Edward Davies: Pharma is changing. Can doctors say the same?

Edward DaviesAbout 13 years ago I attended my first US mega meeting of doctors. I was there for a research agency, working on behalf of a large well known pharmaceutical company, analysing their marketing campaign for a new drug.

From the moment I got off the plane, I was slapped into brutal submission by the advertising of this drug. My first hit came in the form of an advert as big as a house in the arrivals lounge of the airport, from where I got on a bus with the drug name emblazoned on the side in 10 foot high letters, on which I sat in a seat with a headrest sponsored by the drug, and drove through the city streets admiring the flags announcing the drug to passers-by.

On arrival at the conference centre, I went to the registration desk, and was given my conference bag with the drug logo on it, full of information about the drug, just next to the exhibition hall which had a 30 foot high stand at the front, advertising the drug, which contained a small theatre showing regular performances of a play, which featured, in the lead role, as absurd as it sounds, the drug.

I was to be interviewing doctors from a small stand in the corner of the exhibition hall and as I made my way through I could see crowds of delegates admiring the Belgian Chocolatier on one side, and the circus performers on another. After finding my own stall I was curious to find a queue of doctors some 50 yards long for the presentation next to us. It turns out the company was offering a guided tour of its stand with a branded personal cassette player, and at the end of your tour you could keep the cassette player (for this was the dawn of personal CD players, let alone MP3s).

The day was filled with an array of frivolity and freebies until about 5pm when all the stands turned speakeasy and in exchange for a business card or kind word, you could drink the evening away in a haze of jolly champagne parties. And people did.

Fast forward 13 years and I arrived at the American Society of Clinical Oncology in Chicago last week. One of these mega-meetings. The pharma presence is still here, but it’s very different. There was an advertisement at the airport, but far less prominent, and one or two pharma-sponsored car firms holding signs for delegates in the arrival hall, but no sponsored bus and no branded headrests. There were a handful of banners and bus stop signs as we drove closer to the conference center, but my conference bag was shorn of showy sponsorship and the fancy plays and freebies were long gone.

And yet as I took a tour of the exhibition area, the crowds of doctors were still there in force. Regulations stipulate far less enticing fayre these days, but you could still get a small ice cream or cupcake and the longest queues at the conference were to be found at the stands where a doctor could pick up a free latte from a coffee “barrista” mid morning.

I couldn’t get a free cassette player, but a free memory stick with preloaded information wasn’t out of the question and nor were the bits of stationary I now have on my desk.

We at the BMJ are swift to put the boot into pharma when the relationship with doctors goes awry. But are we as good at asking the same questions of the doctors (and indeed myself) when we know full well that they can be influenced by even very small gifts?

It’s easy to blame industry for questionable relationships that have occurred and do occur between medics and business, but it takes two to tango. By a combination of choice, economy, necessity, force, and the law, the attitude and behaviour of pharma companies in this relationship is gradually changing. Can doctors say the same thing?

Edward Davies is US news and features editor, BMJ.