In our discussion last week we explored corruption within the science community. As Hitler’s Nazi Germany is rightfully discussed, we touched on corruption within modern American medicine. It seems, within our group, there is a level of skepticism as to how a doctor these days can fall victim to corruption. After all, they each swear to the Hippocratic Oath (internet sources claim there are many different versions currently used by medical schools.)
According to the Food and Drug law journal, there are armies of non-medical salespeople preying on physicians. In the article I read from 2005, the number of pharmaceutical sales reps employed to influence doctors exceeded 100,000 or 1 for every 6 physicians in America. You may wonder how much they spend on those physicians. “The U.S. total for detailing expenditures, excluding all medicine samples, is nearly $ 5 billion a year.” 63 Food Drug L.J. 799, 804. This number reflects the amount spent on gifts and excludes the money spent on free drug samples.
The competition among the salespeople vying for face-time with doctors is fierce. After all, doctors are treating patients and any time away from that is money lost. So, the salespeople come with gift in hand. They bring practical gifts such as staplers, pens, and pill counters for general office use while some come with unsolicited money and equipment for the office—all in exchange for time to explain the benefits of their new medicine. 63 Food Drug L.J. 799, 802.
Some states enact legislation to prevent this type of influence. Drug companies counter with claims of “trade secrets” and “free speech” arguments. 63 Food Drug L.J. 799, 815. After all, we are a free enterprise system that allows actors within the system to let the market adjust itself, right? Only Nazis restrict free speech. No one is holding a gun to the doctor’s head and making her take the gifts, are they? Surely the medical profession as a whole will self-regulate.
The problem with self-regulation is that there are no clear and uniform standards. There are no uniform public reporting requirements. 63 Food Drug L.J. 799, 811. Everything is left to the doctors and pharmaceutical representatives to not violate whatever regulations there may be with no threat to the doctor’s license. Id. Doctors may not see the “implicit effects” of receiving the gifts while the sales people do not get paid to not see the doctor. 63 Food Drug L.J. 799, 821.
In conclusion, whether the influence on the doctor is by the stick (Hitler) or the carrot (pharmaceutical companies) doctors are subject to influence. In today’s market, the doctor writes a prescription based on influence. In Nazi Germany, the scientist performed research based on influence. This does not answer whether science is likely to repeat the darkness of the Nazi scientists, but it may alert us to a different type of influence that left unchecked may take a dark turn.