As I prep for a two-day psychopharmacology workshop, I confront my troubled relationship with the drug companies. It’s beyond love/hate; and as egregious acts of greed are committed, such as price gouging life-saving EpiPens, I realize we all play a part in this.

I knew something was up even in medical school when once a month we’d traipse up to the top floor of the inner-city hospital where I worked for Drug Fair. It was Halloween and Christmas rolled up in one. As the doors to the auditorium opened, attractive drug reps smiled and handed us tote bags emblazoned with the logo of hot-new —and expensive— drugs. We’d grab them and race down aisles of booths where everything was free. Later, as I’d dump the booty onto my apartment floor, I thought, People don’t give you stuff unless they want something in return.

So I did the research and learned that drug companies spent thousands, and even tens of thousands, per physician per year in direct marketing. It was everything from coffee mugs to all-expense-paid Caribbean cruises where you’d be called a consultant —wink wink.

A decade later and I’m at a convention in Toronto where we our name tags have bar codes. There’s still lots of free stuff, although by this point I’d stopped accepting it. Even so, every time I stepped onto the shuttle bus from my hotel —paid for by a drug company— my badge was scanned. And while new rules had emerged that discouraged docs from taking freebies, they were everywhere.

At the time I wrote opinion pieces for a major medical tabloid. In the past they’d run everything I’d sent, but my snarky essay on free jumbo shrimp dinners, theatre and sporting-event tickets was rejected.

“What gives,” I asked my editor.

“You need to look at our publication,” he replied.

The light went on. Of course he couldn’t run it, most of the ads in that paper were for drugs. You don’t bite the hand that feeds you.

It’s a bitter realization that my profession’s integrity has been so compromised by our relationship with Pharma. Supposed peer-review journals that come to my house are bought and paid for by the drug companies. I’ll bring several to the workshop. We’ll tear them apart and divide the pages into three piles: articles, advertisements for drugs, and other. Depending on the journal, the drug ads will comprise a third to a half of all pages. Which begs the question, are these journals or are they a more-nuanced form of advertising? What publication so heavily supported by Pharma, would run anything negative about a medication? Unless it was an older, off-patent compound and there was now something newer, shinier, and a hundred times more expensive?

It gets worse, and for those of you reading this, thinking those evil doctors they should know better. Well, if you have a retirement account chances are good your Vanguard, Mass Mutual, Prudential, or Fidelity funds contain a rich mixture of pharma stock. They’d be stupid not to, considering it’s one of two industries in this country that typically reports double-digit profits.

What does impress me is that there’s lots of information about this stuff, everything from burying unflattering studies to concealing or down-playing adverse reactions. As part of my workshop I instruct participants in how they can become millionaires by going to drug-company sponsored dinners and taking careful notes when the paid-presenter, often a respected area physician, talks about non FDA-approved uses of a drug. “Sure, it’s an anti-convulsant, but man this stuff works great for anxiety. I’ve even used it for a mood stabilizer.” They’ve just broken the law and there have been hundred million- and even multi-billion dollar settlements against illegal —off label– marketing. The whistle blowers and their legal teams get millions.

As I arrive at the disheartening truth −we are all in bed with Pharma− I come to a line from a novel I wrote. My heroine, a plucky drug rep, has just realized that the love of her life, a pharma CEO, is in fact Satan. His response, “I’m the head of the world’s largest pharmaceutical company. Global makes billions from off of suffering, pain, and disease—who did you think I’d be?”

Charles Atkins, M.D., is a psychiatrist, author, and the chief medical officer for Community Mental Health Affiliates with offices in New Britain, Torrington, and Waterbury. He is also a member of the volunteer faculty at the Yale School of Medicine.

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