"Kickbacks" of various kinds are endemic, and it starts with medical students

"Kickbacks" of various kinds are endemic, and it starts with medical students. A group of the latter have an organization going whose members pledge NOT to accept any unethical "consideration" --including pens, donuts, what have you--from drug companies. (I have followed this issue for some time, and at one point in my career, was actually on staff at the then-largest PR agency, doing PR for a major drug company--since gobbled up by the largest--AND for its chairman/CEO in his capacity as serving head of the drug industry trade association, which was then called the Pharmaceutical Mfrs Assn. I did not seek out this assignment, though I wanted to get some experience with this agency, which I ultimately resigned from over largely ethical issues. But I did get some very upsetting insights into Big Pharma.)

Drug companies buy lists through specialized brokers that tell them how much of which drugs are being prescribed by individual doctors. Your purchasing record at the local pharmacy is hardly confidential! ! I forget, right now, how overt the influence/kickback aspects of these activities are, but at the very least, it helps them "target" doctors for more rep visits. And I think it goes well beyond that, in terms of punitive and/or rewarding actions. One may believe the best about one's own doctor--and may even be right-- but the industry isn't spending billions(?) to court doctors and other providers just to give away bucks. They KNOW it works, and the return on investment is enormous. (But just remember that, at election time, a good majority of voters reelect their own Congressperson- -convinced that they are exceptions to the general pattern of corruption. But SOMEONE in Washington is voting all those pro-pharma/etc and anti-consumer laws into effect.)

There is lots of info on this issue in the newspapers regularly, if one bothers to read one; even a daily digest, such as are available free by email from the NY Times or The Washington Post, and many more regional sources. Not to mention Web articles, which include some that probably claim all these folks are honest and just indulging in "freedom of commercial speech." Then, of course, there are all the MDs taking lucrative drug-testing con- tracts. Some of these are "regular," local clinicians-- not just MDs on staff at major medical schools or hospitals. (If you want an inside look at how this worked in the case of Prozac. buy or borrow--your library can get it free for you via Inter-Library Loan--a book called Talking Back to Prozac. The doctor who wrote this got the data that we would otherwise never see...Detailed, patient-by-patient results on the trial that the manufacturer legally had to submit to the FDA....but which went nowhere after that...until this doctor used the Freedom of Information Act, which ultimately got the incriminating stuff...There is far, far more to say on this than I have time for, or detailed knowledge of.