I had lunch the other day with an old friend, Julie, a pediatrician from the Midwest, who'd come to Manhattan to see a few
shows and take a break from her practice. She deserves one. She's got a tough job: 40 patients a day, almost all of them on
Medicaid, and almost all with multiple problems—physical, mental, educational, financial, legal, and behavioral.
Julie doesn't have much contact with drug companies. She's forced to use mostly generics, and because she's got a pediatrician's
inbred conservatism, that doesn't bother her much. She wouldn't mind being able to use samples, but her employer requires
so much paperwork that she mostly can't. She's not hostile toward pharma companies; she just doesn't have much to do with
Still, there was one episode that had her fuming, even though it happened a couple of years ago. Patients who were taking
a particular brand-name drug started showing up at the office, and their parents wanted to talk about a letter they'd received
from the manufacturer. I haven't seen the letter myself, but the parents apparently took away a pretty consistent message:
Their child's doctor had asked the company to get in touch with them to make sure they came in to get their child's prescription
switched to a new extended-release version of the drug.
Needless to say, Julie had done nothing of the kind. She spent weeks explaining to parents that she didn't want them to switch,
and that, no, she wasn't withholding a better medicine from them. For a 40-a-day doc with a big population of non–English-speakers,
it was a nightmare. Worse, it undermined patient-physician trust in a setting where trust is unusually important.
Julie complained to the company, the state, her colleagues—and eventually to me. She banned the company's rep from her office,
and now she avoids prescribing the product when she has a choice. What else could she do?
And what could you do? Depending on your perspective, the story illustrates a lot of different points. To Julie, it shows
that one particular company is inhabited by unbelievable jerks. To a critic of the industry, it could be evidence of the evils
Here's my own take: Poverty, lack of education, and disease are just as much a single syndrome as diabetes and heart disease.
With patients who suffer from the trio, it is incredibly easy to do damage through a marketing tactic that might be acceptable
for another group. It's not that they'll be tricked into taking an unnecessary drug. Their lack of health coverage will prevent
that. But they'll lose something in the relationship with their physician that they desperately need. And you don't want to
be responsible for that.
I confess, my opinion is shaped by my regard for Julie. She's one of those people who have a vision of what medicine ought
to be and put their souls into it. She could easily work with patients whose problems are mild and whose insurance coverage
is good. But she doesn't want to. Instead, she goes on fighting the good fight. She works in a segment of healthcare that
is broken, and she does her part to hold it together. You don't have to thank her, but don't make her job any harder than
it is. Like the fellow said, first do no harm.
I'm pleased to announce the launch of Pharm Exec Direct, our new newsletter. I'm sure your inbox is already crowded with services that link you to the day's pharma headlines and
press releases. We've decided to offer our own reporting and analysis on a select handful of stories, with the same sort of
tight focus on your needs that we try to provide in the magazine. Many of you have already received the first edition by e-mail.
If you haven't and would like to see a sample, please go to
http://www.pharmexec.com/ to sign up.
Patrick Clinton is Pharmaceutical Executive's editor-in-chief and can be reached at firstname.lastname@example.org