PracticalDermatology

We’ve hit a lot of the hot topics this year (I hope the piece on manners sticks with us for the long run). It seems like the more we think we remember about fundamentals, the more they escape us. But, there are a few elephants still left in the room, aren’t there?

I’ve been trying to bite my tongue on this one, especially to not bite the hands that feed us…but can we all agree that this whole “no alcohol at dinner programs policy” is pathetic? Let me count the ways, which I am sure are not overlooked.

It seems like a never-ending paradox with the whole pharmaceutical industry. Believe me this is not the place to bite the hand that feeds. But when we hear about how residents and young physicians are not allowed to see pharma sales reps because their professors are concerned about bias, which is basically tantamount to telling incredibly smart people they cannot make their own adult decisions about relationships, isn’t it hypocritical to make decisions about adult beverages creating an environment of entertainment over education?

First, a promotional pharmaceutical dinner is not an evening of entertainment, nor is it an event of education. It is exactly as it sounds—a promotional program to increase sales, otherwise known as marketing in a capitalist environment (at least for now). In this setting, compliance officers dictate the message being sent, oversee the slides and written messages presented without room for deviation, and the audience is neither compensated nor offered CME credits. This is not a template for education, although it is the charge of the guest speaker to deliver a message, with some hope of education as dictated by the script. Second, a physician taking an evening away from family after spending a day seeing patients to hear a promotional message is hardly considered seeking entertainment. The attendee knows what he or she is getting into, as being present is optional. Yet the issue now facing pharma is that serving alcohol blurs the line between education and a night of entertainment, even though last year it didn’t matter, and every other industry known to man uses dinner and drinks to create an inviting environment for marketing. Another example of the inverse relationship between compliance and sales.

I have been involved with promotional speaking since early in my career, back when we wrote our own lectures on Kodachromes and were able to engage with audiences of 20-30 dermatologists as intense as a society meeting. Many of my mentors and the biggest names in private practice and academics—department chairs, textbook authors, and lead investigators—were on local and national tours, mainly because the focus was on education with partnership with the sponsor. Words like “industry whore,” “bought and sold,” and “influencers” were hardly in existence then. Most of the lectures were the speakers’ own work and selling drugs wasn’t part of the message even though it was a natural segue from engaged industry partners. Depending on the speaker and location, even executives of the companies would come and see the show. Unfortunately, in today’s world of pharma, a lot of colleagues are not allowed in the same room (ok then).

Fast forward to today: the vast majority of attendees are office staff with few clinicians. The slides are filled with safety information written in small font impossible to see from the back of the room. The personality of the speaker is hardly represented except by delivery. But the message that attendees have to purchase their own drinks so that there is no message of influence or liability is a bit flawed when anyone can get overserved on their own dime and still drive home impaired and blame the host. The paradox is also that these programs often require a private room and dedicated staff, which is expensive for the host company aside from the use of a third-party agency that adds to costs. What is ironic is that now that alcohol is not on the menu, it is rare that the spend at the event will even come close to the minimum charge from the restaurant, so over time the losses from writing the checks for the difference to meet the minimum will add up and prove that the exercise for promotional programs will be futile.

In the end, attendance at programs probably isn’t going to change much. Those who wish to drink have no problem buying better wine or cocktails, and maybe this intervention will help with some diets and calorie counting. Even better, bring a good bottle and share it with your friends and tip the server a little more. The programs are definitely shorter in duration, and for some it may be a good night out to see colleagues.

But the trend is clear: physicians have gone from the bias of pens, post-it notes, and other SWAG to now being told that adult decisions are no longer in our scope. As with anything involving doctors, we just keep nodding our heads and accepting more regulation while continuing to turn on each other as either biased or conflicted. One must be pure of conflicts to evaluate guidelines, yet academia continues to hold a hand up while holding a hand out for grants. We say quid pro quo is obsolete, and yet the high writing hostage takers while still want their pieces of the pie. So the beat goes on…

If this doesn’t make anyone thirsty, the message is working, and who knows what is next. For the next program, go enjoy the show, support the team, and save the sauce for home.

—Neal Bhatia
Chief Medical Editor