Doctors: Stop Taking Pharma Gifts

It is wrong for physicians and their staff to accept trips, meals, or gifts from pharmaceutical companies. Pro or con?

Pro: A Categorical No-Thank-You

During the past 10 to 20 years, there has been a growing intrusion of pharmaceutical companies and medical device makers into the day-to-day practice of medicine. Industry gifts—pads, pens, logo bags, and the like—have grown commonplace. In many doctors’ offices, hospitals, and medical centers, the free lunch, courtesy of industry sponsors, has turned into an accepted way of life. And these gifts can also include dinners at expensive restaurants (to hear a lecture by a physician also being compensated by industry) or free travel to meetings at fancy resorts (to participate in a medical education event sponsored by industry).

That is not to say I don’t value our relationships with the pharmaceutical industry. Indeed, we depend on our industry partners to carry the fruits of our research to market. At the same time, data increasingly show that even small gifts influence the drugs physicians prescribe. On a larger scale, physicians who serve as paid consultants to industry are more likely to recommend the approval of a drug or device to the FDA than those not receiving consulting fees.

In 2005, I appointed a faculty task force to develop a policy on how Stanford should ensure that our relationships with industry are ethical and appropriate. In October, 2006, we enacted a policy across the Stanford University Medical Center campus, prohibiting our faculty members from accepting gifts of any kind, however small, anywhere on the medical campus or at off-site facilities where they may practice.

It also bars industry sales and marketing representatives from wandering the hallways of our two hospitals and our laboratories, and prevents companies from directly paying for meals in connection with educational programs—once a fairly common practice. It requires that those involved in the decision to buy formulary drugs or clinical equipment disclose any related financial interests.

We are also developing guidelines for physician participation in “speakers bureaus,” which offer generous honoraria from companies for taking part in presentations related to company products.

Since our policy went into effect, many other academic medical centers have followed suit. As we train the next generation of physicians under these new standards, we will sow the seed for what could be a wholesale cultural change in the U.S. medical profession.

Con: Yes, But with Conditions

U.S. physicians are committed to quality health care. It’s part of the oath they take. So, despite what critics say, it’s insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary. What’s more, there are regulations and a comprehensive industry ethics code to help make sure information about new treatments provided by America’s pharmaceutical research companies is accurate and well-substantiated.

Existing federal law is very clear: Pharmaceutical research companies and their technically trained representatives, including some health-care professionals, must not give physicians anything of value in exchange for the doctors writing prescriptions for their medicines. The companies must also ensure that information they convey to physicians is consistent with pharmaceutical product labeling approved by the Food & Drug Administration. The fact is, federal and state authorities, including the FDA, the Justice Dept., and state Attorneys General are closely monitoring for improper activities.

For its part, the Pharmaceutical Research & Manufacturers of America (PhRMA) sponsors ethical guidelines to keep communications between its member companies and physicians focused on proper use of medicines and the needs of patients. The PhRMA ethics code says all forms of entertainment are inappropriate and only modest meals—such as sandwiches—should be provided when doctors meet with pharmaceutical research companies. Additionally, our code says items given to physicians should not exceed $100 in value and should be things, including stethoscopes and medical dictionaries, that benefit patients or support a medical practice.

In the end, it’s clear pharmaceutical research companies have the most extensive information about new medicines. After all, they devote 10 to 15 years and spend nearly $1 billion to develop just one new medicine in a process that generates thousands of pages of scientific data.

To us, the evidence is compelling: Physicians meeting with well-trained company representatives gain crucial knowledge about side-effect profiles and proper use of medicines. And when doctors are given free pharmaceutical samples, they receive valuable firsthand experience that helps them decide which medications to prescribe. The simple fact is company representatives help physicians provide effective patient care. And that often saves lives.

Opinions and conclusions expressed in the BusinessWeek.com Debate Room do not necessarily reflect the views of BusinessWeek, BusinessWeek.com, or The McGraw-Hill Companies.

Reader Comments

random

"U.S. physicians are committed to quality health care. It's part of the oath they take. So, despite what critics say, it's insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary."

It may be insulting, but the truth is often unkind. One of the first things a marketer learns in business school is that by giving people freebies, these people will develop a positive response to your brand name and logo. In psychology, this concept is known as emotional equilibrium. If I do something nice for you, you will want to do something nice for me in return. It's an evolutionary drive present in social mammals like us. It builds social standing and allows the community to stay stable and orderly.

So we can angrily demand to know "how dare someone accuse doctors of being influenced by promotional freebies?!" but that doesn't negate the fact that doctors are human and the rules of evolution and social interaction apply to them too.

