The Hungry Physician
It seemed like a straightforward invitation. Dinner at an upscale uptown restaurant, sponsored by a drug company, where the topic was to be financial planning. "What's the harm in going?" I said to my wife, also a physician, born in Moscow, who had always wanted to try this cozy, hard-to-get-a-reservation French restaurant, and who was also interested in learning about prudent investments.
We arrived to find the place jammed with similar-minded doctors. We managed to squeeze into a side table where we were immediately tapped on the shoulder and warned that we were in the way of the projector. There was an abundance of wine at the table, and I quickly downed a glass of red while we waited eagerly for the appetizers. Instead, the projector started and we had to duck to avoid seeing our shadows on the screen.
It was soon apparent that the lecturer was a drug representative speaking not about finances but about the antidepressant his company was famous for. He presented sweeping graphs footnoted with multiple FDA approvals for multiple indications, but without mention of the significant side-effects, which include weight gain, stomach upset and sexual dysfunction. Smiling, healthy-looking people advertise this product frequently on television; who could guess that their sex lives were affected?
A psychiatrist I referred patients to had warned me that clinical experience was the guide to prescribing such medications, not the almost-automatic FDA approval. This psychiatrist had placed a large placard on his door to ward off the drug salesmen who dared to approach his office while he conducted his therapy sessions. "No Solicitation," the placard read.
"What happened to the financial adviser?" my wife whispered as the drug slide show continued. "What happened to the food?" I replied. Apparently, the lecturer was taking advantage of the fact that this large group of internists, money-starved by managed care, would be so eager to see the inside of a restaurant we could no longer afford that we would be willing to listen to a string of platitudes about a product as long as the talk led to the payoff of a tasty piece of fish.
Internists certainly see a lot of depressed and anxious patients, but we aren't in a position to know the nuances of the depression medications the way a good psychiatrist is--the way we know our blood pressure and cholesterol drugs. The lecturer clearly thought our inexperience made us more susceptible to his entreaties. In fact, drug companies are spending millions in advertising dollars these days having their salesmen preach to doctors about products that we could easily find out about from more reliable, more objective sources. Receiving favors in exchange for distorted information has a slippery, underhanded feel to it, especially when one considers that the real consumer, the patient, absorbs these costs in terms of the grossly inflated prices of medications.
At the dinner, the drug company seemed to hope that the wine and the brightly colored slides would create a memory cue in our minds, leading ultimately to prescriptions. But the hungrier among us were already becoming restless by the time the first lecturer was replaced by the main speaker of the evening. A dynamic investment banker in an expensive blue suit, he spoke not about clues to entrepreneurial planning, as my wife had hoped, but about the major drug stocks and how they made solid investments in the current slipping economy.
"Let's get out of here," my wife said, even as this speaker was in turn replaced--not by waiters bearing food but by yet another salesman distributing evaluation forms. "Let us know what you think of the presentations," he urged. I wrote on my form, "Too angry from waiting for the food to ever prescribe your medication again." I signed it "Bulgakov." Bulgakov, a dissident Russian doctor/novelist, had satirized the Soviet rulers.
We rose to leave even as the minuscule sea bass and the garden salad--supposed to be the first course--arrived together. "Have to go. Baby's coming," my wife muttered to the amazed drug reps who tried to stop us. Later, sitting in a nearby deli munching overstuffed sandwiches, we marveled at what we'd just experienced. "Some of those doctors are going to respond to that," I said. "They're happy just to be invited. They're going to prescribe the drug as a result."
"Not me," my wife said. "I'm depressed just thinking of that drug and the way it's marketed. I don't need salesmen to teach me about medicines. This sort of propaganda reminds me of Soviet Russia. And I'm never going to that restaurant again."
"We still haven't been to that restaurant," I said. "Maybe someday we'll actually get to try it."