Indian Taxi Wallahs and American Medicine

In India, we’re just back from a visit, cab and rickshaw wallahs receive commissions from emporiums and other shopping outlets for bringing customers. As a result, when you are with a cab driver they recommend only those places which gives them commissions.

Cab drivers are thus not reliable sources of information about shopping and may even resist your attempts to get to the places you really want to visit. The situation is complicated by the fact that in India shops’ names are often near duplicates of each other and every store will claim to be that government emporium your guide book recommended.

Sound familiar? While on a different monetary scale, the situation is similar to the corroding effect of drug company’s gifts, consultant fees, salaries, “fourth phase” research funds etc, on physicians in the U.S. We’re talking thousands to millions of dollars here. At the most basic level, these funds, commissions if you will, are designed to encourage physicians to bring their clients to the pharmaceutical company’s products. These payments at a minimum give the impression that physicians are not objective sources of information about treatment and may have an actual conflict of interest. In the U.S. we’ve more fully developed the system so that the agents of the pharmaceutical companies (detail people) can actually check with pharmacies and confirm that their physician wallahs are recommending their product and if necessary provide more effective incentives to influence them.

This timely article explains, in part, how it works.

What the hell has happened to my profession!

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