Editor's note: This opinion piece was originally written for our sister publication, ADVANCE for Nurse Practitioners. We're adding it to our site because it also applies to physician assistants. Please feel free to share your thoughts on this piece in the comment section below.

Although most health care providers would firmly deny that they are influenced by pharmaceutical marketing, evidence to the contrary is mounting. The truth is that pharmaceutical marketing--the three "F's" of flattery, food and freebies--are powerful tools that adversely influence our patient care decisions.

What's the Harm?
Pharmaceutical marketing increases the number and cost of prescriptions. So while the drug companies pay for dinner, our expenses are passed on to patients and third-party payers and, ultimately, increase health care costs for all of us. Patients become two-time losers: They pay more for drugs, and they also pay for the marketing freebies.

Say No
My own professional journey away from drug marketing took years. The lunches and free "educational" events are hard to give up. Like many NPs, I was uncomfortable with the three F's, but I viewed them as part of normal professional practice. I liked dinner at a nice restaurant. I was also naive enough to think that the programs were all educational. And my patients were grateful for free samples--until they filled the prescription!

It is not easy to say no. A physician colleague observed that participation in marketing is like an addiction, and this analogy has been used for years. The Web site www.perxinfo.org has helpful information and a series of educational modules about evaluating drug information.

You've Got a Problem When ...
Based on my observations, you may want to reconsider your pharma perceptions if the following apply to you:

You use large bags to collect goodies at meetings. Conference exhibit halls are often the site of unusual freebie frenzy. NPs often carry large tote bags to cart all the pens, papers, candies and other items given away at the booths. At one meeting, I was surprised to find several NPs carting around suitcases for freebies.

You attend a meeting because you will get food. I know of one professional group whose industry-sponsored dinners were attended by NPs who left after the meals. Ask yourself, would I attend this meeting if there were no food? If yes, you can attend the meeting and refuse the food.

You see a drug representative only to get something. Sampling is a good example of using a drug rep to get something. The truth is that you get the samples, but the samples get you and your patient. The sale of prescription drugs increases significantly when they are sampled. The strategy for increasing sales is not hard to follow. Prescribers are taught to use the drug because they are handing the drug out to their patients. In many cases, time matters, and if prescribers have quick information at hand, the drug soon becomes one of their main arsenal agents. Samples also have a positive effect on patients, but the benefit may be short lived. Often the recipient is treated with a more expensive alternative to generic drugs.

Recent guideline changes from the Pharmaceutical Research and Manufacturers of America are limiting noneducational materials to health care providers. (Read the guidelines at www.phrma.org.) The new guidelines may limit freebies, but they have not curtailed the food and activities. Still, it is a change in the right direction.

Nancy Crigger is a family nurse practitioner and nurse ethicist who has a PhD in nursing and a master's degree in philosophy. She is an associate professor at William Jewell College in Liberty, Mo.