I think it’s time we all grew up and developed some perspective on our relationships and those of our patients with the pharmaceutical industry.

We are neither in cahoots nor in competition with them. The welfare of our patients is not in competition with the industry’s striving for profit: It is no secret that our patients, from the most affluent to the most destitute, have benefited from the research of basic scientists and the planning of corporate executives.

My door, whenever possible, is open to pharmaceutical company representatives. I accept their pens, note pads, chicken salad and potato chips, articles, and lecture tapes and will attend a meeting they have funded, with or without formal CME credits. I am impressionable: I may be more likely to prescribe Luvox for a newly diagnosed OCD patient a few days after a visit from the Upjohn representative or Zyprexa after being reminded by an article supplied by the Lilly rep that it may be better tolerated by my EPS-prone elderly patient with psychosis.

While information provided by drug reps, industry-supported speakers, and, for that matter, critics of the industry may be biased, it is incumbent upon us as clinicians to consider the content and context of all information in the best interest of our patients.

Yes, I would like the pharmaceutical industry to cut the prices of its products and play a little more by the supply-demand rules of real-world economics. I would also like the FDA to develop more expedient guidelines and requirements for drug research and development with respect to safety, efficacy, and the time-honored quest for reasonable profits.

Real acknowledgment of the pharmaceutical industry’s critical contribution to the length and quality of life of suffering people should balance criticism of its profit motive. Because of the pharmaceutical industry, I don’t have to go home at night and boil tree bark hoping I can produce some concoction that may make my schizophrenic patients drowsy.

In considering the relationship of physicians to the industry, we tend to become hung up on the appearances of conflicts of interest. I am not too proud to ask a drug company to provide free medication for an indigent, and sometimes not-so-indigent, patient. In contrast, I also appreciate pharmacists’ prerogative, in the Sunshine State, to substitute a "generic equivalent."

Am I skeptical of the sometimes overzealous sales pitches of drug reps? Sure, and I tell them so. I don’t like the fact that the companies can track our prescribing patterns, but since I have no formal loyalty, financial or otherwise, to any particular company or product, I reluctantly live with this reality. However, I also tell pharmaceutical reps how much I appreciate their commitment to patient care, physician education, and product development. In the end, our mission is theirs also.

The individual physician must determine his or her comfort level of interaction with industry. While complete abandon of scientific objectivity and selling out to a business entity is unacceptable, I think the other extreme of total isolation from and hostility toward an industry that provides, even at a profit, balm to the suffering is at best overcautious and at worst sanctimonious and counter to the best interest of the patient. Some clinicians accept only drug samples and educational materials: for others, small gifts such as pens, pads, and coffee mugs are OK. But what about the chicken salad and potato chips, let alone noneducational meals, shows, and quasi-educational and outright recreational trips?

Since the behavior of individual professionals does indeed reflect on the entire profession, it is appropriate and necessary that ethical and even legal guidelines exist to help the less discriminating among us draw the line. Each physician must be aware of how his or her participation in any of these activities may influence decision making (that is, choosing medications) and self-impose whatever limits are necessary to minimize bias in day-to-day practice, education, and research.

As a profession dependent on and cooperative with industries that serve the same population, we need to maintain communication. We can teach our patients and the drug reps how we choose a particular agent in a given clinical situation. In so doing, we may ourselves begin to understand how we make decisions in the context of the biopsychosocial model.

We have to keep the lines of communication open, because by doing so we are in the best position to advocate for our patients.