Shifted perspective

In his shortlisted essay for the 2017 John Henahan Writing Prize, 
Dr Rahil Chaudhary says the primary concerns for any medical professional need to be the patient’s welfare and society’s benefit

Rahil Chaudhary

Posted: Wednesday, September 27, 2017


Dr Rahil Chaudhary

To become an ophthalmologist, you spend years honing your abilities and deepening your knowledge. When you are finally ready to start a practice of your own, you will have the opportunity to use your skills to serve patients. However, the moment you open your doors to patients, you also attract customers of another kind. Drug representatives and other device manufacturers will pursue you as well, offering gifts and a sales pitch.
As young ophthalmologists, we need to be especially wary of such advances. The primary concerns for any medical professional need to be the patient’s welfare and society’s benefit. That is why the industry is governed by a code of ethics, which is managed by professional organisations.
In order to protect our integrity and our careers as ophthalmologists, we need to understand the risks of accepting gifts and other indulgences from for-profit companies.
First, we need to understand what these companies are all about. Obviously, pharmaceutical companies and device manufacturers play a critical role in medicine. They provide products that can and do help patients. If these companies did not exist, there would be limited innovation in the field of ophthalmology, and our ability to provide for patients would be diminished. These companies provide drugs and technology that we can leverage to provide better outcomes for our patients.
However, these companies need to make money. This means that their products may be useful, but that usefulness must be judged by our professional standards and not theirs. For these companies, it does not matter if the product or drug is actually the best. Instead, the company simply wants to make money. As ophthalmologists, we are dedicated to our patients. For-profit companies have a duty to their stockholders or owners. If we forget this distinction, we risk being regulated by the government and losing the respect of our patients.
In order to avoid being compromised by the commerciality of manufacturers and drug companies, we have to know what such compromise looks like. Drug and device companies use a variety of techniques. This starts with free gifts. They may offer travel cups, pens, keychains and more. They may also try to attract your attention with a free meal or a free trip. These venues serve as the backdrop of their sales pitch, which is designed to hit us while we have our guards down. All gifts or other perks need to be understood in context, and we need to acknowledge the risk of compromise when we accept any of them.
When free gifts are offered, most of us do not think they are risky. After all, we are professionals. We can sit through a free lunch without feeling committed to buying. Unfortunately, that is the mindset for-profit companies use for their gain. These fun events and attractive venues create a positive association with the product. In essence, these companies use our good moods to make their products even more attractive. All they have to do is get us to sit down for the presentation, and they have already made progress in their marketing efforts.
Most of us would argue that we still approach these meetings critically enough to escape the risk. However, research clearly shows that no one is immune to such advances. If we accept gifts or perks, our habits in the office usually begin to change. We tend to recommend those drugs and devices more often, and the more we take free gifts, the more 
our perspective will shift. This happens without our knowledge, and it compromises our professionalism.
The danger lies in the inherently coercive nature of marketing. No matter how good the product is, marketing is still about persuasion. Sometimes, this is an overt process, but the effect can also be subtle and cumulative.
When sales representatives present information, they do so in a controlled context. In essence, they provide only one side of the story. They extol the positive attributes of their product without discussing the drawbacks or other comparable techniques. Moreover, these companies do not discuss problematic elements of the product, such as the cost to patients or society.
Even when representatives provide data, we need to be critical. These companies sponsor research to get the results they want. This creates an inherent bias that we cannot allow. In order to decide if the product is right for our practices, we need to rely on professional research and comprehensive analysis of the cost and risk of the product.
For many ophthalmologists, drug representatives provide excellent access to pharmaceuticals our patients need. However, these sales representatives have a specific goal to make money. Accordingly, drug representatives are almost always personable, and they take the time to get to know us and our practices. This is their way of developing a professional relationship. Over time, this can create a bias in any practice. We will start to favour that company, even if we do not intend to be biased. These representatives may be an inevitable part of the business, but we need to be wary of investing in a relationship with one.
Ultimately, nothing is truly free. If we take a gift or perk, we are creating a relationship with that company or salesperson. With every gift, that relationship strengthens. This will compromise our integrity and create a conflict of interest. Instead of looking out solely for our patients, we will start to think about our loyalty to the company. Moreover, we will stop considering the best practices and look for the easy solution. This conflict of interest will impede our ability to serve our patients faithfully.
This conflict of interest can also shortchange our careers. Many doctors have been wooed away from their practices and universities to work for for-profit companies. There is simply no way for other institutions to match the perks offered by such employers. This means that the best and brightest doctors in ophthalmology are no longer actively practising. This deprives patients of their doctors, and it eliminates the potential for powerful mentoring relationships with upcoming ophthalmologists.
Therefore, we must remember our priorities. If we focus on our practice of ophthalmology and keep commercial interests at bay, we can protect our careers and our patients.

Dr Rahil Chaudhary is Managing Director at the Eye7 Chaudhary Eye Centre in Delhi, India