Article: Gifts from Drug Companies
GIFTS FROM DRUG COMPANIESDoctors deny that ‘freebies’ influence themMonday, November 14, 2005THE COLUMBUS DISPATCH
The pen you sign in with at the doctor’s office might have Lipitor, Nexium or Zoloft on it. The mug the receptionist drinks coffee from might say Zocor on the side.
Notepads, tissue boxes, wall clocks, clipboards that hold medical charts — everything is an advertisement.
It all comes from drug-company salespeople who regularly visit offices hoping that these marketing tools will translate into more prescriptions for the medications they’re pushing.
Doctors say they’re not influenced by hand sanitizers, wall calendars or pockets full of pens. But what about free medical textbooks, blood-pressure cuffs, stethoscopes and pizza lunches for the entire office staff?
"The calendar on my wall says Premarin (a hormone). When I look at that, do I prescribe that for a patient? Abso- lutely not," said Dr. David Stockwell, a Columbus obstetrician. "It’s a nice thing. They provide that so I don’t have to go to Staples and buy it for my office.
"Anybody who has any ethics at all would not be persuaded by these things."
Busy doctors don’t like taking time to talk to four to six drug representatives a week, but some do it solely to collect the free samples they bring.
Dr. Kathleen Lutter, a Columbus gynecologist, relies on free medication samples for her patients who can’t afford costly drugs. She said pitches from drug reps don’t influence her.
"If you have any brains as a physician, you can get past the marketing ploys," she said. "As every year passes, I get more and more critical of letting drug reps in."
But the freebies do influence physicians, said Dr. Harrison Weed, an infectious-disease and internal-medicine specialist at Ohio State University Medical Center. He doesn’t meet with drug salespeople, and when he finds any freebies around his office or clinic, he throws them away.
He cites national studies that have found that, when people are given something free — no matter how small — they can’t help but feel obligated to reciprocate. And that includes doctors.
"When you meet with them and talk to them," Weed said of drug salespeople, "and you’re the teacher, you want them to succeed, and their drugs to succeed. You have to acknowledge that influence."
The practice has been around for decades.
In the 1970s, the drugmaker Eli Lilly and Co. sent every medical-school graduate in the country a leather doctor’s bag loaded with all the tools of the trade, said Bill Fassett, professor of pharmacy law and ethics at Washington State University. "No one thought much of it until some students refused to take them. One school had a bonfire.
"The companies were just mystified by that. The older physicians said, ‘If these guys are going to be corrupted by a medical bag, they shouldn’t be in medicine.’ "
But over the years, the practice grew worse, to the point that it became common for drug companies to take doctors to sporting events and concerts or pick up the tab for seminars at Caribbean resorts.
In 1992, the American Medical Association created ethical guidelines on physicians accepting gifts. They boil down to three things: A gift should benefit patients — drug samples, for example. It should be worth less than $100. And it should have an educational benefit.
"No gift should be accepted if there are strings attached, if they expect something in return," said Dr. Cecil Wilson, a member of the AMA board of trustees.
He acknowledged that drug companies are quick to disseminate research about their drugs but said salespeople shouldn’t be the sole source of information for doctors.
"At the heart of this, physicians have an ethical obligation to help patients make a choice," Wilson said. "In a market-driven entity such as the drug industry, they have certain goals that don’t overlap with a physician’s need for information."
The drug industry’s trade association — Pharmaceutical Research and Manufacturers of America, known as PhRMA — also has guidelines for giving gifts to doctors, including a $100 limit. There’s no limit on handing out drug samples, pens or notepads. The occasional stethoscope is OK; but sporting events, golf outings and trips are not.
"If you’re sitting on the thirdbase line in Wrigley Field in Chicago, you’re not focused on the business at hand," said Jeff Trewhitt, PhRMA spokesman. "Watching Barry Bonds hit a home run has nothing to do with the study of a new medicine."
The solution, said Fassett of Washington State, is public disclosure, with drug companies documenting how much money they spend marketing to each doctor.
"The responsibility of each physician, each nurse, each dentist is to remember that they took an oath to put the patient’s well-being first," he said. "They say they are not influenced, but research shows that they are influenced."
shoholik@dispatch.com
posted by Kathie Bracy at 5:28 AM
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