I was a young doctor. I had it in my power to help this guy. So I did.
He was a drug rep. Sitting opposite me in my consulting room. Half a century – most of a lifetime – ago. He had been waiting outside for much of my morning surgery, as reps used to in those days, hoping I would see him before I started on my paperwork and visits. As usual it had worked – me being too soft-hearted to say no and send away a fellow human being with a wasted morning. ‘There but for the grace of God’, and so on…
So there he was, and as well as laying out his samples and his glossy leaflets and his free-lunch offers, he was telling me a personal tale of woe. It may have been his idea of a novel pitch, but something about his demeanour struck me as genuine and it got round my usual defences big time. I remember it went something like this: company cutting down on reps – prescribing figures in his patch down – in danger of losing his job – children at home – wife…
So. I had an impulse to help him. To my utter shame as a rational scientific doctor, from that day and for a long time afterwards I changed the routine medium strength painkiller I prescribed to one of the preparations he had been pushing. I mean promoting. Paramol 118 was the name of the drug. A nicely packaged mixture of good old paracetamol and dihydrocodeine. The latter a mildish opiate in widespread use at the time under the trade name DF118. So it was a perfectly legitimate preparation of well-established ingredients likely to be effective in one of the commoner clinical indications – pain control.
I should explain that in those days long ago, before limited prescribing lists, National Institute for Clinical Excellence (NICE), generic substitution, and even before NHS prescription charges, the doctor’s clinical freedom was regarded as sacrosanct. We general practitioners (GPs) could write prescriptions for any approved drug that we liked. The pharmacist would dispense it without question and the NHS would reimburse them.
The point of this story is that it taught me a valuable lesson – it made me realise how easily my judgement can be influenced. I am not proud of that, but I am proud of the fact that I acknowledged it and took steps to protect myself. I made it an inflexible rule that I never saw reps, so the receptionists told them that and they never sat all morning waiting in hope. I never went on drugs company lunches, in fact I never had had time for them anyway, and with one exception I never went on ‘freebies’. The one exception was when a local company, Merk, arranged for a glider flight at the local airfield, Lasham, which was irresistible and remains a sensational memory. Most particularly, I never allowed reps to set up their stalls in the corridor while I was a course organiser on the Wessex GP Training Scheme.
None of this was particularly popular. The most respected GP colleagues would tell me confidently that they never allowed themselves to be influenced as I had been. But somehow I always doubted that the average of four thousand pounds per GP per year that the pharmaceutical industry was spending in those days, was entirely wasted, even on them. The fact that in subsequent years my prescribing costs were the third lowest in Hampshire (something I had to work out for myself from the tables we were sent) added to the feeling that I was right about this.
The moral of this story is that we are much more open to influence than we like to think. We now know that the various organisations seeking to influence the 2016 EU referendum used social media to target voters in a way which was vastly more sophisticated than anything employed against the judgement of doctors like me in the 1970s. We know that a foreign power, Russia, used similar techniques to achieve the same objective. By analysis of millions of stolen social media records, yielding frighteningly-detailed personality profiles, both identified people who were likely to be persuadable. Arguments were chosen that were likely to strike a chord with these individuals. (In the same way that my rep, years ago, struck a chord with my human sympathy). They then bombarded each of these people, in a way which was hidden from general sight, with messages of prejudice, hatred and misinformation. What’s more, they subsequently claimed credit for swinging the result of the referendum and precipitating the expected withdrawal of the UK from the EU.
So, when I read people saying that they think it unlikely that these campaigns of targeted propaganda had a significant effect on the result, still less that they cast the validity of the result into serious doubt, then I remember the respected colleagues who were so sure that the pharmaceutical industry was wasting its money in trying to influence their magisterial clinical judgement.