Healthy Skepticism Library item: 2378

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

Rindfleisch T.
Area medical staff change how they do business with drug companies
La Crosse Tribune ( Wisconsin) 2005 Aug 28
http://www.lacrossetribune.com/articles/2005/08/28/news/z4news28.txt

Keywords:
gifts

Notes:

Ralph Faggotter’s Comments: At last, somewhere in the world (in this case in La Crosse, Wisconsin),a group of doctors has agreed amongst themselves to voluntarily forego the free wining, dining and gifts which the pharmaceutical industry likes to constantly shower upon them. Healthy Skepticism and No Free Lunch ( see http://www.nofreelunch.org/ ) have been advocating this for years. Hopefully, the wisdom of this approach will become accepted more widely.

Full text:

Published – Sunday, August 28, 2005

Area medical staff change how they do business with drug companies

By TERRY RINDFLEISCH La Crosse Tribune
.
One La Crosse doctor called it “prescribing under the influence.”

For many years, La Crosse area physicians and medical staff were wined and dined by pharmaceutical companies. They were handed gifts, dinners, golf outings, vacations and trips to conventions, all financed or supported by the drug companies.

It helped companies gain access to doctors and market their products. Even though few doctors will admit these gifts might have influenced their prescription decisions, the barrage of “perks” raised ethical issues and questions.

But in the past few years, that showering of gifts has been limited in the La Crosse area after medical groups and institutions developed stricter ethical policies.

Gundersen Lutheran has had such a policy since 2000, and Franciscan Skemp Healthcare’s policy went into effect in 2002.

The bottom line: Try to avoid accepting any gift.

“We’re not going to be pen and coffee cup police, but not accepting gifts is a good policy,” said Dr. P. Stephen Shultz, Franciscan Skemp medical director and chairman of the system’s ethics committee that developed its gifts and gratuities policy.

“Doctors say the gifts didn’t influence their decisions or change their minds,” said Shultz, “but it didn’t look good and who knows if it really did change their minds?”

One research study in the Journal of the American Medical Association concluded gifts from drug companies did change physicians’ prescribing practices. A researcher reviewed 29 studies and found physicians are more likely to prescribe fewer generic drugs and more new, expensive medications, even when the drugs don’t offer any advantages over cheaper drugs.

“I think these gifts were considered the cost of doing medicine, just like it’s done with other businesses,” Shultz said. “But it was a bad habit that has been broken in the past five or six years by some national discussion and new ethical guidelines.”

“This whole issue is a moving target, and it’s about perceived influence,” said Joan Curran, Gundersen Lutheran’s administrative director for pharmaceutical services.

So no more lunches and dinners. No more free conventions and meetings solely sponsored by drug companies. Educational meetings are permitted, but with a “modest meal” that spouses no longer are welcome to attend.

Local drug company representatives can’t show up at a doctor’s office without first registering. Drug company advertising now is discouraged in doctors’ offices and clinic or hospital lobbies as well, though educational information is still allowed, Curran said.

The national pharmaceutical representative association now follows the American Medical Association guidelines, said Dr. Todd Mahr, a Gundersen Lutheran pediatrician and allergist who helped develop the medical center’s ethics policy.

Drug samples, often given to patients who could not afford a specific drug, also are limited under the new policies. Mahr said the appropriate use of drug samples now is to allow someone to try a new drug for a month, though some doctors still try to help patients for a few months with samples.

“A lot of places don’t have samples anymore because all drugs have to be tightly controlled with elaborate recordkeeping to meet safety standards,” Shultz said.

Shultz said Franciscan Skemp’s policy followed the Mayo Clinic model and is stricter than many medical staff policies.

“Some medical staff are relieved by the ethics policy, because they don’t have to make anyone mad by refusing a gift,” he said. “Now can say, ‘It’s out of my hands,’ and they don’t feel pressured.”

Dr. David Rushlow, a Franciscan Skemp family medicine physician, said doctors need to take the patient’s perspective when it comes to accepting drug company gifts.

“It’s good to see this issue has been more formally defined, and I think it will benefit patients.

“Yet it would be completely wrong for us to be anti-pharmaceutical, because some of the drugs these companies have developed have improved and saved lives,” he said. “But now there’s a clear understanding of our policies, and the line is drawn.”

Terry Rindfleisch can be reached at (608) 791-8227 or trindfleisch @lacrossetribune.com.