Healthy Skepticism Library item: 1990

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

Moore K.
Drug companies push pills to doctors
Morning Journal Writers 2002 Oct 7

Full text:

LORAIN — Whenever Marcie Striker walks into a physician’s office for the first time she knows she will be stereotyped. She also knows her failure to live up to that stereotype could cost her a customer.

Striker, 28, is a pharmaceutical sales representative for Berlex Laboratories.

Compared to the industry giants of the world like Merck and Pfizer, Berlex barely registers on the Fortune 500 list.

That means smaller expense accounts for the sales staff, which isn’t a big deal in most businesses where failing to take clients out for a dinner won’t eliminate a sale.

But in Striker’s profession the game is played differently.

Scuba adventures, ritzy nights out, even flowers and a bottle of wine — these are just some of the perks with which pharmaceutical companies court doctors in the name of educating them on the merits of their newest drug.

Doctors can get all of this for attending a lecture, watching a video or just giving a pharmaceutical sales representative 10 minutes of their time.

‘‘The gift-giving stigma is something that is very attached to the pharmaceutical industry, and doctors expect the freebies,’‘ said Striker. ‘‘Honestly, without the budget to offer all the perks, I had to work extra hard to gain the contacts that reps with a bigger budget gain in no time because of what they can do for the physicians.’‘

Although there is a constant stream of prescription drug ads on television and flashy print advertisements, the top target of the drug companies is not the consumer but the physician.

‘‘Before a physician and I negotiate a sale or sign a contract, I am asked at least once a week if I’m going to send the doctor on a trip because they are using my product,’‘ she said.

Striker, who covers territory stretching from Toledo to Youngstown to Columbus, said she can offer the most basic of perks, a lunch, maybe a dinner or two, some drug samples and of course the standard pens and note pads — all small potatoes compared to what the big-time players can offer.

In 2000, the drug manufacturing industry spent $15.7 billion promoting drugs, with $5 billion — or 33 percent of all promotional dollars — spent on promoting products to doctors, according to the American Medical Association.

Pharmaceutical companies spend more than $11 billion each year to promote and market drugs — an estimated $8,000-$13,000 per physician per year. This money is often spent on free samples for physicians to hand out to their neediest patients, but is also given in the form of meals and entertainment.

A recent study done by the Kaiser Family Foundation, a non-profit health research organization, found that a majority of physicians reported they have been given meals, tickets to events or free travel for either seeing pharmaceutical sales reps or using their products.

About 12 percent said they have received financial compensation from companies to participate in drug trials, and 13 percent indicated they had received other financial or in-kind benefits.

A study done by Ashley Wazana, a resident in the postgraduate psychiatry program at McGill University School of Medicine in Quebec, has indicated this freebie campaign works and that doctors are more likely to write out prescriptions for the newest, most highly marketed drug as opposed to the generics that are cheaper and considered equally effective.

The brand-name drug industry says the attention paid to physicians is a way for doctors to be educated on new products in a cluttered market, products that doctors otherwise would not take time to look into, according to the Pharmaceutical Research Manufacturers of America, the lobbying arm of the brand-name drug makers.

The American Medical Association has mounted an educational campaign targeted at educating doctors and drug company representatives on the ethics surrounding the gifts. It is telling physicians they would be better off if they disregard the saying to ‘‘never look a gift horse in the mouth,’‘ and instead take a look at the AMA’s Code of Medical Ethics.

Pharmaceutical gifts have been part of the medical scene for decades, but over the years changes in the industry’s marketing strategy have been beefed up.

Along with millions spent on promoting drugs to doctors, there is now one pharmaceutical sales representative employed for every 11 physicians in the United States.

Gifts, especially the extravagant ones, like cruises and large sums of money became a problem in the late 1980s, according to Dr. Andrew Thomas, who is helping spearheading the AMA’s campaign.

In 1991, the AMA’s Council on Ethical and Judicial Affairs developed ethics guidelines regarding gifts to physicians from industry. These guidelines were created partly in response to the federal government’s increased scrutiny of gift-giving activities, and were subsequently adopted by the AMA.

‘‘However, as the pharmaceutical industry became increasingly competitive in the late 1990s we began to see the problem surface again,’‘ said Thomas.

The AMA council says any gifts should entail a benefit to patients and should not be of substantial value. Text books, modest meals and other low-cost gifts are considered appropriate if they serve a ‘‘genuine educational function.’‘

‘‘I try to market myself on the merit of the product not on the value of gifts I can offer them,’‘ said Striker. ‘‘Actually, the fact that the AMA has initiated this sort of crackdown on the pharmaceutical industry is a good thing for my company because it might level the playing field.’‘

‘‘It is hard to know where to draw the ethical line,’‘ she said. ‘‘I think it is considered ethical for me to buy a doctor lunch, well then what about buying the physician’s whole staff lunch? That may get up around $100 or so, and that is the same price as the TV and VCR that the physician has asked me to buy him for his waiting room.’‘

Thomas said sales reps are not the worst of the drug companies’ marketing tactics. He reserves that place for the direct-to-consumer television spots.

However, he said the sales representatives are providing no more educational information to doctors than the pamphlet that a pharmacist hands to a customer when a prescription is filled.

‘‘The thing is, the sales reps are not really very informational. The FDA has ruled that they can’t talk about off-label info that is in the medical journals,’‘ he said. ‘‘Doctors really need to be doing their research in other places.’‘

Off-label information includes research that hasn’t yet been proven as factual. It may appear in medical journals but isn’t going to be on pamphlets or labels seen by most patients. This information could be rare side effects or even alternative uses for a given prescription.

However, just as the AMA is clamping down on the traditional gift-giving tactics of the industry, it seems the drug companies are staying one step ahead.

Electronic devices such as Palm Pilots, with patient-based programs and new software and hardware aimed at helping physicians computerize their offices at little or no expense, are one new breed of gift.

The American College of Physicians/American Society of Internal Medicine is reporting that the drug companies are now giving lucrative grants that help clinics set up new programs.

Critics worry that these promotions will only increase the potential for conflicts of interest, while the pharmaceutical companies are arguing their new gifts are full of benefits to the patients.

The consensus, however, is the fine ethical line that doctors and drug companies walk in regard to giving and accepting gifts becomes even finer as the stakes to control the market become bigger.