Healthy Skepticism Library item: 1295

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

Japsen B.
AMA says drug reps not welcome in exams
Chicago Tribune 2003 Jun 18

Full text:

As a drug sales representative, Barbara Miller says she was encouraged by her supervisors to pay doctors for the privilege of sitting in on the most intimate office visits between patients and physicians—all in the name of making a sale.

Miller says she never felt comfortable doing so, in part because she is a patient herself. She suffers from an inflammatory bowel disorder known as Crohn’s disease.

“I was never trained to view a human body like a physician does,” says Miller, a La Porte, Ind., resident who has since left the pharmaceutical industry. “I personally found sitting in on an exam embarrassing. This was one of the areas of my job I didn’t understand and didn’t agree with.”

Nor does the American Medical Association, which voted Tuesday to stem what it calls “patient shadowing” without the explicit agreement of those being treated. The Chicago-based doctors group says the practice is unethical and violates patients’ privacy.

AMA members say patient shadowing is the latest attempt by pharmaceutical companies to influence physicians’ prescribing habits. By winning doctors’ loyalty through “educational” grants, free golf outings or takeout steak dinners, drugmakers increase their market share and profits.

Further, doctors attending the medical group’s annual meeting in Chicago this week say that drugmakers may be trying to use confidential information gathered during such office visits to market their latest and often most expensive brand-name prescription drugs. That could be a violation of new federal standards designed to protect patient privacy, doctors say.

“There are concerns about patient privacy,” said Dr. Ronald Davis, an AMA board member. “What is in the best interest of the patient has to reign supreme here.”

AMA leaders also said doctors shouldn’t be taking money from drug companies for shadowing programs. “That sounds very inappropriate to me,” Davis said.

To end the practice, the AMA’s policymaking body agreed to oppose the presence of drug representatives in clinical situations without the consent of patients and to work with the drug industry to protect patient privacy. If that doesn’t work, AMA leaders said the organization would use its lobbying clout to push laws to prevent patient shadowing.

“If working with the drug industry doesn’t help, we should take this to the next level,” said Dr. David Fassler, an AMA delegate from Burlington, Vt., representing the American Academy of Child and Adolescent Psychiatry.

“As child and adolescent psychiatrists, we were also particularly concerned when we learned that this kind of shadowing was occurring in situations involving young children, since the issues of informed consent are even more complex with younger patients. Without informed consent, this is totally inappropriate.”

The drug industry defends the practice with both physician and patient consent and said Tuesday that it will work with the AMA to ensure patient privacy. There are benefits to shadowing, says Indianapolis-based Eli Lilly and Co., which was identified by several AMA members as one of several top drugmakers that pays doctors to give its sales reps access.

“Our current practices at Lilly require that the participating health-care professionals must obtain consent from each patient,” said Lilly spokesman Edward Sagebiel. “If you have a better understanding of how that office runs and what the physician needs from you, then you can be a better business partner with that physician or her staff.”

But former pharmaceutical marketer Miller told AMA members that consent isn’t typically sought by the industry and that she could tell patients were uncomfortable when they found out a drug sales representative was in the doctor’s office.

`Fuzzy lines’ need work “I think the pharmaceutical industry is great, drug research is great and educating the doctors through pharmaceutical sales reps is great. But there are just some fuzzy lines that need to be worked on,” Miller said.

Miller wouldn’t disclose the company she worked for, citing a confidentiality agreement with her former employer. She did say she did not work for Lilly.

Miller said her illness has given her a new appreciation for the importance of the doctor-patient relationship and the need for confidentiality.

“I know how vulnerable you feel when you are sitting there in a doctor’s office wearing a paper gown,” Miller said. “Someone who has never sat in a doctor’s office wearing a paper gown would never understand that.”

Drug companies spend up to $500 to observe patients with their doctors.

It’s unclear whether patients are paid, but Lilly said it does not pay patients who are part of its program.

“You are asking them for their time to facilitate learning,” Lilly spokesman Sagebiel said.

As for the payment to doctors, Lilly said they are either paid directly or the amount is donated in the physician’s name to a medical school or charity “for which there is no direct benefit to the physician.”