> Even contact lenses are marketed with free samples.

I mean, yeah? If a shoe company required you to buy a shoe before trying it on without free returns, the shoe may as well not exist.

I used to see this in our country, where 10 people are queueing outside doc's office ( this is public health system) when some well dressed man goes straight into the office not even bothering to ask if there's anyone in there and fast forward a few min and the doctor is 'on break', whilst drinking coffee with the sales rep, while all those people sit and wait. Eventually it got outlawed.

That's extremely rude. How could he just barge into the doctor's office? A physical examination could be taking place.

In my experience at a specialized neurology practice: they wait outside until the doctor is free, then knock on the door and ask if they have a moment. They would almost always get straight to business, never wasted more than half a minute of people's time socializing.

Drug companies offer a lot of free samples. It's the same drugs the psychiatrists were going to prescribe anyway, they're just trying to get them to prefer one brand over the other. Sertraline, for example, is first line treatment for depression, anxiety. Getting free sertraline samples reduces costs for patients and really helps them out. Especially in my country where generic medication is often found to not be of the same quality as those manufactured by big pharmaceutical companies.

Everyone talks about the relationship between drug reps and doctors like it's the most incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a doctor is going to spend his limited downtime perusing the PDR (which no longer exists, and was always heavily influenced by the drug manufacturers anyway)?

Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.

Part of the job, as stipulated by medical regulators around the world, is keeping up-to-date with evidence. This can be achieved by reading journals and attending conferences, in theory.

But.... journal publishers exploit their monopolies, and conferences are funded by corporate sponsors. So perhaps they're not so different.

Medical conferences basically would not exist if it wasn't for suppliers and drug companies paying for sponsorships, trade show booths, opportunities to speak, etc. Not really any different than any industry's trade conferences.

Sounds just like every technology conference I've ever been to. A bunch of software and hardware vendor booths, and most of the speakers being authors hawking their latest books.

It's their responsibility to stay up-to-date. If a dev can keep up with front end tech stacks, doctors, who are much more elite in their education, should keep track of latest treatment breakthroughs in their domain of expertise.

First of all, the vast majority of devs do NOT stay "up to date." Most know one language or even just one platform... i.e. "WordPress developer" or "Oracle admin". Secondly, how do you think YOU hear about new technologies... usually due to marketing. Did React just come out of nowhere? No, Facebook marketed it relentlessly. Did people discover Kotlin on their own? No, JetBrains and Google hit people over the head with it. Etc, etc

Is it really the case that Facebook marketed heavily React? Why? What do they gain from it? Real question, or not like react was an entry point to their API?

It was fairly obvious when it was an up and coming thing. They sent out engineers to talk about it, you had these articles popping up about it more or less out of nowhere, etc. If you weren't there (which I'm guessing you're not, otherwise why would you ask), it is hard to imagine. Perhaps it makes more sense when you consider how normal "advertorials" are now.

Continuing medical education not only a responsibility but also a requirement to maintain a medical license in many states (e.g. California [1]).

[1]: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Ren...

Take a look at what that actually entails. Inexpensive online courses with guaranteed passing exams, many of which have zero to do with actually treating sick people -- Secondhand Smoke. Medical Ethics. Herbal Medicine Review.

Even if a practitioner took it seriously and wanted to get a real education about actual medical issues, they aren't going to find coverage of brand new drugs in an educational setting unless it was arranged by the drug companies themselves.

https://www.netce.com/specials.php?productid=MD22X,MDSUB

Scrubs covers this: https://www.youtube.com/watch?v=JVTWoPeMWSQ

> How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines?

With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.

Who is teaching the courses? Where do they get their info? Given the very limited oversight of "continuing education", it's trivial for Merck or Pfizer to ensure their advocate teaches the class or records the online seminar -- with zero requirement that they disclose that fact. At least when a drug rep visits the office and buys lunch, you know the source.

At this point we need public policy to stop such bad actors. Or you mean we should give up and do nothing? But why?

In Illinois Doctors have to go to a one week conference every year that is supposed to talk about this stuff. They also have to take board exams every few years that make sure they're staying caught up on new advances.

It's 60 hours every 3 years, of which webinars are acceptable, and no records need to be submitted with the renewal application. There are no tests or exams. The "new advances" they must keep up on include Sexual Harassment Prevention and Implicit Bias.

https://www.isms.org/CME/Medical-License/License-Requirement...

Is there no continuing training throughout the career of a doctor? And if not, how are they qualified to evaluate the claims of a sales rep?

> How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines?

They are supposed to study. Continuously.

Study what? Even the New England Journal of Medicine is full of articles funded by drug companies. And for good reason -- the results of drug trials should be communicated to physicians. Buying them lunch may be less prestigious, but it's essentially the same thing.

Merck, Dec 2021: https://www.nejm.org/doi/full/10.1056/NEJMoa2116044

AstraZeneca, Jan 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2112431

There's more material available, not just scientific journal articles. The medical specialty associations periodically release detailed guidelines covering new criteria, methods, treatments. For example:

https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA....

