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Is There Some Joke I'm Missing Here?
Perhaps some Swiftian baby-eating thing that's flying over my head? Because, if not, this LATimes piece by a Seattle doctor named Steve Dudley is one of the creepier things I've read in a long time.

What's lunch, $8, $12, $20? This guy's a whore for it, to the drug company reps, and only in exchange for a little Caesar salad, veal Parmesan, Italian rolls, marinated veggies, tiramisu, and a few pens:

I listen politely and even agree to use their drug. I'm always polite. And I haven't had the tiramisu yet. Everyone is happy. Yet there's a little devil on my shoulder whispering in my ear, wanting to stir up the pot. Should I tell them about their competitors who breezed through earlier in the week inviting me to the ballgame: box seats, free beer and brats? But I don't. I am a polite doctor, choosing not to bite the hand that feeds me. And, oh, that tiramisu looks good.

The free pens are nice. I'm frequently losing pens, so these will come in handy. I can always use the Post-its too. And these friendly people with their $600 suits take such an interest in me. For 30 minutes, I feel like a king. The least I can do in return is prescribe their drug. What does it matter to me?

And then it hits me. No, not a severe case of dyspepsia from seconds on the veal. I'm talking about the big picture. When patients come to see me, they expect me to be their advocate, free from external influences. People trust me. They willingly place the most intimate details of their lives in my hands.

Afterward, late in the afternoon, I step into Room 7. One of my older patients is eager to see me. He's not doing well. In spite of his advanced age and feeble health, he is trying to care for his ailing wife at home, with the assistance of home nurses. He is utterly lost without his wife. He adores her so much. She is his whole world.

He is looking for solace, hope … anything to ease the pain of losing his soul mate. I think to myself that she's dying — there's nothing we can do.

But you can't tell someone in the midst of a crisis something like that. What he wants is hope in the form of a pill. Something to help her talk or sleep or be less depressed, anything.

I want to help him. He needs something to hang his hopes on. And about then, I burp. The acid taste of tiramisu rises in my throat, burning the whole way up. It sure tasted good at the time, but I'm not so sure now. Nevertheless, this brief eructation reminds me of my wonderful meal and those kind people who went out of their way to bring it to me. Didn't they leave plenty of samples of that new antidepressant? Lucky for my patient that he came in today instead of yesterday. The sample cabinet is full of brightly packaged pills with pictures of smiling people.

I suggest that I think we may be able to help his wife with one of the new pills, an antidepressant. It works great and just may help perk her up.

My patient reaches for the little box of pills as earnestly as if it were a life ring from the Titanic. He turns it over and over clumsily in his calloused hands, examining it every which way, this new little talisman. His face brightens. His tears dry up. He has hope. And I have played a part. I'm a hero. I like that.

What I don't tell him is that it's not much different than older drugs, just newer and sexier — and pricier, once the free samples run out. We'll deal with that later. I'm in a bit of a rush right now. First pitch is at 7:05 and the beer and brats are waiting for me.

Yeah, I think I'm catching the self-loathing he's expressing...but it's just not good enough.

Posted by aalkon at May 15, 2007 11:22 AM


I think the author is very deliberately revealing what goes on between doctors and pharma sales people.

I have a cousin who does this sort of sales to doctors. I've not talked to him in detail, because I find the whole situation distasteful, but it's clear that the sales people can offer a lot of very valuable freebies to doctors. In other fields this would be called bribery and corruption.

Posted by: bradley13 at May 15, 2007 12:30 AM

I am too tired to write, but I think it goes well with this column in Reason.

I think the doctor's point is that whether people know it or not, whether they have an overt agenda or not, everyone can be biased.

Posted by: jerry at May 15, 2007 1:09 AM

I've twice had doctors prescribe drugs for me that were a little nuts, considering. In New York, I went to a shrink once when I was in my 20s and having kind of a hard time, and, at the end of the first appointment, the guy thought he'd give me lithium! (Vetoed by me!) Now, most of you haven't met me in person, but Lena has, and I'm a very sane, very happy person who was having a hard time for very good reasons -- because I couldn't find a boyfriend and I wasn't making very much money. I wasn't suicidal or bipolar, and this wasn't some weird, baseless depression, or even a chronic depression.

Posted by: Amy Alkon at May 15, 2007 4:22 AM

And P.S. Check out the shelves the next time you're at your doctor's office. I don't know about you, but I'm not a shrink or a psychiatrist, and I'm always reading new books and studies and my shelves reflect that. Is the latest book on your shrink's shelf The Breakdown of the Bicameral Mind? I mean, I have it, too, but I've read a few books since then, too.

