for a variety of drug companies, he shrugged and said, “Better a whore than a concubine.”