I base prescriptions on the medical literature. I read several journals, subscribe to several medical letters, and attend professional meetings, (many sponsored by the drug companies, and for the most part unbiased in their content). I've even gone to dinner talks and found them to be informative. Most physicians do the same. Most also insist that drug rep visits don't affect prescribing. If that's the case, then why do we see them? Since I don't need the samples, and I get my own information on medications, I'm no longer willing to waste my time, or the pharmaceutical representative's time. Let's let the drug companies put the millions spent on PSR salaries into research and development or price relief instead of pointless hucksterism.

As Chief Clinical Officer of a county ADMHS board, I believe the public sector must maintain a strong working relationship with the pharmaceutical companies. This will be true at least until that unforeseen time when we have universal health coverage and access to prescription drugs for all. Until then, while I share many of Dr. Ivan's sentiments, I do not think those of us working in the public sector can shut our doors to the pharmaceutical sales representatives. (In the spirit of full disclosure, Todd is not only a valued colleague but also sits on the board for which I work.)

With the growing numbers of uninsured and underinsured, our patients and our clinics could not survive without patient assistance programs and samples provided by the pharmaceutical industry. No more than I could get the cash card without the test drive, we cannot expect to get help with free meds without some sort of sales pitch in return. For me that is the quid pro quo, so I listen politely. I gladly accept reprints of peer reviewed articles, even if I've already read them in the original source. Occasionally I learn something new, but I never assume its accuracy.

I am bothered by some colleagues who appear to accept pharmaceutical sales representatives as legitimate experts. In truth they are salespersons, and like salespersons in all industries, some are very knowledgeable and others far less so. As far as pens and pads, I have come to believe only non-prescribers should display them in their work setting. Let the psychologists have all the pens or if you must, take them home to your kids.

Our relationship with industry is symbiotic. We really do need each other. In addition to samples and programs, company reps can be extremely helpful when the true innovations become available. Without industry support, as self-serving as it may have been, we would not have seen the substantial use of clozapine in the 1990's and long-acting risperidone today. And our patients would have suffered.

The drug companies are slick and put great educational tools together. We shouldn't need them for our own continuing medical education, but they may be very helpful to our patients, their families and others. I've been giving all sorts of educational audiotapes, videos and CDs (often unopened) to our consumer run education center. The patients find them very useful. And we are happy to accept help from the drug companies in the Crisis Intervention Training we have been doing with our police officers around the state. Officers' experiences of virtual hallucinations are often transforming. And I don't have to be concerned about whether officers' prescribing patterns are being subtly influenced.

Like Todd, I wish all the marketing would go to R& D or lower medication costs. I wish my colleagues were less eager to accept meals and trinkets from the drug reps. But in truth it may be the price we must pay for the closets full of samples and to keep the patient assistance programs going. I think if we're smart and careful we can let the sales representatives do their job, help our patients and not be co-opted in the process.