“Drug Makers Cut Out Goodies for Doctors” and “Drugmakers Pulling Plug on Free Pens, Mugs & Pads” read headlines in The New York Times and The Wall Street Journal Health Blog at the end of 2008 after, in a very public act of contrition, 38 members of the pharmaceutical industry vowed to cease bestowing on prescribing physicians goodies such as pens, mugs, and other tchotchkes branded with their names. Some physicians and ethicists had long expressed concern about the “relationship of reciprocity” that even a pizza or cheap mug can establish between doctors and drugmakers, and branded trinkets also send a message to the patient, who might reason that Gardasil must be a good drug if her doctor wields a reflex hammer inscribed with its name. But while the popular press celebrated this sudden attack of nanoconscience and while we still gravely debate whether physicians’ loyalties can really be bought for a disposable pen or a free lunch, the $310 billion pharmaceutical industry quietly buys something far more influential: the contents of medical journals and, all too often, the trajectory of medical research itself.
How can this be? Flimsy plastic pens that scream the virtues of Vioxx and articles published in the pages of The New England Journal of Medicine would seem to mark the two poles of medical influence. Scarcely any doctor admits to being influenced by the former; every doctor boasts of being guided by the latter. In fact, medical-journal articles are widely embraced as irreproachable bastions of disinterested scientific evaluation and as antidotes to the long fiscal arm of pharmaceutical-industry influence.
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