NOFREELUNCH NEEDS YOU!

By Des Spence
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

We were just the thicky medical students destined for the wasteland of general practice. Why should anyone listen to us. I sought to better myself with diplomas only to realise that my new letters were an anagram of “Mickey Mouse”. According to my hospital correspondence my only expertise lies in misdiagnosis and mismanagement. Now this could seem bitter but I really don't give a damn what other people think of my inner city career choice. I passionately believe in general practice and know that it is the heart and soul of medicine. I believe that General Practice is a vocation and would choose no other job in the world -vomit break . This might seem trite nonsense but I know that lots of you wets secretly feel the same way ! On a different tack, ever get fed up with experts? How often have you seen stories berating GPs written by experts who have never spent a single day in the trenches of general practice? Why is the health agenda dominated by the secondary sector ?

Now you are probably saying “what the hell has this to do with nofreelunch and this guy is more of a soap box nutter than I thought.” Bear with me as in a round about way these are some of the core themes of nofreelunch.

The problem is that the health agenda is focussed on disease and not health in its broader context. This is why we get angry at the hospitals, when our fading patient, who really only needs quality community nursing care, gets “best evidenced” care. We see inappropriate polypharmacy and a merry-go-round of referrals to other “specialists”. We feel powerless to intervene because the specialist is always right. You can't completely blame the hospitals for this distortion of health as much of the intervention obsession has been fuelled by financial interests of the pharmaceutical industry. The Industry have systematically and cynically targeted opinion leaders, controlled research, pressurised leading medical journals, manipulated the media and poured money into patient support groups.

The industry costs the UK £10 billion a year and rising. To give some perspective on this money, consider that £1 billion would provide 40 000 extra police officers in the UK. What impact might this have on the health of many communities across the UK? Consider also that the industry spends £10 000 per doctor per year on promotion which is defended as “education”. This “education” is delivered by a network of 8,000 representatives targeting 70,000 NHS doctors. We could all attend a full time boarding school for this sort of money! We all know that this isn't really education but it hard to escape the marketing under current conditions. A recent confession of a medical representative gives a flavour of the methods used.

“You use every other tool at your disposal …….flattery, flirting, trips, expensive dinners. I used to come away some days feeling like an escort. ………..I know some reps who'd sleep with doctors just to get their drug prescribed………I think everyone is aware of the ABPI codes, but even if we did take notice of them, there were always ways of getting round them. We used to set up mock conferences, college reunions, or pay for doctors to go to the States for a conference, but really it was just a holiday.”

We said things at our admission interviews that still makes our toes curl and then stuck our hands up as 23 year olds and took an ancient oath. Mine was in Latin, but the rough translation goes that I have a duty of care to put the needs of my patients above all others. Do we still believe this?

We don't need the freebies, the syco-phantic dinners and the patronizing pulped education delivered by experts in the pay of pharmaceutical companies. Buy your own bloody lunch, you can afford it! Go home and have dinner with your family and friends. As for education - you don't need to hear how a cardiologist manages “Hyper-tension in Primary Care” because they've never damn well done it.

We need the support of GPs at nofreelunch and you can make a difference. GPs have life skills and a perspective wrought from shoring up the lives of society’s most vulnerable. Seeing pensioners existing on £70 a week, but being dispensed a £100 worth of questionable medication per month. Being whisked off to lunch by a representative in a BMW, only to walk past your patient begging at a bank ATM.

Finally we are not anti capitalist hippies and fully accept the need for an innovative pharmaceutical industry. The current relationship, however, is undermining public trust in doctors and is simply wrong. We are calling for the Industry to produce an open public web-based register of all contact, hospitality and payments received by health professionals. If there isn't a problem then why should anybody object.

Want your say come to www.nofreelunch-uk.org.

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.