There are courses available if you wish to be taught. There are events where people present new developments. There are paid sites like UpToDate. Even textbooks eventually get new editions and there's always plenty of fundamental science in them that doesn't change

Did you check the Disclosures section of your article? Are there any drug companies NOT included there? Like it or not, private companies fund the vast majority of medical research in the U.S., and any doctor who wants to stay up to date cannot (and should not) ignore it all.

The authors have no conflict of interest to declare, but declare lecture honoraria or consulting fees as follows: T.U., Bayer, Boehringer Ingelheim, Hexal, Vifor Pharma; C.B., Servier, Menarini, Merck Pharma, Novartis, Egis, Daichy Sankyo, Gilead; N.R.P., Servier, Pfizer, Sanofi, Eva Pharma; D.P., Torrent Pharmaceuticals; M.S., Medtronic, Abbott, Novartis, Servier, Pfizer, Boehringer-Ingelheim; G.S.S., AstraZeneca, Menarini, Pfizer, Servier; B.W., Vascular Dynamics USA, Inc, Relypsa, Inc, USA; Daiichi Sankyo, Pfizer, Servier, Novartis, Menarini, Omron; A.E.S., Omron, Novartis, Takeda, Servier, Abbott.

The NIH funds a huge fraction vast of biomedical research in the US. Pharma does important work too, but it’s largely concentrated in the very last stages of getting a product to market.

These COI disclosures also strike me as hard to interpret. It’s certainly possible that some of these people are deeply invested in a company and are pushing its particular therapy hard to buy a new boat or something. However, I’d bet many of them are $250 to participate in a focus group, or free conference registration to be in a panel. It’s important to know who’s buttering the authors’ bread, but it’d be helpful to know how much it’s being buttered too.

> The NIH funds a huge fraction vast of biomedical research in the US.

This document https://www.researchamerica.org/sites/default/files/Policy_A... states that in 2017 private industry spent $121 billion on Medical & Health R&D Expenditures in 2017 compared to $39 for the federal govt ($32 of which is NIH). $121 billion in a single year -- I honestly assumed the number was in millions till I re-read it.

This article https://www.baltimoresun.com/health/bs-hs-trial-funding-2015... says "Industry funds six times more clinical trials than feds"

You are probably right that the drug companies are (not surprisingly) focused specifically on drugs while NIH research is more general and widespread. But that is still a very large difference.

I did see that. I don't see that as a reason to doubt the recommendations of this particular article.

I thought we were talking about direct marketing by pharmaceutical company representatives by the way. It is of course impossible to separate modern medicine from the pharmaceutical industry since many therapies depend directly on them. It's still the doctor's job to figure out which medicines are actually good and what's merely some salesman's product.

> I don't see that as a reason to doubt the recommendations of this particular article.

No conflict of interest, except they're directly paid by drug companies. That's the sort of thing you'd expect to see in a banana republic, not established medicine. It should call the integrity of the entire system into question, frankly.

What’s a better solution though?

Do you really want to ban all interactions between researchers/clinicians and drug companies?

Why is "direct marketing" (drug reps) verboten but an article paid for by the same company is legitimate? What if the reason for the drug rep's visit is to bring a copy of the article to the doctor?

> Why is "direct marketing" (drug reps) verboten but an article paid for by the same company is legitimate?

Scientific articles are published and read by the community. There are, for example, social media and messaging groups where doctors will post and discuss articles, including their methododology and limitations. There's always the possibility that the study could actually be relevant.

Drug company representatitives talk to doctors in private in order to try and convince them to prescribe drugs. Like all marketing, there's an inherent dishonesty to it. You always assume they're overstating the positives, downplaying the negatives and ignoring alternatives. Doing this is actually the doctor's job. It's our job to pick these claims apart and figure out what's true and what isn't so that patients don't have to do it.

Doctor-drug industry relationship is at its healthiest when they're just giving doctors free samples of the drugs they were already going to prescribe anyway. Doesn't change the doctor's conduct and helps patients with free medicine. Doctors are already going to prescribe angiotensin receptor blockers for hypertension, drug company representatives won't change that. They can and should provide free samples though, free medication helps everyone.

> Drug company representatitives talk to doctors in private in order to try and convince them to prescribe drugs.

Everything a drug company does is ultimately about selling more drugs. It's not limited to the drug reps.

> they're overstating the positives, downplaying the negatives and ignoring alternatives

Again, not at all exclusive to drug reps. This behavior can be traced all the way back to Phase I of the clinical trial.

Your position in this thread makes no sense. I stated the drug reps help doctors stay up to date on the latest drugs and treatments, you disagreed and said doctors should "study. continuously." What should they study? Articles sponsored by the drug companies. How can you square that? Further, I'm sure you're aware that only a tiny percentage of doctors actually read the fancy journals and fewer understand the statistics and the details (perhaps those are the docs who sit around on the message boards you mention). For the other 90+%, the drug reps are the conduit who deliver relevant info to doctors. Ate they aggressive? Yes. Sneaky? Sometimes. Ultimately, do they help doctors discover drugs that help their patients? Unless you believe the drugs being approved by the FDA are ineffective, the answer is yes.