Heart Health


May 11, 2009


I was thinking a lot about pens today.  I’ve been using the same pen for nearly two years now—it’s a well-worn metal ballpoint that I keep alive with Cross medium-point black ink refills.  With all the writing I do, especially with hospital rounds, I’ve gone through more than a half-dozen refills during the lifespan of my trusty writing instrument. This is something of a miracle for me since I used to be able to hold on to a pen for no more than a week—I seemed to have the habit of setting them down somewhere and forgetting them, and I had to always have a stash of back-ups in my white lab coat.  These days I’ve gotten pretty good at hanging on to my reliable ballpoint.

I’ve known doctors who spend hundreds of dollars on a Mont Blanc pen and stick with it for years.  I could never understand this—partially since I couldn’t see myself spending that kind of money on a pen, and mostly since I know I’d misplace it before lunch.  I suppose now that I’ve kicked the pen-losing habit I could see myself owning something like that (although I still can’t see actually paying for one).

For the first time, we medical professionals will have to start actually buying our own pens

The reason I starting pondering pens today was that, for the first time, we medical professionals will have to start actually buying our own. You see, up until January 1st of this year sales representatives from the pharmaceutical industry were allowed to bring pens to doctors’ offices.  And they did so—by the handful.  Not just pens, but also coffee mugs, clocks, note pads, and pretty much every other cheap “office-type” accessory you could imagine.  Ever since I started medical school twenty years ago the pens I’ve used (and which fill the drawers of my house) have borne the logo of some medication or company name.

Most of the pens we were given were pretty cheap but occasionally I’d happen across a nice one that I’d try to keep as long as possible.  I still have some of the better ones at home with names of medications like Procardia and Prinivil that went generic years ago and no longer adorn the paraphernalia of any modern pharmaceutical rep.

Most doctors’ offices have stashes of “drug pens” that they continue to draw upon, but as time progresses these provisions will be gradually depleted.  At some point we doctors and nurses will have to face the harsh reality that we can no longer rely on handsome, well-dressed marketing reps to refill our pockets with shiny new ballpoints and gel tips.

Under pressure from Congress and public watchdog groups, the pharmaceutical industry has taken it upon itself to discontinue the policy of providing branded tchotchkes to medical offices in order to decrease the perception of industry meddling in medical care.  The idea is that a doctor will be more likely to produce an unbiased treatment plan if he or she is not holding a pen labeled with the name of an expensive drug.  Reps will no longer be able to “bribe” doctors with trinkets.

Most of my colleagues actually think this is a step in the right direction

You might think that doctors and nurses would object to a plan that curtails their supply of free Vytorin coffee mugs and Viagra wall clocks.  To the contrary, most of my colleagues actually think this is a step in the right direction (I include myself in that mix), but not for the reason Congress intends.  We think it’s just a huge waste of money.  Think about it. In 2006, drug makers spent $6.7 billion, or about $8,000 per physician (a staggering amount), on detailing, according to pharmaceutical market research firm IMS Health Inc.  That’s a whole lot of cash that could be going elsewhere, like back into research and development or providing low-cost medications to underprivileged patients.  I have to imagine that pharmaceutical execs also exhaled a collective sigh of relief at no longer having to come up with mountains of pens and other trinkets that mostly get tossed or collect a lot of dust.

Which brings me back to my original thought: What are we going to do now that we have to buy our own pens?  I conducted an informal poll among my partners and found that most have already adapted without too much difficulty.  Some have adopted my practice of sticking with one nice one for years and purchasing refills.  Others just go with the giveaway pens our office supplies to our patients as they fill out their forms.  A favorite among a couple of our mid-level providers is the Avery eGlide Rollerball at $1.36 a piece (less if you buy in bulk).

So, for the $8,000 that was supposedly spent on me in 2006 I could have purchased 5,882 eGlide Rollerballs to stuff into my pockets (I could lose one a day for next 16 years).  Or, I could just stick with my trusty ballpoint, sport for the refills myself, and ask the drug companies to use the money for something more sensible.

  1. Jill Ogg-Gress

    Is it the pen that is the payoff? How about the free "drug" lunches that are still served on a frequent basis? Or a commercial on TV pursuading my patient that one drug is better than another? I guess the days of pharmaceutical company sponsored golf trips to the islands of "hush hush" are long gone. That being said, does any of this influence us as providers? I hope as professionals we are fully capable of making informed decisions for our patients based upon science and not what drug sponsored our office lunch. They can keep the pens. Dr. JOG has always been true to the Eglide. Five years running.

  2. Jeff

    While I can personally and professionally get along quite nicely without the latest throw away pen or coffee mug, I am concerned about the relentless regulation of the pharmaceutical industry in the name of reducing conflict. I may be naive, but I feel pretty confident that I have not altered my prescribing style based on the pen that I am holding in my hand. While these trinkets are minor, I have seen a ongoing reduction in our ability to interact with the pharmaceutical companies and our peers around this regulation. A couple of years ago, there was a story on NPR about a fundraiser held on Captiol Hill for new Congressmen. The price of admission to lobbyists was $10,000 which was to go to offsetting the expense of these men and women having run for office. As you stated in a recent blog, the typical new physician comes out of training over $100,000 in debt, and yet we can no longer accept a free pen! Apparently those who serve in Congress and make these rules, have a much higher opinion of their ability to sort out these conflicts of interest than I do.

  3. Tara

    Although I do miss the free pens, I agree that the money saved should be used for something more productive. It would make more sense to use the money to help defray the cost of the drugs for the patients.

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