Meandering round the Milngavie Reservoir the other day I beheld the awesome sight of an Emirates Airbus A380, newly airborne out of Glasgow, and passing overhead at about 3,000 feet. The enormous airframe seemed almost stationary in the cloudless sky, defying the laws of physics, the engine note remarkably quiet. In a few moments it had disappeared into the deep blue. I think on the same day news had come out that Qatar was to gift President Trump a brand new, extremely luxurious, and extremely expensive Airforce One. It’s not really for me, said the President, but for America. Timeo Danaos, et dona ferentes. (As a child studying my Virgil I used to think of Donna Ferentes as a Latin American pop star. The name has a certain euphony; all Latin verse lines end in the same rhythm: strawberry jam-pots.)
Political leaders have been in receipt of gifts since time immemorial. Think of Lloyd George and cash for honours. More recently, Tony Blair’s New Labour were in receipt of £1,000,000 from Bernie Ecclestone, and, by a curious coincidence, the ban on cigarette advertising in sport was found not to extend to Formula 1. Sir Tony had a kind of Teflon defence – it was perhaps its first manifestation – that clearly everything had been done in good faith because, “Most people know I’m a pretty straight sort of guy.” When more recently I heard of the Prime Minister et ux receiving gifts of fine apparel and free tickets to Taylor Swift’s Eras tour, I remember I shook my head and muttered, “Don’t they know there is no such thing as a free lunch?” These transactions carry with them a vaguely noxious subliminal aroma. People who donate are not merely philanthropic; they expect something in return. A friend of mine once attempted to shout another friend a coffee in a place in Sicily. The barista shook his head and said, “Everybody pays for himself here.” That was how the Mafia got you, with a gift. Once you take the gift, they own you. You may not think they own you, but your opinion no longer matters. They’ve got you. A big guy with a quiet hoarse voice, his gums stuffed with cotton wool says, “That’s a lovely wife and family you have. It would be a pity if something unfortunate were to happen to them.”
I found myself smugly reflecting that I would never succumb to a bribe. After all, I’ve never even received a professional bonus (apart from when as a boy I delivered newspapers for £1.00 a week. I got £2.00 at Christmas). But then I remembered.
When I was in medical practice I would see representatives of pharmaceutical companies – drug reps. Not all my colleagues did. They refused to be influenced to prescribe one drug over another, other than on the basis of evidence-based medicine. Many of them prescribed generically, without recourse to brand names. I saw reps largely as a courtesy. If they had the patience to sit in the waiting room until I had finished consulting, it was only polite to give them five minutes of my time. I had a running joke with the practice receptionists – politically utterly incorrect – that I would see them if they were attractive enough. The receptionist would pass me the rep’s business card and say, “You’ll definitely want to see her!” I told myself that whatever the rep’s pitch, I would not be influenced; water off a duck’s back.
Twenty odd years ago I had a fling with a rep, and when she eventually dumped me I buried my sorrows my going on a spree of posh pharmaceutical meetings. Perhaps I wanted to wreak some generic revenge upon the industry – who knows? This was at a time when going on such junkets was deemed perfectly acceptable. Indeed they were almost a requirement of continuing medical education, the need to demonstrate that you had attended so many hours of lectures, seminars, etc. I went for the top end, and I remember in particular three weekends at five star hotels, first at Gleneagles, where I occupied a suite, with exquisite underfloor heating, the size of a badminton court; then a golf hotel in St Andrews round the corner from the Old Course; and finally, of all places, Trump Turnberry, though the President-to-be had yet to acquire it. I remember little of the academic content of these meetings. I do remember at Turnberry a lawyer giving a talk on medical misadventure, litigation, and the perils of going to law. “Remember,” he said, “When you go to law, you may think you are inviting us to enter your world. But we are not entering your world; you are entering ours.” That is remarkably similar to what the barista told my friend in Sicily.
Of course, I ended up prescribing the drugs of the pharmaceutical companies hosting the events. They didn’t even have to advertise them, plug them, push them, or give me a scintilla of evidence that they were more potent, or efficacious, than those of their competitors. The names, the branding, the ambience; these were enough.
Shortly afterwards, meetings of this kind came to an abrupt end, when, as I recall, a pharmaceutical company hosted a group of GPs to a dinner of spectacularly conspicuous consumption. A dozen people in a restaurant racked up a bill of about £50,000. Scandalous. This happened around the time of Shipman, and the whole creaking edifice of drug-sponsored continuing medical education was replaced by “Appraisal”, a system by which every GP would be assessed annually by an appraiser, ostensibly to ensure they were keeping abreast of the contemporary customs and mores of practice. I actually trained as an appraiser, and appraised 25 of my colleagues over the course of a year, before packing it in. I never believed in the efficacy of appraisal. It was just another hurdle to be negotiated. I colluded with my appraisees: this is the easiest way to tick this particular box.
GPs generally adopted an attitude of resigned cynicism towards appraisal. “Shipman would have been an exemplary appraisee!” It was said that he was rather a good GP, and a popular one. There was indeed something vastly incongruent about appraisal as a logical response to Shipman. Shipman after all was a serial killer. It was as if an airline pilot had been discovered to be poisoning his passengers when they visited the loo. In order to ensure this would never happen again, the pilots’ ability to fly the aircraft would be more rigorously assessed. It was as if General Practice as a whole was being collectively punished because the most prolific serial killer in the history of the UK happened to have been a GP. When Shipman committed suicide in jail, I happened to be at another medical meeting, in London, not sponsored by Big Pharma, but by the British Medical Association. On news of Shipman’s death, David Blunkett, Home Secretary at the time said, “De-cork the champagne bottles!” Or words to that effect. I voiced disapproval. The Home Secretary should not rejoice over the death of a prison in-mate, no matter how heinous his crimes. My observation did not go down well.
Now that I’ve hung up the stethoscope, I’m not aware that I am the recipient of any bribes, bungs, or sweeteners. But you never know. That is the subtlety of a bung; it is invisible. One of the delights of retirement is that you can shout your friends a meal without any expectation of reciprocation. When they demur, I say, “Give me this small pleasure!” It’s as if I want to demonstrate that there is, after all, such a thing as a free lunch.
jamescalumcampbell 