Right now, Dr. Daniel Carlat’s article, “Dr. Drug Rep,” is sitting atop the vaunted Most E-mailed list on nytimes.com.  Featured in Sunday’s New York Times Magazine, Dr. Carlat’s narrative recounts his year as a paid speaker for Wyeth Pharmaceuticals and its depression drug, Effexor.  Carlat, a psychiatrist with a practice in Newburyport, MA and author of a great blog, spins an intriguing tale complete with dialogue, disillusionment, and Broadway glitz in four parts.  If you haven’t already read it, chances are someone has sent it to your inbox.

No doubt: We are a list-crazed culture. From the fatalistic travel book series 1000 Places to See Before You Die to the Seven Habits of Highly Effective People to Casey Kasem’s American Top 40, we are a people in love with the list.  And “Most E-mailed” at nytimes is no exception, showing a real-time ranking of the stories being sent (and to extrapolate, being read) most frequently from the New York Times website.  “Most E-mailed” has been elbowed as an echo-chamber metric, perhaps most charmingly by The Onion, which reported in April that the coveted top-ten was tearing the New York Times newsroom apart.

But despite this and other “real news” criticisms, nytimes.com “Most E-mailed” has become the sidebar to watch for what people are talking about around the web-based water-cooler.

And what they are talking about today is Carlat’s “Dr. Drug Rep.”  Over every other Times news story.  We read this as a really good sign that pharmaceutical influence on doctors—the economics of it, the tactics, the pervasiveness (Carlat cites a report that estimates about 25 percent of U.S. physicians receive money for speaking about or helping to market drugs)—is at the top of readers’ minds.  And though we’re biased, we think that’s where it should be.

The blogosphere is also a-flutter with Carlat’s confessional (the story is currently at #8 on the Times Most-Blogged tab), and is yielding some interesting side stories, including a comment on Pharmalot from an ex drug rep who says that some pharmaceutical reps just go through the motions of setting up speaking engagements and ‘ghost-dinners’ under pressure to spend their speaking budgets. More blogs here, here, and here.

All of this buzz comes along as more and more legislation is being introduced at the city, state, and federal level to alter the way drug companies court and co-opt doctors.  Recent headliners include the Physician Payments Sunshine Act, similar legislation slated to be introduced in the House, Maine’s data-mining restriction bill, and the Safe Rx Act being considered by the D.C City Council.  It’s a natural feedback loop, and the volume is growing. 

Does all this add up to our nation taking stock, just as Carlat did, about the ethics and consequences of our relationship with medicine and the pharmaceutical industry, and the relationship we permit between the two?  Perhaps.  Or perhaps it’s too a big leap to see the patchwork of moves by individual, corporate, academic, and public healthcare stakeholders as the actions of a united, albeit clumsy, moral agent.  Either way, it seems we can read the growing policy and media attention—measured in bills and newspaper inches and airtime—like a loudening macro version of the silent internal dialogue Carlat describes having with his conscience after each Wyeth talk he gave. 

It will be interesting to follow this story and see whether this interplay among policymakers, press and the public concludes, as Carlat’s tale did, in a collective, incremental “No Thanks.”