Pharma journalist Matt Herper, who’s generally quite savvy about these issues, argues on his Forbes blog that little things like free meals and modest speaking fees don’t really influence doctors. He says that as a journalist he avoids quoting physicians who receive tens or hundreds of thousand of dollars from industry, but small payments don’t bother him. Pharma may no longer give out free pens like in the old days but marketing will never go away. Get over it and get used to it, he argues.
But I think he misses an important point here. For many people, small things like pens or meals are a litmus test: if you’re against them then you’re an acidic pharamscold, wasting your time on the most trivial of matters; if you’re ok with them then you’re a base defender of industry.
Admittedly, there is something silly about the whole pen discussion. I certainly don’t believe that any decent doctor is going to change his or her prescribing practices because of one free pen. And that’s often the way the discussion gets framed. Doctors say that they are insulted by these sort of accusations.
But let’s face it, pens are just the entry-level drug in industry’s armamentarium, the first step of the slippery slope.
There are key chains, hotel key cards, bus head rests, free meals, journal ads, promotional talks, and websites. There are advisory panels and public relations campaigns and publication programs. And then there’s financial support for CME programs, academic medical organizations, and patient and disease advocacy groups. All these activities, and many more I haven’t mentioned, have a cumulative and nearly overwhelming effect.
Let’s ignore for a moment the studies that have demonstrated the potent effects of advertising and marketing, even in sophisticated populations like doctors. Let’s also forget that it is nearly impossible for any individual to detect the unconscious influence of advertising and marketing on his or her own thought process.
Because here’s the question I want to ask those people who blithely dismiss the free pen issue: if the pens and meals really are worthless and have no effect, then why spend so much time and effort defending them? In other words, if the best argument in defense of these things is that they simply have no effect, why even try to justify them? If only to avoid the appearance of conflict, why not get rid of such a potent symbol?