Healthy Skepticism Library item: 4475

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Richards D.
Guess who’s coming to dinner
Australian Doctor Weekly 2004 Jan 29

Full text:

One year after Medicines Australia clamped down on champagne and caviar for GPs, what ’ s changed? Deb Richards reports.

Sydney GP Dr Deepak Malhotra doesn’t go to many drug company parties. He’s a marked man. When he has replied to invitations to sponsored functions, he’s been told that they are “full up”.

His rejection stems from having taken a hidden camera aboard a Pfizer cruise to film the entertainment – barely clad ladies doing a knees-up cabaret act – which was broadcast on Channel Nine’s Sunday program. It led to a public outcry and added to the campaign to have stricter controls on drug company promotion.

In January last year Medicines Australia launched a new code of conduct that limits drug company sponsorship of educational events for doctors

One year on some divisions of general practice, which once enjoyed pharmaceutical companies’generosity, are feeling the effects of the new austere environment.

“We used to have a family cricket day against the Illawarra division,” Shoalhaven Division of General Practice CEO Ms Eve Craddock says.

“It was wonderful, and the drug companies would pay for the meals. Now, we’ve had to alter that and it’s a big blow.

“Our numbers are a little down at evening seminars too, as we can’t offer the food that we used to. We hoped it wouldn’t affect us, but the companies aren’t giving the reps a lot of money to spend. When we ask for sponsorship they now say: ‘Sorry, we’re not allowed. It’s against the code.’”

So what has happened to the money usually earmarked for such sponsorship?

While pharmaceutical companies contacted by Australian Doctor all declined to detail what had changed in relation to their marketing budgets and priorities since the 14th code of conduct was introduced, SA GP Dr Peter Mansfield has a theory on how their spending has changed.

Dr Mansfield, director of health marketing watchdog Healthy Skepticism, says pharmaceutical companies are relieved the code of conduct has given them a valid reason to cut their hospitality costs. He says they were spiralling upwards because of pressure to outdo one another.

He likens it to the “fruit box phenomenon”, where people in a crowd follow one another in standing on boxes, then small ladders and then tall ladders to gain the best view.

A former drug sales representative, who spoke to Australian Doctor on condition of anonymity, agreed that entertainment costs were blowing out before last year’s code of conduct was introduced, adding that it was partly because of doctors’demands.

“It was starting to get bigger than Ben Hur,” she says.

“When I first repped 20 years ago, there was none of this. You’d just go round and visit and talk. Then it became a bit of lunch while you watched a video. Then I can tell you the demands started coming and you’d be taking the whole clinic out to dinner, including three receptionists.”

Compounding the benefit to drug companies of not having to spend as much on entertaining, Dr Mansfield says research is showing small gifts to be at least as effective as big ones at influencing prescribing.

“If it’s lavish, it’s more overt and in a way easier [for doctors] to defend [themselves] against. If it’s a small gift, you don’t think it’s a problem. But it acts at a subconscious level of awareness where decisions happen. When reps come to see you, they leave you with a positive feeling.”

Medicines Australia manager of marketing strategies, Ms Heather Jones, is also secretary of the code of conduct committee that oversees complaints. She told Australian Doctor the new code had made a noticeable difference.

“Companies are really thinking now about what they’re doing,” she says.

“We’ve had a lot of phone calls and e-mails from member companies, health care professionals and advertising agencies wanting guidance on planned activities.”

Sanofi-Sythelabo medical director Dr Victoria Elegant also says there’s been a change for the better.

“The venues are now appropriate and [conferences are] focused on appropriate clinical content,” she says. “As an industry, the more we can do to add educational value, the more our reputation is enhanced.”

Dr Ken Harvey, of Latrobe University’s school of public health in Melbourne, has studied the impact of marketing on prescribing habits for many years.

He laughed when Aus tralian Doctor asked him to assess the impact of the new code of conduct.

“It’s true that they have tightened the regulation of entertainment, but they can drive a truck through it …They [drug companies] still need to market their products,” he says.

Dr Harvey says no code governing conduct will ever be adequate.

“As with tobacco and alcohol, inappropriate medicinal drug use will not be brought under control until pharmaceutical promotion is restrained,” he says.

“The measures needed include: transferring a substantial proportion of the industry promotional budget to the National Prescribing Service, to provide more independent information; insisting that generic names are promoted in larger type face than brand names, as in other countries; ensuring that adverse effects and contraindications of drugs are given equal promotional space to claims of efficacy; and rewarding drug reps for achieving appropriate use of their products rather than increased sales.

“Until then we are just pissing in the wind.”

Mr Martyn Goddard, health policy officer for the Australian Consumer’s Association, also finds fault with the code.

“The code is not judged on the basis of principles,” he says. “Anything not specifically prohibited is allowed.”

Of the 48 alleged breaches of the code of conduct investigated by Medicines Australia last year, only a few related to gifts or sponsorship. In two cases, which occurred before the new code was introduced, health professionals had complained about a competition where Palm Pilots loaded with MIMS software were the prize.

But the committee found against the complaint, saying the prize was educational enough to be acceptable, even under the toughened rules.

The committee felt the questions for one quiz may have breached the code. However, because no one had complained about them, the committee couldn’t make a finding.

Many major conferences last year went on as usual. The ADGP lost a substantial amount of pharmaceutical sponsorship from its national conference, but software producers and phone companies picked up the tab instead.

While sponsorship money was down for NSW Rural Doctors Network events, its conferences were still supported by about 15 pharmaceutical companies and a company that provides locum services.

Conference attendee Dr Louise Barker, a GP from Currimundi, Queensland, didn’t notice much difference.

“This was the best rest and relaxation I’ve had,”she told the conference organisers.

“And a great conference with it.”

On the menu

Summary of changes affecting GPs:

n Gifts to doctors limited to a value of $10

n Competition prizes limited to a value of $500

n Modest venues and food for functions

n No invitations to corporate boxes at sporting events, tickets to the theatre, ski trips or golfing weekends

n No give-aways like car washes or facials in return for access by drug sales representatives

n No trading takeaway food for time to discuss products

n No lavish entertainment at medical dinner meetings

n No luxury resorts for conferences

n Airfares are limited to economy class in most cases and marital partners have to pay their own way

Farewell to freebies

SA GP Dr Bruce Groves doesn ’ t believe drug company hospitality influences prescribing habits.

“ No one has yet shown me any convincing evidence that largesse influences prescribing behaviour, ” he says.

“ If it ’ s a new drug and it ’ s good, then it gets prescribed, but it would have been anyway. ”

He is disappointed the code of conduct now limits drug company sponsorship and gifts.

“ All the entertainment has gone, ” he says.

“ It ’ s now all very dry and sanitised. I used to enjoy going to the footy or the tennis a few times a year, but linking the sport to the educational component has all stopped. ”

Dr Groves feels there are fewer industry events, and he doesn ’ t feel like going to many anyway.

“ It ’ s harder to get me to turn up. I must say that none of my colleagues think this is a good idea. There ’ s a general feeling of regret and disappointment that this is the way it ’ s gone. ”

Sydney GP Dr Akbar Khan says a drug company-sponsored dinner was never the lure to attend educational events.

“ You have to go to a minimum number of lectures to refresh your education, ” he says.

“ You may go for a bit of ‘ hello, hello ’ and mixing socially, but no one is going to prescribe something just because they had food given to them. ”

ADGP chairman Dr Rob Walters echoes this sentiment: “ Doctors have the intelligence to evaluate information from a clearly biased source. ”