Posted by: Amy Alkon at May 15, 2007 4:35 AM

A Vanderbilt physician professor offered this definition of a doctor at his retirement dinner. “A doctor is someone who prescribes medicine for you until you either heal yourself or die.”

Posted by: Roger at May 15, 2007 4:44 AM

I have a "friend" who works for a medical equipment company. He travels New England, going to clinics and hospitals. Is his job to teach technicians how to use the grand, life-saving machines his company makes? Is he showing the staff people how to educate patients about the benefits of the machine's capabilities?

No, no— his job, which pays in the mid 6 figures thank you, is to teach the people who use the machine how to BILL INSURANCE COMPANIES FOR USE OF THE MACHINE, and what procedures to push on people so that the machine can generate the most billable time.

The fact that this job even exists makes me want to puke.

Posted by: Deirdre B. at May 15, 2007 4:50 AM

It sounds like Sid Vicious is back from the dead, and he's traded in his guitar for a lab coat. This guy did his residency in Nihilistic Medicine. He absolutely despises his patients.

But you know what? This kind of creepy testimony could play very well as an article of evidence in an argument for universal healthcare -- or for a less market-based system. I think he knows that.

Posted by: Lena at May 15, 2007 7:11 AM

My doctor is ALWAYS trying to prescribe something for me. I tell her everytime that I won't take anything unless its been on the market for at least 10 years, and has actually been tested on a very large sample size. I also ask for a complete list of the so called 'side effects' which I always call real effects.

Fortunately my health is good, but I think these doctors really do take advantage of the desparate.

Posted by: Chrissy at May 15, 2007 9:06 AM

I know they hire really attractive young women (beauty pagentesque) to sell drugs to the docs. I saw it on The Daily Show.

Posted by: PurplePen at May 15, 2007 9:29 AM

So pharma sales and docs can be sleazy? Who knew?

Posted by: justin case at May 15, 2007 9:38 AM

I don't think there's any grand subtext to the story, it's just poorly written. The tiramisu-burp thing didn't work at all. Especially right after the veal dyspepsia bit.

Then the author contradicts himself by saying "my patients expect my to be their advocate" shortly before telling the story of a patient who just wants pills to magically solve their problems, which the pharma reps were all to willing to provide.

A better angle would have been "the pharma reps want me to sell their pills, my patients pressure me to sell them pills, who am I to get in the way? I'm just a silly uneducated doctor."

Posted by: Gary S. at May 15, 2007 12:17 PM


How could you experience self-loathing, when you appear to loathe everyone else? Also, I love the comment describing yourself as a "very sane, very happy" person. Can a person really self-diagnose whether they are truly sane or not?

Posted by: Samantha Don at May 15, 2007 3:04 PM

Perhaps not. But, Albert Ellis called me sane in print.

And the way you loathe me, Samantha, most recently posting:

So your just cheap?

...Self-loathing seems like overkill!

Did I run over your cat or something?

Posted by: Amy Alkon at May 15, 2007 5:43 PM

"So your just cheap?"

Is "just cheap" a noun phrase I just haven't heard of before, that would take a possessive modifier? Because, if not, Samantha, that should have been, "So YOU'RE just cheap?"

Posted by: marion at May 15, 2007 7:27 PM

Amy dear, you're feeding the trolls again. Stop it. What Samantha writes reflects more on her than on you. The sarcasm of your self-loathing remark was totally lost on her -- don't bother to educate the uneducatable.

Posted by: Marie at May 15, 2007 10:59 PM

"Albert Ellis calls her "saner than most of the therapists I know." " I think that's a relative judgement not an absolute one.

What happen to the free speech mantra of this site?

So, Marie, if someone writes something with which you don't agree, then you call them a troll?

Posted by: Samantha Don at May 15, 2007 11:33 PM

Wise advice, Marie.

Posted by: Amy Alkon at May 16, 2007 12:42 AM

Hmmm, it seems Samantha speaks a little too freely. Samantha, it turns out, is also "Todd" posting nasty remarks on the blog item about LA Times panel I moderated, and the another nasty snipe on the Dodgers game I blogged. And she or he once even posted under the name "Brian" on the piece about LA traffic.

Seems Samantha has a truthiness problem.

Here, I'll paste them in below (sorry that my software squishes them a bit) . Samantha, what's your real name, honey?

