I have written in the past that, although pharmaceutical sales reps are usually considered to be one step above head lice on the food chain of life, they actually perform quite a valuable service in educating physicians, many of whom have absolutely no time to time to keep up with the literature on new drugs.
Little surprises me any more, but that changed last week--in a big way.
A friend of mine who has been going through some rough times decided to give drug therapy a chance. He was put on one of the standard SSRI antidepressants by a very expensive New York psychopharmacologist.
Within two weeks, he was feeling nauseated much of the time, and had lost a lot of weight, so he called me for advice. It didn't take House to figure out this one. Nausea is one of the very common symptoms of SSRI use. Fortunately, it can be controlled with Zofran, an anti-emetic drug originally developed to treat chemotherapy-induced nausea and vomiting (CINV). It did this so well that oncologists maintain that it revolutionized the field, enabling patients to complete their chemo, even with the most emetogenic drugs, such as cisplatin. And to do so with far more comfort than before.
Zofran (generic name ondansetron), one of the most important pharmaceutical discoveries in a generation, is now also used to treat nausea and vomiting caused by general anesthesia, morphine, pregnancy, viral gastroenteritis and SSRIs.
So, it took no special wisdom for me to suggest that he call his doctor and see if he would call in a script for some. Which was a perfectly fine plan until he called me back, saying that the doctor had never heard of it.
After removing my jaw from my desk, I tried to come up with any explanation of why a $400 per hour New York psychopharmacologist had never heard of a drug that had not only been on the market since 1991, but had transformed the fields of oncology, obstetrics and pediatric care.
The best I could do was "he was having a bad day." But I don't really believe that.
Being in the pharmaceutical universe for my entire career, it's not unusual that I sometimes know more about certain drugs than the doctor I'm visiting. They are generally pleased to learn something new. But this is not my job.
In the absence of any Continuing Medical Education requirement for physicians about new drugs, it becomes the job of the reps to inform physicians about new products.
This is a valuable service, and perhaps it is time that this side of the story is considered. Although this system certainly has its flaws and the potential for abuse, on the whole, I believe it is far more useful than harmful.
I told my friend to get another doctor, and this time to check whether there was actually a license behind the desk. I feel badly for the other patients. Unless there are shrunken heads on the wall, or bottles of chloroform lying around, they may not know that they are seeing someone with a frighteningly limited knowledge of modern pharmaceuticals.