Representatives of equipment, drugs and device companies have always requested appointments to meet with doctors to display their wares. They come equipped with glossy brochures and the company line for their new products. Within the public hospital system it is difficult, but not impossible, to change the usually supplied products but in private the decision is almost exclusively in the hands of the doctor managing the treatment or surgery.
Surgeons have always stated their preference is not influenced by the gender of the sales representative, the number of pens or notepads supplied or the educational dinners held. If this was true then the altruism of the companies would be difficult to explain to the shareholders. At a recent national meeting of the medical device industry, when asked if they had any experience of unreasonable demands being placed on representatives by doctors, almost all raised their hands.
Marketing of products is something we all live with on a daily basis. Food, holidays and cars are but a few examples, but in these situations we are also the purchasers. In the medical industry the doctors authorise the purchase but the patient, insurer or government pays.
Most doctors would like to practise ethically uninfluenced by marketing pressures. They need to be kept informed. Representatives visiting, discussing and debating new products is appropriate. Educational meetings after hours with appropriate modest catering seems reasonable. Cheap or expensive giveaways are probably inappropriate.
For years clinicians have been asking for more resources to research, evaluate and record the outcome of new interventions. Companies have cried poor. No wonder, if lavish trips and dinners have been provided by their marketing departments. Perhaps this expenditure could be redirected to legitimate trials of their products rather than overseas testimonials.
Learned societies, hospital meetings and medical trainees all benefit from the resources of the medical device and drug industry. Provided this support is accounted for, acknowledged and focused it brings together the shared aims of education and evaluation. Without their involvement, overseas experts could not be invited, registration fees become prohibitive and the risk of staging meetings is beyond most organisations’ financial capacity. We need and expect well-informed doctors with ongoing education occurring.
Some years ago it was alleged that a surgeon asked for support of $8000 to attend an overseas conference. The company approached recognised he was one of their busiest surgeons, generating in excess of $30,000 a week in implant sales, and offered him $8000 not to go to the meeting. These days have hopefully long gone and a new era of ethical behaviour from doctors and industry has arrived.
The Royal Australasian College of Surgeons has recently provided a code of conduct for dealing with the medical industry. This has filled a void in producing guidance to surgeons on appropriate behaviour and the industry on what behaviours they should expect of surgeons. It remains to be seen if both parties will play their part. The vast majority do and the others will eventually realise the landscape has changed to the benefit of patients, payers and the Australian health system.
Get Crikey FREE to your inbox every weekday morning with the Crikey Worm.
*Guy Maddern is professor of surgery at the University of Adelaide. St Anywhere is fictitious, but the events and issues are real