Prescribing Under the Influence?

Earlier this year, a group of physician leaders from some of the nation’s top medical schools called for a ban on physicians receiving gifts like stethoscopes office supplies, free lunches, tickets to sporting and entertainment events, drug samples, and money
for attending educational seminars sponsored by drug companies often held at vacation destinations and/or fine restaurants. Drug companies also pay physicians as “consultants” when they appear on panels at conferences and seminars speaking on behalf of the benefits of the drug. Some physicians are even provided “ghost writers” from the drug companies so that the doctor can publish an article in a journal regarding the use of the drug and may be recruited to be a member of their speaker’s bureau. The doctors published an article calling for the ban in the Journal of the American Medical Association (February 2006).

The marketing budget of drug companies is huge: last year it was estimated at $21 billion of which the majority is directed at physicians. By law, pharmaceutical companies are forbidden to directly pay a physician for prescribing a drug or a medical device. But beyond that, everything else is self-regulated and voluntary.

Drug detail representatives visit doctor’s offices and hospitals in the hopes of gaining direct “face time” with physicians. Their intent is to convince the doctor that their particular drug is better than others to treat his or her patients. With so many new drugs available today, some physicians welcome the latest information on what medications are available and believe that if they are given anything, it’s simply a transaction reimbursing them for their time. Doctors contend that they certainly are not “bought off” with marketing trinkets of pens, pads, or lunches brought to their office. On that score, most of us would be inclined to agree.

Yet, some studies have shown that doctor’s prescribing habits are related to the drug samples they have on hand to give out to patients and that the subtle psychology of repeatedly seeing drug company logos on office and medical paraphernalia along with the unspoken need to reciprocate when given a gift (no matter how small) is having a positive effect in increased drug sales. It’s hard to believe that an industry would spend billions of dollars on a strategy that clearly wasn’t working.

The more troubling marketing tactics, I believe, are those that offer physicians consulting arrangements, doctors participating in drug company sponsored speaker’s bureaus, journal articles prepared by drug company medical writers on behalf of a physician reporting positive results in using the drug and sponsorship of continuing medical education events that are clearly tied to promoting a drug held at vacation destinations.

Here’s one example: When Searle launched their drug Celebrex they invited 300 doctors and pharmacists to Disney World to recruit them as members of a new speaker's bureau to spread the word
on the wonders of their new anti-inflammatory drug. Besides being paid for their time, they were treated to open bars, filet mignon, and all the hospitality that Mickey Mouse could muster. But even Mickey wasn’t enough, so Searle rented out Universal Studio for the attendees and their families so they could enjoy a whole night of no waiting-in-line rides. The docs were told they’d be paid $500 for every speech they’d give on Celebrex following the conference. The strategy sure seemed to work: Celebrex was the first drug to generate a billion dollars in sales it’s first year out.

Though this may seem like an extreme case, the incident is a lightening rod on the issue and continues to spark the debate as to how much drug company marketing efforts affect prescribing behavior of physicians. To clear up any doubt and maintain the trust and integrity of the doctor-patient relationship, here is what the medical school physicians recommend:

 Ban all gifts, including free, working and/or educational lunches and dinners;

 Prohibit doctors from accepting free samples, which the authors warn is a "powerful inducement ... to rely on medications that are expensive but not more effective." Instead establish a centralized voucher system to distribute samples to low income people;

 Prohibit doctors with financial ties to pharmaceutical companies from serving on panels that recommend which drugs should be prescribed (such as hospital formularies – a preferred list of drugs that a hospital pharmacy dispenses to patients);

 Ban medical school faculty from participating in drug company speakers bureaus or publishing articles ghostwritten by pharmaceutical industry medical writers;

 Require medical school faculty with industry consulting agreements or unconditional grants to post them on a publicly available Web site;

 Prohibit pharmaceutical companies from directly paying for continuing medical education classes and instead create a system by which pharmaceutical manufacturers contribute to a central account that supports educational programs.

These sure seem reasonable to me.

YOUR TURN

1. Would you like your doctor to tell you if he or she had a financial relationship with a drug company? Does it matter to you?

2. Are the drug companies merely offering an educational service that benefits the patient? Or is this influence-peddling that can actually harm patients?


Want to read more?

Kaiser Daily Health Policy Report
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=34993

Abstract of JAMA Article Urging Ban on Drug Company Gifts
http://jama.ama-assn.org/cgi/content/abstract/295/4/429