NISHIKANT

A good debate but with no solution. Doctors are human, too, and greed for these freebies applies to them as to any one of us. Moral values are rising, so maybe the conscience of the doctors will govern the issue. Pharma companies are there to make a profit, so whatever it takes to lure doctors, they will do.

RXone

To those who support the con perspective, I must respectfully ask you to remove the wool from your eyes. I have been in this industry for 20 years. I have seen many instances where marketing trumped science, and physicians were influenced to prescribe. PhRMA may sponsor ethical guidelines; however, they are left mostly to the physicians and others being "detailed" to enforce. There are many ethical physicians who remain true to their science roots. I suspect this is the minority.

Nina Chamness-Aguirre

The medical boards of each state should include as part of their ethics statements that doctors cannot accept any gifts or freebies of any kind from drug-company or medical-device representatives. Access to information about drugs and innovative machines should be available to doctors and the public at conferences and in medical journals--but not through marketing or sales campaigns.

longnt

It is not wrong or right for physicians to accept these freebies. It is their actions after receiving gifts. Pharmaceutical companies, like ones in other industries, have to advertise their products in the most effective way. Their target is doctors, not ordinary people, who have no right to choice what drugs to use. If we look at the percentage of their spending on advertisements, it may be much lower than in other sectors. Imagine that a marketer visits a doctor for whom time is money. He may refuse to accept. Do you want to spend your precious time for nothing? The drug catalog dropped on his desk will surely be thrown into the bin.

If companies' products cannot sell, they will go bankrupt. No one will do research to produce drugs to cure our diseases. All of us could die prematurely.

lee

Pro, con, that's the issue? The issue is how pharma makes nothing that works and sucks the money out of people. Pharma, tobacco, alcohol, and sugary foods, crap. All crap.

Dr. M Johnson

If the freebies didn't influence physicians, would intelligent, sophisticated companies with access to the most advanced marketing research in the world spend so much money on them, year after year after year?

If the freebies don't influence physicians, why do pharma companies resist banning them?

Greg Kelly

The bottom line is, are America's physicians to be trusted to do the right thing? History shows the vast majority of doctors always put the interests of their patients (and by extension their professional reputations) before any gift they get from drug companies.

And national polls consistently show that the vast majority of Americans (in the 90% range) trust doctors to give them unbiased advice. Let's leave it at that.

Greg Kelly
Editor
Physicians' Financial News

Robert Laughing

Free? Nothing from Big Pharma is "free." Everyone pays 10 times over for these trinkets and baubles. They also need the money to ensure Congress permits them every method of marketing and pricing abuse, and should their actions become so uproariously outrageous, our government "fines" them a few pieces of silver. And that just goes to Congress to spend, spend, spend. I'm voting against every incumbent come November. It is the only way.

Roger McNamee

Mr. Kelly, editor of Physician's Financial News, claims, "History shows the vast majority of doctors always put the interests of their patients...before any gift they get from drug companies."

I just searched the most likely databases of publications and found no data and no historical work that demonstrate that the vast majority, a slim majority, or any proportion of doctors always put the interests of their patients before gifts from drug companies.

As an editor, Mr. Kelly would not make a claim that is totally unsubstantiated. Perhaps he could provide a citation for the claim that history shows it.

RXone

I agree with Greg Kelly to the extent that "the vast majority of doctors always put the interests of their patients (and by extension their professional reputations) before any gift they get from drug companies." The crux of the issue as I see it is this: Physicians may prescribe a medication that is indeed in the best interest of his/her patient from a medical perspective. I believe it is incumbent upon physicians to be good stewards of our resources as well. This is not to say they should prescribe medications with inferior outcomes. They should simply be objective about reviewing the clinical trials, by removing the bias introduced by PhRMA, and prescribe what is in the best interest of the patient both medically and financially.

Back to the Caveman Days

Wow, so you are saying most doctors are greedy. I say some are but not the majority. If you spent more time banning tobacco and liquor, the main health concerns for the public, maybe you would not need all those 3-cent pens or $6 pizzas. Maybe ban all computers--that's why the USA kids and adults are lazy. People like you have no clue. People today including you and doctors live at "free will." Do what you want to do to yourself and others, and as long as it is legal--tough break. Sorry, you lose.

laurenpharm

Mr. Johnson from PhRMA states: "To us, the evidence is compelling: Physicians meeting with well-trained company representatives gain crucial knowledge about side-effect profiles and proper use of medicines." In all my years as a hospital pharmacy supervisor or director, I don't recall being educated by the drug rep on the side effects of the drugs they were marketing. The side effects are downplayed, just as they are downplayed by the industry during clinical trials and post-marketing periods. Just look at the kind of massive public outcry that had to occur to get PhRMA and the FDA to issue suicidal ideation warnings on children and antidepressants.

dadpatel

Let's not forget politicians and lobbyists while we are on the related matter. The decisions politicians make with the same type of implied change in behavior has more far-reaching effects than a doctor's writing an extra prescription for Viagra.

oldalchemist

In the last several years while visiting several medical centers, I talked with many pharma reps. None had any science background but held B.A.'s and MBA's in marketing or business. These very pleasant folks could only repeat "co.line" when I asked tech "trick" questions, especially about dominions of related drugs or locus and ethnicity of clinical trials--forget the math. I am the recipient of a recent implant about which I have grave doubts, especially after interface with three company reps.

