February 16, 2005

Educating doctors

Dr. Centor responds, more graciously than I would have, to an email defending drug reps.

The substance of the emailer's argument is that without drug salesmen to help doctors stay up-to-date, physicians would be incapable of keeping abreast of the latest drug information.

Technically, the drug reps are right when they claim to be educating physicians. This is exactly why they ought to get the heave-ho. If they were merely selling, and not educating, they'd be much less dangerous. Education is powerful stuff, but it's not always a good thing.

We like to think of education as an unvarnished good, because we confuse education with the mere acquisition of knowledge. Education certainly includes the acquisition of new facts, but it also involves ranking these facts, using these facts, and identifying which of these facts are more important than others. All of this involves judgment, which is in turn dependent upon values.

This is why education is valuable, and why it's dangerous. We trust people who have been educated in medical school and residency to practice medicine not merely because they've learned some facts and skills about anatomy and physiology, but also because they've learned to make judgments about these facts and skills that are consistent with the values we believe a physician should have. We would not say that an equally knowledgeable person who was taught his medicine in a school of Exquisitely Slow and Creative Torture had been educated to be a doctor.

If this is true, and if it's true that drug reps really are educating physicians, is this a good thing? Do we want our physicians taught by representatives of Big Pharma? Do we think this kind of education is best for our patients? Big Pharma teaches facts about drugs, but as Dr. Centor suggests, they also teach other things: the newer drug is better; any drug is usually better than no drug; most patient complaints should result in a drug prescription. These aren't necessarily the values of a good physician.

If it's true, as Dr. Centor claims, that our current system of CME isn't working, he's also correct that the solutions should come from the state medical societies and the medical schools. Not the drug reps.

Posted by Carey at February 16, 2005 09:48 AM

A somewhat separate question is whether keeping abreast of the latest drugs is really good for patients. It's certainly good for the pharmaceutical companies, but you imagine that if it was really super-awesome for patients there'd be a built in incentive for the doctors.

Posted by: Heidi at February 16, 2005 02:27 PM

I have to respectfully disagree with you on this one. I have a close friend who is a drug rep. She is EXTREMELY knowledgeable about the drugs she sells--and she works very hard at keeping up to date. She doesn't try to educated from the medical standpoint--but from the pharmacological standpoint--about which she may know more than some physicians. The physician takes this knowledge and filters it through is medical experience.

As attorneys, we are constantly being educated by non-lawyers about aspects of our cases. I really see no difference.

Posted by: Jerri Lynn Ward at February 18, 2005 03:10 PM

Jerri Lynn Ward: I'm not arguing that drug reps don't have a lot of valuable information, or that they don't educate physicians.

In fact, I'm explicitly arguing that they do educate docs. That's why they're dangerous.

I'm also not arguing that there's any difference between non-physicians educating docs, and non-attorneys educating lawyers. Of course this happens, and of course it's often very valuable. Clinical pharmacologists, for example, should accompany physicians on rounds because they do make valuable contributions to patient care. They often know more about drugs than the docs do.

Here's the difference: a pharmacologist on rounds, presumably, is trying to improve patient care by providing helpful drug information. A drug rep in a doctor's office is trying, above all else, to influence the physician's prescribing behavior in a way that benefits her drug firm's bottom line.

If you'd like to argue that the conflict of interest in this latter scenario isn't dangerous for patients, or that doctors shouldn't shun drug reps because their teachings improve patient care more than they harm it, then state your case.

Otherwise, I'm afraid your comments aren't germane to the issues I raise in my post.

Posted by: Carey at February 18, 2005 03:52 PM

JLW: if we, as attorneys, got our education about cases from people who had an interest in the case that didn't coincide with our client's interest, we'd be guilty of an ethical breach.

Posted by: Heidi at February 18, 2005 07:01 PM

My argument is that the "education" provided by drug reps--like my friend--is of some value to the physician--if properly filtered and weighed by that physician. I thought that you were arguing that such "education" is dangerous and not valuable at all. Did I misunderstand?

Reps like my friend convey the known facts about a particular drug (cancer drugs in her case) their employer sells. Of course, there is a conflict because she'd like to sell the drug. That doesn't mean that the facts she conveys are not of some value.

One thing that I think should be considered is that a physician is a sophisticated consumer. He is capable of weighing the information given him by the drug rep and to make choices based on that information, his training and his own independent research.(which I hope he is doing) I certainly don't think that the physician should rely solely on the information given him by the rep. But it is certainly a place to start.

I would equate this to attorneys consulting an expert when preparing a case. The attorney has a duty to screen and check the opinions of the expert--and to fit it into the legal framework of the case--but the information is still valuable even though the expert is not an attorney.

My experience with my friend convinces me that drug reps are not like your run of the mill salesmen. I know that she is extremely informed about the details of the studies on her line of drugs. Often, she will schedule little seminars for the doctors that include speeches by other doctors and pharmocologists.

Assuming that the physicians are being diligent in their consideration of the information conveyed by reps like my friend, my opinion is that the risk you accurately point out is outweighed by the value of the information conveyed by the drug rep.

Posted by: Jerri Lynn Ward at February 18, 2005 07:38 PM

There's nothing wrong with education, per se, as you describe it. How about some pamphlets? An hour long seminar in a classroom with an overhead? It's just sort of weird that the drug reps "education" includes -- say -- a really expensive CD alarm clock with information about Zoloft imprinted on the bottom. Or a seminar describing the uses of Lipitor, held in a four star hotel in Hawaii.

Indeed, drug reps are not run of the mill salesman.

If the attorney consulted with an "expert" who had an interest other than the client, and the "expert" paid the attorney, rather than vice versa, there would be hell to pay for the attorney.

Posted by: Heidi at February 19, 2005 08:13 AM