Prescription for a free lunch

A diligent researcher has estimated that the average GP in this country receives 56,000 pages of advertising material from pharmaceutical companies every year through the post. Since this is only an estimate (in fact, an extrapolation from a count of pages received over a period of four months), the true figure might be only 42,000; on the other hand, it might be 70,000. It seems hardly to matter.

I should like to be able to say that none of this material has any effect whatever upon the prescribing habits of doctors: that each and every prescription was the outcome of a purely rational decision based solely upon the patient's diagnosis and a scientific consideration of the relative advantages and disadvantages of the various possible drugs.

As we know, however, many extraneous considerations come into prescribing decisions. For example, prescriptions for psychotropic medication - antidepressants, tranquillisers and so forth - are handed out to young men in our inner cities not because the drugs will do them any good, but because they want them, and their doctors are afraid of them. A little bit of what they fancy is the easiest way to get them out of the surgery. And fear is a great prescriber.

As for advertising, we doctors are surrounded by it. It seeps into our lives like damp into walls. Although I do not see company representatives and throw all promotional material straight into the bin, I find that on my desk on which I write this there is a stand for pencils advertising an antidepressant, a clock advertising another antidepressant, two pens advertising respectively an antibiotic and a drug for dementia, and a memo pad advertising Viagra. I have never prescribed Viagra and quite possibly never will; but if I ever have to, it is most unlikely that I shall have forgotten its name. What, then, is the little memo pad for?

More important, how did it get there? I have never seen a representative of the company that manufactures this drug. Do drug companies employ itinerant people to scatter promotional material in the dead of night? It puts me in mind of evangelists who used to leave leaflets in trains, in the days when carriages had compartments.

Almost all medical meetings are now sponsored by drug companies. The very sandwiches (or quiches) one eats at them are paid for by these firms. It must be admitted that the quality of the catering has improved immensely since the companies took over from the NHS, which (I am convinced) once had a secret underground facility for making sandwiches for every hospital in the country, since all NHS sandwiches were exactly the same. But is it right that as we prescribe, we should be accumulating quiche for the future?

As a hospital doctor, I am sometimes offered trips to meetings abroad, all expenses paid. Once - but only once - I succumbed to our national obsession with getting something for nothing; it is curious, is it not, how even quite prosperous and well-fed people are willing to make considerable efforts to obtain a free meal of only moderate quality?

I discovered on my trip that there were doctors whose proud boast it was that they had been around the world without having spent a single penny of their own money. They greeted one another with questions such as "Did you go to Prague?" or "I missed Venice, what was it like?" They were completely mystified when I decided to go out to dinner with some acquaintances in the city to which I had travelled, a dinner for which I should have to pay myself; for what was the point of going on a drug company trip if you ended up paying anything for yourself? They even sent a bill to the drug company for their taxis to the airport. And they ate and drank for the same reason that people first climbed Mount Everest: because it was there.

I can't even remember now what drug it was that the companies were promoting in that far-off luxury hotel. The lectures about it were deadly dull and held in an overheated conference hall in which most people went to sleep, dreaming of the next table d'hte.

I vowed never to go on such an outing again: and, most unusually, I have stuck to my resolution. If I really want to go to Rio or Florence, I'll pay for myself. And needless to say, I am not in the least influenced in my prescribing by any promotional material whatever: though just now and again, on those rare occasions when I am stuck for an answer, I cast my eye around my desk for inspiration.

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