Millicent Blair

I just gave a presentation at the university I attend. It was on "Present Day Medicine." As part of the talk, I showed a DVD called Money Talks and also one called Side Effects.

It was on this very subject, and in the film "pharma reps" showed and talked about methods that were used to influence physicians to use the products they were representing. Not all physicians know they are influenced (they do need to find out all about the products represented). However, many of the drug companies told them only part of the story. (The drug companies often locked away reports of adverse affects of the new drugs.)

Often the purpose of introducing a new drug was money alone--in order to be able to charge more than other, older drugs that did the same thing, although often the new one caused dangerous side effects that the older drug usually did not have.

All for financial gain.

Thomas

Insulting? It's insulting that people of science wouldn't acknowledge the basic law of business: pharma companies wouldn't dump millions of dollars into these programs if they didn't work. The idea of doctors as heroic icons that are immune to the concepts of social marketing is laughable. I should know, I'm related to a doctor and that person is no better than any of us regular folk.

Sam Rainey

Okay, so let's ban other forms of marketing and promotional gifts for everyone, not just doctors--no business meals, no trips to the Super Bowl for clients, etc.

Otherwise, who are you to single out physicians? You have no right to regulate their behavior in this way. It's a free country and physicians can act as they like.

regularreader

We are talking about business and with business there will be profit. Who demands profit? Share holders. Who are share holders? The "public" (although the percentage of people who participate in the stock market directly or indirectly is another question).

Every individual has the fundamental right to further his business using fair business practices. A pharma sales rep is as good or as bad as any other advertising channel. Because in the end, if the doctor cares about his reputation, he will be careful to prescribe the medicine he thinks is most effective, irrespective of how many sales reps called on him.

Sometimes we, the general public, are not aware of what a doctor does before prescribing a new medicine. Here are some of the things he or she often does:

1. Talks to his/her peers, his/her seniors, and other personal/professional contacts.
2. Reads about it
3. Attends lectures (yes, paid for by the indsutry), symposiums, etc.

So you have a choice to either trust him or not. If you are not happy with the prescription practices of your doctor, you are free to change. That is the beauty of the system.

Then there are also insurance companies and pharmacies that replace the prescribed medicines with equally effective generics, reducing the costs to the consumer. So if you see the current system as a whole, you will appreciate that it is continously evolving to benefit the consumer.

daniel

I worked for Sanofi-Synthelabo {now Sanofi-Aventis} and Sandoz {generic firm of Novartis} as a medical rep in South Africa. I hated having to bribe my way to get scripts and orders by giving gifts and dispensing bonuses and cash backs. It is a use and abuse system where the doctors flock to the latest company offering an 'incentive' and the pharma companies use questionable tactics to get the most business from the doctors. The doctors and pharma both abuse each other for what they want. There is no loyalty or ethics where big profits are concerned.

The saddest thing of all is that the patient always loses out to the corrupt motive for profit by both the doctor and big pharma. I am no longer in the industry and I have come to despise it.

Jacob

There seems to be a common logical theme: If the lunches and trips and perks didn't influence doctors, then why would Big Pharma spend millions a year on them? If there were no ROI, then why would the money be spent? Further, if doctors really cared about their patients and the general public, then wouldn't they say, "Hey, these drugs are expensive the way it is, let alone with all the extra expenses of trips and dinners, so please don't spend this extra money on trying to bribe me, and just help my patients." But they don't, and instead choose to accept perks and bill like crazy and then point their finger at insurance companies for the raising cost of health care.

Blame it on others

Surprise. First we don't want to eat and live healthy. We want more and more prescriptions. Now pharma companies want to take full advantage of your laziness. Lift that fat ugly backside of yours, and start living healthy.

You won't need a doctor, medicine, or pharma companies either.

pat

Ban all forms drug advertising on TV and nonmedical magazines. Ban drug rep visits and lunches in doctors' offices. Pharma companies should be allowed to promote their products in regional meetings. All speakers at the meetings should disclose the grants they receive from the drug companies. If a drug rep treats a doctor with a $100 dollar wine and dine, he can influence the doctor's prescription habits.

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