And this is interesting because? Todd Getting There Is More Tha... 2007.04.27
Its a fricking book festival. Why should it matter how "well put the together" the paneli... Todd LA Times Festival Of Book... 2007.04.30
I think the other panelists look just fine. I would prefer to hear what they have to say ... Todd LA Times Festival Of Book... 2007.04.30
I went to Festival of Books on Saturday. Had I wanted to hear what this panel had to say I... Todd LA Times Festival Of Book... 2007.04.30
So your just cheap? Samantha Don LA Times Festival Of Book... 2007.05.01
Amy, I am many children have you raised. What I love is how people who don'... Samantha Try The P-Chip 2007.05.05
Yes, it would be great if somebody could do something about the traffic, but Amy what reas... Brian LA Would Be A Big Small T... 2007.05.07
"Albert Ellis calls her "saner than most of the therapists I know." " I think that's a rel... Samantha Don Is There Some Joke I'm Mi... 1 hour, 10 minutes ago

Posted by: Amy Alkon at May 16, 2007 12:49 AM

When we were kids, Samantha/Todd/Brian was the one ratting you out while they hid behind their mothers skirt.

Posted by: Roger at May 16, 2007 5:18 AM

I loved your call out on this column (and Gary's mini-analysis above).

I don't like the transparently mawkish details about the eldery patient, nor the air of "lite" self-mockery by the writer as he very, very, very gently beats himself up for his moral indigestion.

Posted by: Jody Tresidder at May 16, 2007 5:48 AM

Right. I smelled a troll, didn't I?

Posted by: Marie at May 16, 2007 6:47 AM

"How could you experience self-loathing, when you appear to loathe everyone else? Also, I love the comment describing yourself as a "very sane, very happy" person. Can a person really self-diagnose whether they are truly sane or not?"

As with the cheap comment, your grammar is lacking. You should have written it this way:

Can a person really self-diagnose whether HE OR SHE IS truly sane or not.

Please, when attempting at an insult, at least use correct grammar. Have you considered that, possibly, you are not intelligent enough to follow the insight Amy extends through her writing, especially her artful use of irony, metaphor, and tone? It is what good writers can do.

Just curious, but why are you so offended by Amy's ideas?

Posted by: kg at May 16, 2007 9:57 AM

I try to schedule my doctors' appointments right after lunch, because that's when many of the foxy pharmaceutical saleswomen (are they still called "detail men'?) drop by.

(Incidentally, as I've let Amy know off-board, I am most decidedly not that "Todd." Though I was at her Festival of Books panel!

Posted by: Todd Everett at May 16, 2007 11:32 AM

Meet the new drug, just like the old drug. Maybe. The doctor really has no way to know, unless his patients try it. Yes, some are pretty much the same. Some, hopefully most, really are better. The average life expectancy is still rising, so some of this must be working.

Absent the drug companies, we'd be in a very bad way when the next AIDS epidemic starts. We now have germs resistant to most antibiotics. I'd prefer the drug companies keep looking, thank you. Anyone who prefers the Cuban or Canadian model is welcome to try them.

There really is no way to get the benefit of new medicines without the cost. Somebody is going to pay, or we'll all do without.

Posted by: MarkD at May 16, 2007 2:07 PM

There are actually seven people that live here. Do you know them as well? We "discovered your site, and are very amused.

Posted by: Samantha Don at May 16, 2007 3:50 PM

All seven of you using the exact same computer to post from, huh? Samantha, admit you've been caught, and take your petty, grammar-challenged ass elsewhere.

Posted by: Amy Alkon at May 16, 2007 4:09 PM

Amy, Amy, Amy, I have so few outlets for my grammar fascistic tendencies, and you're sending away such a ripe target? I never get to have any fun! Whine!

Posted by: marion at May 16, 2007 6:09 PM

It's one of the many things I enjoy about you. Something tells me she'll be back to spread many more tiny turds. Of course, slapping the likes of her (and/or the rest of the alleged seven dwarfs) around is kind of like shooting fish in a barrel - only easier.

Posted by: Amy Alkon at May 16, 2007 6:42 PM

I so tried to stay away from this one. I was in medical equipment and hubby still is a doc. It may be tough for some people to hear, but medicine is a business like any other. (More heavily regulated though.) Docs are not allowed to have gifts but there are lunches. Hubby's group has a drug rep (previous commenter absolutely correct about beautiful young woman part) they hate. She is a pain in the ass, brings the shittiest lunches, but she has the BEST drug for patients. The group has a competing rep- much more personable and provides awesome lunches- but the drug is too expensive and the efficacy level is not on par with irritating rep's brand.

The better drug is prescribed.

Posted by: miche at May 18, 2007 12:49 AM

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