Capitalizing on the recent congressional pressure and guidelines adopted by the American Medical Association about drug company inducements for doctors to prescribe their wares, Merck Sharp & Dohme has taken the reverse tactic.

Under the heading, "Statement of Principles Guiding Promotion to Physicians" MS&D now brags that they only offer doctors gifts of nominal value, do not pay physicians subsidy to attend conferences or meetings or pay for travel or hotel (although the company did, it hastily points out, for "some" of their educational meetings before the AMA guidelines were adopted).

MS&D's president John Zabriskie has even sent a letter to doctors announcing their support for the AMA guidelines and asking them to fill out a questionnaire indicating what they think of the company's new policy in order to "promptly correct any problems".

Can it be long before drug companies compete over who hands out the cheapest ballpoint pen, sends doctors to the worst conference centres or offers the most paltry honorarium?

Meanwhile, MIMS magazine enclosed an insert with its latest issue, entitled "HOW DO YOU DEAL WITH A DEPRESSED TEARFUL PATIENT IN SIX MINUTES?"

"The problem with these patients, "said the inside copy,

"is that talking to them always seems to open a can of worms. One question and you can find yourself immersed in a long and often desperately sad monologue in which the patient pours out their heart and then waits for you to come to the rescue."

But help is at hand, in the form of a MIMS lecture series, which promises to help docs learn how to counsel these patients, work out who the real suicide risks are, determine when to send them onto some other sucker and all this before the patient even has taken off his hat.