At the presidential symposium "The Psychiatrist's Relationship With
Industry" (see Experts
Call for New Ways to Collaborate With Pharma),
private practitioner Jonathan Weker,
M.D., of Montpelier, Vt., presented a historical overview of the evolution of
prescribing from its earliest days as a mercantile exercise by physicians who
were essentially marketing products to the growth of the modern pharmaceutical
manufacturing corporation and the contemporary regulatory structure.
"Pharmaceutical companies began to develop therapeutic agents of
demonstrable utility, safety, and efficacy, which had appeal to a large
market," he said. "And doctors became the portal through which
access to those medicines took place. Where once patients came to doctors
primarily seeking surgery or diets, now they wanted prescription
With the emergence of blockbuster drugs, pharmaceutical companies became
enormously attractive to investors. "They began to experience a kind of
financial success they could not have imagined before," he said."
With this, the nature of pharmaceutical companies and their
relationships with doctors irrevocably changed."
Weker suggested two possibilities for how this new relationship might have
evolved: a professional paradigm in which each party is principally concerned
with improving the health of the populace or a mercantile model.
"In the mercantile paradigm, physicians act as surrogate consumers on
behalf of their patients, and the companies court the doctors on behalf of
their products." This created a situation in which clinical concerns
were not ignored, but they were not alone on the table. "Both parties
were not disinterested," he said. "My sense is that a de facto
decision was made by both parties to adopt this mercantile
But within the last two or three years there has been a rapid turnabout:
the public and federal and state legislators are demanding accountability and
transparency. "No one wants Christmas to end, but Christmas is going to
end," he said.
He urged adoption of a new relationship with the pharmaceutical industry in
which the professional integrity of physicians is respected, and doctors
receive comprehensive, well-reasoned, unmarketed information about drug
"Their products make our practice look good, but at the same time our
ability to diagnose and treat makes their products look good," Weker
said. "If industry and the individual physician wish to coexist
symbiotically in this environment, both parties would be better served by
adopting the professional paradigm." ▪