Doctors Urged to Stop Accepting Bri- —Oops, Make That Gifts—From Big Pharma

Physicians often underestimate the effect of Big Pharma trying to influence their prescribing behavior.

| Jun 12, 2009

Drug companies spend billions of dollars on research, and it's obvious that they spend more billions on advertising. Well, according to the New York Times, they spend the most billions on giving nice things to doctors: pens, samples, banquets, trips, and educational opportunities among them. For doctors, in fact, there is a free lunch: Pharma companies spend as much as a billion a year just on lunches for doctors. And over 90 percent of doctors have accepted at least some of this largesse from the industry.

But Big Pharma doesn't give away all that stuff without expecting something in return, and what they expect is to influence prescribing behavior. The unspoken assumption is that the doctors will use their nice free pens to write prescriptions for the company's product. Does it work?  Apparently it works a lot better than the physicians themselves realize, because they often underestimate the effect that it does have on them. Social scientists have found that people can't really assess their own bias, especially if that bias is financially beneficial to them. Even free pens exert an influence, and the free lunches are especially effective because people are apparently more receptive to information when enjoying a good meal.

This is not really news: Between 2001 and 2008, there were at least 16 prominent reports calling for change in the financial relationship between medicine and Big Pharma, and DH commented on the practice back in 2007 ("Hey Doc, Let's Fly to Maui to Talk About Drugs"). But it is attracting even more notice lately, most recently from the Institute of Medicine (IOM) of the National Academy of Science, an extremely prestigious nonprofit organization that provides "unbiased, evidence-based, and authoritative information and advice concerning health and science policy."

In April, the IOM issued a report that told doctors in no uncertain terms to lay off the free stuff. In particular, the report emphasized the need to regulate the complex relationships between medicine and industry. In 2007, industry footed nearly half of the $2.54 billion bill to provide doctors with required refresher courses, known as Continuing Medical Education (CME), as well as funding over half of all American biomedical research.  And in the April Journal of the American Medical Association, a group of doctors themselves expressed their concern about taking corporate money to fund the development of "practice guidelines," which are considered the final word on how to treat patients. They also came out against allowing doctors with industry ties to serve on practice guideline committees.

The IOM report recommended that Congress force Pharma to publicly disclose all payments made to doctors. There is already legislation pending to do just that, sponsored by Iowa Republican Senator Charles Grassley and Wisconsin Democratic Senator Herb Kohl, both of whom are clearly pleased with the IOM's blessing.

The largest drug makers (but not device and biotech companies) did agree last year to stop pushing the pens and other little gifts, but they are still underwriting the meals, refresher courses, and practice guideline committees. And of course, the companies are not convinced that keeping their fingers out of the medical pie is such a good idea. With regard to the practice guidelines, a spokesperson for the Pharmaceutical Research and Manufacturers of America told JAMA that such policies would disallow the input of all the experienced doctors, most of whose research is industry-funded, leaving the decision-making to "very junior people who have no experience."

What do you think? Can medicine extricate itself from business sufficiently to prevent conflicts of interest? Or is Big Pharma right? Use the Comments box below to voice your opinion.

Sources: The Prescribing Project
The New York Times
The Institute of Medicine
The New England Journal of Medicine
Journal of the American Medical Association

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Categories: Doctors & Nurses, Medications Research, Pharmacy

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Posted by Anonymous on 13 June 2009

Well, I think they have to do something to be able to compete. The pharmaceutical industry is so burdened with government regulations that they are not allowed to do business.

For example, after spending millions of dollars coming up with a new medicine, the government allows other companies to LEGALLY steal their formula thanks to the anti-business Drug Price Competition and Patent Term Restoration Act.

Generic manufacturers do not incur the cost of drug discovery, and instead are able to reverse-engineer known drug compounds to allow them to manufacture bioequivalent versions.

Generic manufacturers also do not bear the burden of proving the safety and efficacy of the drugs through clinical trials, since these trials have already been conducted by the brand name company.

And why should a drug company prove the safety of the drugs they manufacture to government bureaucrats in the first place? Because as we all know, the best way to make money in the pharmaceutical industry is to make drugs that don't work and kill people.

It has been estimated that the average cost to brand-name drug companies of discovering and testing a new innovative drug (with a new chemical entity) may be as much as $800 million

Generic drug companies may also receive the benefit of the previous marketing efforts of the brand-name drug company, including media advertising, presentations by drug representatives, and distribution of free samples.

I'm surprised drugs are not even more expensive. If I knew someone was going to steal my invention in a few years, I would try to milk it as much as possible as soon as possible.

Posted by Anonymous on 13 June 2009

It is sad how much trouble the pharmaceutical industy is given while it's really just another bunch of companies making money by creating and selling good products. Yes, the drug industry is not perfect, but which industry is? For years pharma has been increasingly squeezed so that now rules restrict it's companies even from making pen with their own name on it. How many other American companies are free to market their products with out scrutiny? Or free from harassment of raising costs? Does anyone complain about the TV commercials Comcast plays on every station while their cable TV rates are outrageous? Probably not. Pharma gets picked on because its big, it makes good money, and people think healthcare is a birth right so they shouldn't have to fork up the needed cash. Despite any "questionable" marketing practices of drug companies, many of the same, if not more are common place in other industries that play large roles in our lives. I know this may be a reach for some to understand, but if I went through a decade of intense academia to become a physician and people thought my decisions were influenced based off of what drug pen I used, I would be greatly offended. Even more so if they thought that the lunch a drug rep brought to the office to talk about his products would make me prescribe them, even if their was a better and cheaper alternative, I would be irate. I know I am greatly thankful to the pharmaceutical industry for my sons job, but I am even more thankful for the vaccine it recently created that saved my wife's life. It costed me a couple of pay checks, but my wife is here and healthy still and I would have gladly paid more to have her cured. And if I knew which sales rep was the one who educated my wifes doctor about this vaccine while he catered their offices lunch, I would return the favor and take him out for dinner to say thank you. No company or person is perfect, but what I do know is that these companies do a lot of good that goes unrecognized. Dont be so quick to provide half the story to sway opinions, be truthful and fair and explain the other side of the issue so people can fully understand the situation.

Posted by Anonymous on 16 June 2009


Posted by Anonymous on 18 June 2009

Well, that's why every time any doctor tries to prescribe me anything my first reaction is 'is he really trying to help me or just hook me on this medication?' There has to be some way to remove this bias/mistrust from the medicine as a whole.

Posted by YODA on 18 June 2009

This is a pernicious problem in diabetes. Doctors and the ADA push a high carbohydrate diet, which increases glucose levels, then prescribe ever more medications to correct the problem they aggravated. Outrageous. No one in the diabetes industry (drug companies, doctors & ADA) has an incentive to treat diabetes inexpensively by directing patients to simply cut carbs.

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