40-a-day

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.

Patrick Clinton

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 them.

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 of marketing.

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 www.pharmexec.com to sign up.

Patrick Clinton is Pharmaceutical Executive's editor-in-chief and can be reached at pclinton@advanstar.com