Healthy Skepticism Library item: 2189

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Publication type: news

Okie S.
AMA Blasted for Letting Drug Firms Pay for Ethics Campaign
Washington Post 2001 Aug 30

Full text:

The American Medical Association is mounting a $1 million campaign to educate doctors about its ethics guidelines against accepting gifts from drug companies — with most of the funding for the effort coming from drug companies.

Nine large pharmaceutical companies are contributing a total of about $675,000 to help pay for the campaign, which is aimed at medical students, physicians-in-training and drug company sales representatives as well as practicing doctors, said Alan R. Nelson, a former AMA president and special adviser to the American College of Physicians.

The ethics guidelines allow doctors to attend company-sponsored conferences and to receive textbooks or drug samples that will directly benefit their patients, but advise them against accepting individual gifts of more than minimal value.

Nelson defended the AMA’s decision to accept grants from the drug industry to publicize the guidelines. “The idea that somehow that money is tainted is not accurate in my view,” he said. “This is a legitimate education program that should benefit the public.”

But some observers criticized the AMA move. “They’re certainly not exactly going to encourage doctors to adhere to [the guidelines] when they’re setting this kind of example,” said Sidney M. Wolfe, director of Public Citizen’s Health Research Group, a consumer organization. “The campaign is not going to have any credibility.”

Kurt Kroenke, president of the Society of General Internal Medicine, said he thought the decision to accept drug company funding for the campaign was reasonable as long as the companies had no say in how the money was used. “I think education of physicians and pharmaceutical representatives on appropriate guidelines . . . is a good idea,” he said.

The guidelines were formulated in 1990 by the AMA’s Council on Ethical and Judicial Affairs and were last updated in 1998. They were issued in response to public concern over marketing practices in which drug companies often treated doctors to expensive gifts, lavish dinners, trips or cash payments.

Publication of the guidelines helped curb such practices in the early 1990s, but more recently, studies and media reports have suggested that gift-giving to doctors by drug companies has increased, according to the AMA. At the same time, surveys indicate many doctors are unaware that the ethics guidelines exist.

Spending by the pharmaceutical industry for marketing has increased dramatically in recent years. Last year, drug companies spent about $15.7 billion on marketing, compared with about $9 billion in 1996, according to IMS Health, which collects data for the industry. Last year’s figure includes about $4 billion spent by companies to promote drugs to doctors in their offices, compared with about $2.5 billion in 1996.

Prescription drug costs have become the fastest-growing fraction of the nation’s health care spending, with newer, more expensive brand-name drugs fueling much of the increase. Many observers believe that aggressive marketing of new drugs to doctors and patients is partly responsible.

Drug companies’ gifts to doctors typically include such items as pens, notebooks, coffee cups, desk accessories and tote bags emblazoned with the name of a company or a drug, said Lisa A. Bero, a researcher at the Institute for Health Policy Studies at the University of California at San Francisco. Companies sometimes offer gifts unrelated to office practice, such as golf balls or golf club covers, she added.

In addition, company sales representatives often provide free drug samples for doctors to hand out to patients and frequently fund educational conferences on new drugs or pay for refreshments at such meetings. In some cases, Bero said, the companies pay travel costs for doctors to attend conferences.

The AMA guidelines state that doctors should not accept gifts if there are strings attached — for instance, if the gift is an incentive or a reward for prescribing a company’s drug. But Bero said research suggests that company gifts influence doctors’ attitudes and behavior.

“Even the smallest gifts make doctors feel more favorable towards a company,” Bero said. “Acceptance of gifts is also associated with formulary decisions favoring new drugs from the company that gave the gift.”

Companies contributing to the education campaign are AstraZeneca International, Bayer Corp., Eli Lilly and Co., Glaxo SmithKline, Merck and Co., Pfizer Inc., Pharmacia Corp., Procter and Gamble Pharmaceuticals and Wyeth-Ayerst Laboratories. Nelson said most companies contributed about $50,000 each, but some gave almost $100,000. The AMA contributed $50,000 plus the time of various staffers, he said. The campaign was created by a working group that also included representatives from about a dozen other large medical organizations.

The money helped to pay for educational kits to be used to teach doctors, medical students and drug company sales representatives about the guidelines, as well as a new AMA Web site on the topic, Nelson added.

Jeff Trewhitt, a spokesman for Pharmaceutical Research and Manufacturers of America, said two staffers from his organization also worked on the effort.

“The goal . . . was to set up a good, comprehensive educational campaign that is going to make it so that new young doctors and new young sales representatives know about these guidelines,” Trewhitt said.