Healthy Skepticism Library item: 1578

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: Journal Article

Edwards J.
Where There's A Pill, There's A Way
Brandweek.com 2005 May 16;

Full text:

On April 23, Dr. Naomi Grobstein received a piece of anonymous hate mail from one of the many drug sales reps who call on her Montclair, N.J., practice to tout new products.

“Many reps do not enjoy going to your office and do not even attempt to see you because of your poor attitude,” the letter said. “If reps ‘waste your time’ and you find them so useless, why do you still eat the free lunch they offer?” It was signed “Sincerely, Proud Pharm Rep.” Grobstein provided Brandweek with a copy of the note last week.

The letter was a response to a newspaper article in which Grobstein had said she welcomed the news that Pfizer was cutting its sales force. “It’s great news,” Grobstein was quoted as saying. “If it was up to me, I wouldn’t let them in the door. They’re crawling all over themselves with trays of food.
It’s a disgrace.”

The letter-writer poured on the sarcasm, asking, “I guess you weren’t busy … when you attended a dinner at Bellissimos (business meeting) in 2004, listened to our speaker and ate a ‘free’ dinner. … I even remember you thanking us ….WOW!! We felt sooo privileged.”

That exchange is an extreme one, but it occurs on the latest battlefront in pharma marketing: the right of sales reps to give doctors free gifts while they pitch their products.

Those gifts-which range from pens and coffee mugs to meals and lucrative “consultant” stipends-have come under increased scrutiny this year as more evidence emerges that marketing, as opposed to science, increasingly sways doctors’ prescribing decisions. (A Journal of the American Medical Association study published April 27 also noted that doctors are swayed by patients who request heavily advertised drugs, even when their symptoms don’t warrant those drugs.)

Some doctors have reacted by banning sales reps from hospitals and practices. The branded gifts, they say, threaten to make doctors look like Nascar drivers as their offices and equipment get covered in marketing product.

In March, Dr. Janet Woodcock, an acting deputy commissioner at the Food and Drug Administration, told a Senate panel that drug companies are still giving doctors too many free trips to exotic places, despite voluntary reforms three years ago meant to curtail those favors.

In April, Pennsylvania’s top state pharmacist-who decides what drugs are on the state hospital dispensary lists-was fined by the state’s ethics panel for taking money from companies like Pfizer while deciding what drugs to put on those lists.

And four sales and marketing execs at Serono, a Swiss pharma company, were charged in April with bribing doctors with trips to France if they upped their prescriptions. The company has set aside $725 million to settle the probe with the feds.

Most recently, when Thomas Abrams, the director of the FDA’s division of marketing and advertising, gave a speech on April 27 to a conference of drug company liaison officers, he was peppered with questions about whether it was acceptable to “reimburse” doctors for attending educational seminars sponsored by Big Pharma.

“It’s coming up every day, all the time,” said lawyer Dan Troy, a former chief counsel to the FDA who is now a partner at Sidley, Austin, Brown & Wood in Washington D.C. “It’s a very hot issue.”

The FDA does not, in fact, regulate gifts to doctors and it is not illegal to give a doctor a marketing gift (unless the gift is a quid pro quo for writing extra prescriptions). Thus doctors are subjected to a stream of trinkets from the moment they step into medical school. Clipboards, pens, mugs, stethoscopes, textbooks, ties, bags, notepads, tissues, soap, and breakfast, lunch and dinner are among the favors doctors can expect to receive.

Jamie Reidy, a former rep for Pfizer and Eli Lilly & Co., said, “I had a giveaway for Viagra that was a little hammer that said ‘Viagra’ on it, [even though] urologists aren’t doing a lot of reflex tests.”

The gift-giving — when you include free drug samples — far eclipses the $4 billion spent every year on consumer ads. Most of the biggest companies either declined to talk or did not return calls for comment.

A spokesperson for Merck would say only, “We have a very strict policy against [giving major gifts, and] we absolutely follow them. [But] Post-it pads, you’ll see those kinds of things, pens, things like that.” A Pfizer official said the company adheres to the 2002 voluntary guidelines drawn up by the Pharmaceutical Researchers and Manufacturers of America. Those rules call for gifts to cost less than $100 and to have some value for the patient or doctor. They were put in place to curb what most agree was the out-of-control level of lavish gift that plagued the business in the 1980s and 1990s. For instance, the PhRMA rules mention the word “golf” 10 times in
56 pages — a function of the trips that companies used to finance to gain physicians’ favor.

Jeff Trewhitt, a spokesperson for the Pharmaceutical Researchers and Manufacturers of America, noted, “We have heard anecdotal stories about hospitals and medical clinics closing their doors to sales reps but we don’t detect a discernible trend.” PhRMA’s guidelines

“You are not going to buy a doctor’s soul for the price of a pen or a notepad or a hoagie sandwich,” Trewhitt said.

But as the number of drug reps in the country tops 100,000, and doctors get five or six visits a day, physicians are closing their doors in frustration.

“Many of the clinicians I know have restricted, the number of drug reps per day and access to the physicians,” said Dr. Edward Langston, a trustee board member of the American Medical Association. AMA’s guidelines suggest doctors refuse gifts unless they help patients or are extremely modest.

AMA, however, has been outflanked on the issue by the American Medical Student Association, which has a policy of encouraging its members to accept no gifts at all. “There’s substantial evidence that all of the marketing gifts — the lunches, the pens — affect prescribing decisions and therefore are a violation of our professional standards and integrity,” said AMSA president Dr. Brian Palmer. His teaching hospital, Mayo Clinic College of Medicine in Rochester, Minn., bans drug reps, Palmer said.

This year, Mayo was joined by Marshfield Clinic in Marshfield, Wisc., which reportedly banned reps earlier this year (Marshfield did not return a call for comment).

The field may be changing. Pfizer announced cuts to its sales force earlier this year, and GlaxoSmithKline chairman Jean-Pierre Garnier also said recently that it would make “more common sense” for the industry to scale back its sales forces. But he also noted that the reason companies are afraid to do that is “because the competition is planning to increase their noise level.”

Meanwhile, more and more physicians are following Montclair’s Grobstein. “I don’t see reps and they know I don’t see them. They soon learn,” she said.