A physician/medical industrial ethos

P hysicians and medical industrial representatives (pharmaceutical, medical service, medical product, surgical instrument) are strange bedfellows. At one extreme, significant diagnostic and therapeutic contributions to the health care of patients have occurred consequent to the mutual cooperation between these two groups. Medical industry is a vigorous scientific and financial supporter of basic and applied research, a consideration of increased significance in the context of curtailed governmental research support. And at the other extreme, aggressive marketing programs by medical industrial representatives in an atmosphere of a free enterprise system can foster inappropriate and biased utilization of those products. Exemplary of these extremes, the dichotomy of which poses an ethical dilemma, is the relationship between physicians and pharmaceutical representatives. Physicians are constantly confronted with a corpus of rapidly expanding and evolving medical knowledge and with the availability of a plethora of pharmaceutical agents. In that context, continuing medical education is essential to physicians if they want to maintain their expertise. What role should pharmaceutical representatives, occasionally themselves licensed pharmacists, play in the provision of information regarding any specific product? The sale of pharmaceutical products is unique mainly because it is indirect. Pharmaceutical advertising campaigns for prescription compounds are rarely directed toward the consumer (patient), but rather toward the intermediate dispenser (physician). When pharmaceutical companies have directed advertising campaigns toward patients, physicians, governmental agencies, and consumer advo cacy groups have raised a vast hue-and-cry reaching even lay periodicals (Should prescription drugs be advertised to consumers? Consumer Reports 1984; 49; 392-393). How should physicians respond to solicitation by pharmaceutical representatives in the form of “curb side” consultations, “free samples,” professional journal advertising, and invitations to attend and participate in pharmaceutical company-sponsored symposia? How impartial and unbiased are any of these modes of interaction? In answer to the questions just posed, it is imperative for physicians to adopt and employ critical analytic skills when evaluating medical industrial products. Adaptation of a scientific methodologic approach to analyses of refereed journal articles, balanced seminars, and personal empiric observations is essential if the health care needs of patients are to be best served. Medical school educators bear significant responsibility in this regard in fostering, demanding, and exemplifying the use of critical analytic techniques, mitigating partial and biased solicitations. It would be naive for physicians to presume that they are immune to the blandishments of “free” samples, books, meals, trips, symposia, et cetera. Equally naive is the view that medical ir&strial representatives are always pernicious and biased, representing a monolithic enterprise motivated solely for profit. Somewhere be tween the quixotic joust against windmills and an uncritical quotidian embrace lies the ethically responsible and appropriate course for a sentient physician.