Tom Curtis to Steve Buser re: Article: Gifts from drug companies

From: "Thomas Curtis" To: "stephen buser" Sent: Friday, November 18, 2005 12:48 PM Subject: 111805 Curtis Resp To Buser Resp; Re Col Dispatch; Gifts From Drug Companies

Hello Steve,

Thank you kindly for your immediate response to this question. I hope you will respond to the others in my email as well.

My desire for a zero tolerance motion is in regards to the STRS employee or board member, not the supplier of goods and services. I believe John's motion dealt only with STRS suppliers of goods and services. So I would see our two motions as being very different.

I am looking for a zero tolerance from our employees and board members. There as been no oversight in this area, so these abuses easily went unnoticed. Because of this, putting a zero tolerance in writing for all employees and board members would solve this problem. You break the rules; you are terminated, period. Due to the political situation in this State, we have been unable to raise much support for punishing the individuals who raped our system. A zero tolerance statement would make this issue very clear. Further, the time and money involved to enforce the rules as they stand has been enormous due to the cost of legal counsel and state organizations completing investigations. Let's nip this situation in the bud and take the problem straight to the greedy person(s)desiring such gratuities, the STRS employee or board member.

Take care, Tom Curtis

----- Original Message ----- From: "stephen buser" To: "Thomas Curtis" Sent: Friday, November 18, 2005 7:33 AM Subject: Re: 111405 Col Dispatch; Gifts From Drug Companies

Dear Tom:

You make a strong case, and I think your position is very close, and perhaps identical, to that of John Lazarus. I would be willing to consider such a policy. However, as in all such issues, my first and last thought will be what is in the best interest of members.

Thus, while I can imagine a situation in which STRS has many possible vendors and members would not suffer from the mandated reduction in our choices. I can also see where the group of best possible vendors is too small to commit to tossing out any and all who violate the rule without weighing the type and nature of the offense against the type and nature of potential harm to members.

Steve

At 01:04 AM 11/18/2005, you wrote: My correspondence to you follows the article below. GIFTS FROM DRUG COMPANIES Doctors deny that 'freebies' influence them Monday, November 14, 2005 Suzanne Hoholik THE COLUMBUS DISPATCH []

BETH SKABAR DISPATCH Drug companies affix their product names to all sorts of giveaways.

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 ORC 3307.15 - not just a wish, IT'S THE LAW!

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Hello Dr. Buser,

The kind of scenario written about in the newspaper article above is becoming abused far too often now. Abuse of this nature should not be tolerated by our employees or board members concerning any type of products or services used by the STRS. Hopefully, this is part of the ethics training each employee and board member will receive. I would think that if anyone is found to have accepted any type of gift from people the STRS does business with that should be automatic grounds for termination. We need a zero tolerance policy. Would you support a motion for that change? If not, please explain why.

I realize the policy has changed at the STRS, but the reason it got abused in the first place is because the STRS leadership sanctioned the abuse themselves, by doing such. No one took the responsibility to oversee what was going on and since that is the case, a zero tolerance should be called for. Each of you board members has to be aware that many things have been overlooked at the STRS for many years. That will not be corrected over night, but we are paying for the "Cadillac" of employees and we are not getting that in return. As I have said before in board presentations, I want value for my dollar and I will except nothing less.

The STRS fiduciaries has taken a portion of my HC benefit promised to me at retirement and revoked it. At the very same time, those same people were just starting to pay for their HC and still have family plans and free dental and vision. This is not right! I would think many of our board members would be well qualified in recognizing where abuses have and still are taking place and would act on such.

My biggest concern about the board is that there is so much to be done and so little time at the STRS to do it in. The enormity of issues needing attention leaves me wondering just how long it will take to return our retirement system to a well run, efficient operation as called for in 3307.15.

In my opinion, we have been getting little help from the executive director to bring this about. Damon has shown virtually no leadership in resolving issues that have been brought to his attention by the membership for the past 3 years. He does not take the memberships' concerns to heart and has offered little in the way of convincing us differently. I hope our board will soon begin to address the issue of replacing Damon when his contract expires February 18th, 2007. Has anything been brought to the attention of the board concerning such to date? Do you support a national search for his replacement?

No board member gets paid one dime by the STRS for his/her involvement and I do not agree with that. Board members should receive a stipend, unless an educational institution or union is paying for their time. We have been paying executives millions of dollars to operate the STRS efficiently, but that is simply not what we have been getting. Now, all of the problems fall in the laps of the board members to try to identify and correct, while the STRS executives continue to hold their jobs and receive substantial pay increases each year. Just what is wrong with this picture? Would you support a motion for board members not receiving income from an educational institution or union where they are currently employed for being there to receive a stipend for their time? If not, why?

We are told that each year's budget is the lowest in the past 5 years. But, we have only seen minor reductions in operating costs, when they rose at a rate as high as 16% during the same time the STRS portfolio was loosing billions of dollars. Why have they not been cut by a greater rate? Our overhead is not providing us with value for our dollar. I am growing weary of the do little comments I receive concerning the issues we have been asking about for 3 years. Dennis Leone prepared a paper outlining what needs to be done, yet the STRS executive staff is still dragging their feet in accomplishing such. Do you support a review of Dr. Leone's research presented to the board in 2003? If not, why?

Thank you for taking the time to answer my questions above. If you do not receive this by email, I will also ask Eileen Boles to make sure each board member receives a copy of this letter in your box. Please kindly find the time to respond to my questions. I have been told by Damon Asbury and the past two board chairpersons that I would receive answers from board members to questions, if put them in writing. That has not been the case for a number of you and I have a hard time accepting such. Would you?

Take care, Tom Curtis