A great article in the British Medical Journal, “Doctors Must Not Be Lapdogs to Drug Firms,” gives great examples of how drug companies get doctors to prescribe their company’s drugs. Andrea Fugh-Berman’s article recounts how drug companies boycotted a medical conference after she gave a presentation to doctors about drug company marketing tactics.

Forget for a minute (if that’s possible) about drug ads on TV. The drug industry actually spends far more marketing to doctors than it does to consumers. Those dollars go for hiring sales reps to call on doctors and for “educational” seminars for doctors to learn about a company’s drugs. Fugh-Berman’s article explains:

Corporate support of continuing medical education courses, meals, and treats are not merely our just rewards for being hardworking, dedicated doctors. The illusion that the relationship between medicine and the drug industry is collegial, professional, and personal is carefully maintained by the drug industry, which actually views all transactions with physicians in finely calculated financial terms. Drug representatives are paid to be nice to us, as long as we cooperate, sustaining our market share of targeted drugs and limiting our continuing medical education lectures to messages that increase drug sales. This is an unspoken agreement, but no less clear for being covert.

The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies. Any subject with the potential to reduce drug sales is anathema. Fair enough. He who pays the piper calls the tune. If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation.

Fugh-Berman’s article generated a flurry of responses from doctors around the world. One U.S. doctor dismissed the article’s concerns, saying the issue of drug companies influencing doctors was “an imaginary problem.” But a doctor from Australia countered that “the main barrier to progress is doctor’s denial that we are often adversely influenced by drug promotion.” Maybe it’s too bad the drug industry can’t make a pill to treat denial.