Drug Wars

It's war between the drug cartels (small fry need not apply). Drug pushers are sent out to the streets to ply their trade, and we're caught in the cross-fire. No, I've not migrated to some drug-lord infested South American nation. I simply work in a hospital.

The hospital, or for the matter any health institution is fertile ground for drug-pushing. I don't mean that in a bad way. Pharmaceuticals is a multi-million dollar industry, and understandably it's break-neck competitive. The prescribing policy of a hospital could mean a windfall for a particular company and bust for another. New drugs and old ones given new indications are pushed into our faces all the time. So how does one choose?

Life just keeps getting more and more complicated. Choices, choices, choices! From skin care to hair care to brand of cereal or fresh milk, I am swamped with choices. Consumer products are petty matters. With drugs, my choices can have a huge impact on patients' lives and health economics. So how do I choose?

All drugs being more or less equal in terms of efficacy, tolerability and cost, do I choose based on

• the strength of evidence of drug trials
  
• my consultant's prescribing preference
• the likeability of the pharma rep
• the agreeable appearance of the pharma rep
  
• the support from pharma company (i.e. sponsorship for CMEs, conferences, department, research grants)?

All of the above for me, to a certain extent, with the exception of the physical attributes of the salesperson (there are more comely young lasses than lads in the pharma industry anyway, so not very interested). Our prescribing practice usually mirrors that of our specialists and consultants in the early years, with some fine tuning along the way as we mature into experienced practitioners. Ultimately, most of us prescribe within the confines of consensus guidelines where they exist, and where cost is not prohibitive.

In the meantime, we enjoy the attention. Sales blitz is the latest marketing ploy, where reps sometimes dress and give out lunch packs or snacks according to theme. My favourite so far? Sushi packs, as sushi=fish and fish="mascot" for one 3rd generation cephalosporin. The most desperate? Secret Recipe cakes for energy to last you 24 hours, to remind us of a certain ARB's "24-hour protection".

We are not complaining.

*CME : continuous medical education; ARB : angiotensin receptor blocker

Disclaimer : Opinions expressed are entirely the author's and may not reflect the truth of the situation, and certainly do not represent the views of the doctors practising medicine in Malaysia.