Healthy Skepticism Library item: 13355

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

Hacker G.
Pharmaceutical freebies for doctors aren’t free
The Register-Guard (Eugene, Oregon) 2008 Mar 27
http://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=84260&sid=5&fid=1

Full text:

I did not seek publicity regarding my stance on the acceptance of “free” gifts from pharmaceutical representatives (Register-Guard, March 2). I was sought out by reporter Tim Christie because he discovered that I am the only local physician who has chosen to join nofreelunch.org, a nonprofit organization dedicated to discouraging relationships between doctors and the drug industry that may influence prescribing habits and drive up the cost of medical care.

During my interviews with Christie I made it abundantly clear that I did not take as much issue with the pharmaceutical industry for offering “free” items and meals to physicians and their staff – although they certainly contribute to the problem – as I do with the physicians who accept them. I also recognized the beneficial contributions of the pharmaceutical companies, such as their patient assistance programs and their research and development of new medications. That does not excuse unethical marketing techniques.

For these positions I’ve been accused of being a doctor who is “20 years behind the times.” This is a serious accusation. The doctor who does not keep abreast of the nearly daily changes in medicine is a dangerous doctor. As a board certified family physician, and as a recently appointed clinical assistant professor of family medicine at Oregon Health and Science University, I not only pride myself on remaining up to date on clinical medicine, I am required to demonstrate that knowledge every seven years on a specialty board exam. I am also required to document at least 50 hours of continuing medical education every year. No other specialty board has higher education and recertification requirements.

I cannot understand how educated people can honestly deny that the acceptance of gifts – pens, cups, and paper tablets; lunches for doctors, nurses and even non-prescribing staff members who have no clinical need to learn about the latest information on new products; dinners at restaurants where most patients can’t afford to eat – does not contribute to the incredibly high cost of medical care.

Someone is paying for this marketing, estimated to be well in excess of $7 billion last year. That someone is the patient. Patients pay for these gifts every time they go to the pharmacy to pick up a prescription.

As the medical director of the Lane Community College Health Clinic and a regular volunteer physician at Volunteers in Medicine, I am acutely aware of the needs of the uninsured poor. More than 75 percent of the patients I see at LCC have no health insurance, and none of the patients I care for at VIM have insurance.

Yes, I do offer samples to some of these patients – although it is amazing how little interest the pharmaceutical representatives have in our clinic. But the problem with offering samples, which are offered only on newer and more expensive brand-name medications, and never on generics, is that once a patient has been started on them they can’t afford to continue.

And it doesn’t always follow that new is definitely better for all patients. Most can do just fine without taking the bright, shiny, new pill. And there have been too many examples recently of the new pill causing problems, leading to patient injury and subsequent withdrawal of the medication from the market. Generic drugs have stood the test of time.

An alternative to offering samples of expensive new medications is to order stock bottles of medications that are prescribed frequently in a particular practice.

Most generic medications can be purchased by clinics at reasonable prices. Patients who need to start a new medication can receive a trial supply of the medication, free of charge, to see how they respond. If they do well, they can fill a prescription at a local pharmacy for $4 a month. If they don’t do well, a more expensive medication may be in order. Most pharmaceutical companies offer generous patient assistance programs to qualified patients on some, but definitely not all, of their medications. This is the approach we have chosen, and it works very well.

I do not take issue with utilizing samples appropriately or with helping a patient with the patient assistance paperwork. This is marketing that helps improve patient care.

I do take issue with marketing that is purely marketing. There is no reason that a physician, whose average income is well above that of most patients, should encourage or accept “free” gifts in any form that does not have some direct positive impact on patient care.

Physicians can afford office supplies and food. Physicians can read journals to get unbiased updates on medications. And if physicians choose to get medical information from a representative of a pharmaceutical company, they can certainly do so without being fed.

Until, if, or when universal coverage is available, it is incumbent upon us all to do what we can to control the cost of medical care while providing good health care to all.

——
Gail Hacker, M.D., is medical director of the Lane Community College Health Clinic.