First, and I want to make clear that I am strongly against any drug rep presence in any medical institution, and have advocated against it in institutions I&#x27;ve been affiliated with: let us draw a hard line between three levels of behavior, because conflating them is ... well, not ridiculous, not quite, but misleading. It&#x27;s not ridiculous to group &quot;slapping someone&quot; with &quot;beating them with a baseball bat,&quot; but it loses something.<p>Additionally, I&#x27;m putting a firm &quot;no&quot; on &quot;informal quid pro quo.&quot; Though you, I, and ever psych major on the planet knows better, most physicians firmly believe they&#x27;re just being advertised to, but <i>are not swayed</i> by the pharmaceutical company ads. Very few of my colleagues believe they&#x27;re susceptible to this sort of shenanigans. Very few would knowingly consent to partake in a &quot;quid pro quo&quot; arrangement of fringe benefits for prescriptions, and most would be earnestly outraged at any such suggestion. You can claim the outcomes are the same, but they&#x27;re not - it speaks entirely different volumes of the characters of the people involved, and approach needed to reform.<p>So, 3 levels:<p>1) Direct pay-offs from drug companies to docs
This is something that has never been as commonplace as people seem to believe (eg, speaker fees), and is very nearly dead since physicians that get this money are now publicly monitored for it. It&#x27;s always been rare, and remains so. So when we say &quot;docs profit,&quot; which implies this level 1, well, let&#x27;s not.<p>2) Physician frills paid for by drug companies
This used to be quite common, and has grown much less so. It used to be &quot;let us subsidize your trip to the bahamas for a 5-day medical conference (during which you will be pitched regularly).&quot; That&#x27;s been on the down-trend for about 2 decades, and is generally pretty rare these days. You&#x27;re pretty much down to getting lunch brought to your office - and you had better believe this isn&#x27;t ubiquitous, but depends on your practice (good private insurance practice of patients with lifelong autoimmune disease, and your co. has a new mAb out? Why, yes, lunch will be arriving soon. Standard PCP w&#x2F; 50% medicare, 20% medicaid, 30% private blend, general population of disease? eh, not so much). And, sure, occasionally dinner - subject to the above. Again, these have grown increasingly rare since these are now public numbers subject to scrutiny. No one wants to show up on that database, and definitely no one wants to be one of the docs that shows up in the local papers as one of the top 10 pharma whores for the year. More common is:<p>3) Drugs in the background
Branded pens. Branded clipboards. Bullshit journals of carefully curated studies. Donations to org. meetings, which result in huge banners and the like. The chance to &quot;educate&quot; docs on new results: these are carefully put together study analyses meant to show the drug in its best light, not overt pitches. They&#x27;re generally very well done studies earnestly presented, with their biases baked in deep in the fundamental study design (e.g., subject selection), so there&#x27;s nothing for casual audience members to be able to nitpick at. It takes an old hand to catch the trickery here.<p>3 is really the big one. It&#x27;s the tickle at the back of your brain; the easy prescription of familiarity, avoidance of the discomfort of getting that sad look from your local rep. But it&#x27;s reasonably subtle, and unless you think docs are making bank on those free pens, it&#x27;s not really what you&#x27;d call &quot;profiting&quot; in any meaningful sense.<p>1 &amp; 2 are profiting, and inflammatory, and mostly a relic of the 80s and early 90s. They&#x27;re also a shit-ton less effective than #3.<p>In a <i>transparent</i> environment, advertising is a lot more effective than bribery. As a strong advocate for complete absence of pharma-to-MD relationships, I don&#x27;t worry about the occasional bit steak lunch that most docs sit through playing on their phones; I worry about the never-ending barrage of advertisements. If you look at where pharma drops their big bucks, you&#x27;ll see they share my priorities.