Healthy Skepticism Library item: 5454

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Publication type: news

Murphy S.
Gifts seen effective by drug company reps
Boston Globe 2002 Nov 17

Full text:

GIFTS SEEN EFFECTIVE BY DRUG COMPANY REPS
Author(s): Shelley Murphy, Globe Staff Date: November 17, 2002 Page:
B1
Section: Metro/Region
While doctors insist they aren’t influenced by the freebies that
pharmaceutical companies routinely hand out, newly revealed internal
memos
from the drug company that paid a record fine for illegal marketing
practices show that employees believed plying physicians with food and
small
gifts was a highly effective strategy in boosting drug sales.

“Candy works after all!!” wrote a TAP Pharmaceutical Products sales rep
to
her supervisor after delivering a bag of sweets along with her sales
pitch.
The 1997 weekly activity report is among a stack of documents filed in
US
District Court in Boston in an ongoing criminal investigation into the
pharmaceutical giant’s dealings with doctors and hospitals in
Massachusetts
and other states. The same sales representative, Jennifer Weiler, won
TAP’s
regional contest for “best idea of the week” for using photographs of a
recent trip to Africa to entice a local urologist with a well-known
interest
in Africa to lunch.

In another memo, Weiler wrote that she planned to target a doctor who
had
just opened a new practice in North Reading because she was “green and
convincible!!”

The interoffice memos and e-mails offer a rare glimpse into how drug
sales
representatives gain access to doctors by repeatedly showing up at
their
offices with bagels, cookies, pizza, and promotional items bearing the
company logo.

Although the American Medical Association and the Pharmaceutical
Research
and Manufacturers of America have cracked down on gift-giving over the
past
year with stricter ethical guidelines, the freebies and fancy-dinner
invitations keep coming, according to a number of doctors interviewed
by the
Globe.

Dr. Charles Welch, president of the Massachusetts Medical Society, said
the
blame should be shared. “There’s problem behavior on both sides of this
relationship,” he said. “What we’re concerned about is that some
clinicians
are willing to participate in not just accepting significant gifts, but
also
participating in bonus programs and other kinds of things which clearly
are
influencing their choice of drugs.”

The AMA advises doctors to accept only “modest meals” that are shared
during
educational meetings and gifts, such as textbooks, worth $100 or less,
that
benefit patients. Industry guidelines that took effect in July advise
drug
companies not to sponsor expensive dinners for physicians. And while
the
trade association approves of in-office meals shared with doctors over
a
sales pitch, it says it’s inappropriate for drug reps to drop food off
at
doctors’ offices.

Noting that the AMA guidelines are voluntary, Welch said drug companies
will
probably continue to try to influence doctors with gratuities until
there
are financial or disciplinary penalties “for the people who offer these
arrangements, and the people who accept them.”

Welch, a psychiatrist at Massachusetts General Hospital, said he
received an
invitation from a drug company to dinner at a posh restaurant just last
week. He said the push by drug companies has gotten worse in the last
couple
of years, with more aggressive sales reps waiting outside his office.

TAP, based in Illinois, reached a record $885 million settlement with
the US
attorney’s office in Boston last year to resolve allegations of illegal
sales and marketing practices and Medicare and Medicaid fraud. Now
prosecutors are focusing on the activities of TAP employees and some
doctors.

In Massachusetts, 14 former TAP employees have been indicted and a
handful
of doctors have pleaded guilty to billing Medicare for drugs they
received
for free from the company.

Court documents show that sales reps pressured doctors to prescribe
TAP’s
prostate cancer-fighting drug Lupron over a cheaper competitive drug.

In a December 1997 weekly report, Weiler told her boss that Dr. David
Kauder
was “tough to see in the office,” so she called him after returning
from
Africa to say she had 18 rolls of film from her trip.

“Well, I ended up having a private lunch with him for 45 minutes,”
wrote
Weiler, adding that she managed to talk about the drug business in
between
photos and considered it a major coup because Kauder represented all of
the
state’s urologists on a national advisory committee for Medicare.
“Africa
was definitely worth the trip here.”

Weiler has been granted immunity from prosecution and testified before
a US
grand jury in Boston that is investigating TAP’s dealing with doctors.

When told about Weiler’s report, Kauder, a practicing physician for 25
years
who works at Urology Consultants of the North Shore in Lynn, said, “Boy
are
they slimy.” Kauder, whose office is adorned with photographs he took
of
zebras and lions during a 1996 trip to Africa, said he recalled meeting
with
Weiler to see photos from her honeymoon in Africa, but said he doubted
they
met as long as 45 minutes.

“I feel somewhat violated by what she did and how she interpreted what
happened,” Kauder said. “The joke is that it doesn’t affect sales. I
can
guarantee you that me meeting with her and talking about Africa did not
affect one iota the sales of drugs I wrote . . . I didn’t give one more
shot
of Lupron.”

In another report in November 1997, Weiler said that Dr. Richard
Krikorian,
an obstetrician and gynecologist at Mount Auburn Hospital in Cambridge,
kicked her out of his office for trying to discuss the drug he
prescribed to
a particular patient.

“I went back the same day with cookies and a letter,” wrote Weiler,
adding
that Krikorian met with her briefly and said he was upset because she
had
breached patient-physician confidentiality.

Reached by telephone, Krikorian said he couldn’t remember the incident,
but
added, “That is not uncharacteristic behavior for me. If I think a drug
rep
is misrepresenting, I will tell them so.”

Kim Modory, a spokeswoman for TAP, said the company has implemented a
new
mandatory ethics training program for all employees since reaching its
settlement with the government.

“Sales reps are instructed not to drop off food. However, they can
provide
an occasional meal where educational information is being provided to a
physician and his or her health care staff,” Modory said.

Kauder said drug company representatives often provide helpful
information
to doctors and can be a very good resource. Doctors, he said, aren’t
going
to be persuaded to prescribe a certain drug because of a tuna sandwich.

“The drug reps shouldn’t all be painted with the same brush,” said
Kauder.
“Reps from TAP tend to be smart, and I think they knew what they were
talking about. But I think they thought they were more influential than
they
truly were.”

There’s a movement afoot to ban all gifts to physicians from
pharmaceutical
companies. In April, the American Medical Student Association urged its
members to take a “purity pledge” and refuse all gifts from the
pharmaceutical industry.

“We believe that the patient-physician relationship is much more
important
than a free pen, and we’re concerned that these gifts to encourage
prescribing specific products erode the public trust and represent a
conflict of interest,” said Eric Hodgson, a physician and president of
the
medical student association.

Robert Goodman, a New York internist who has led a national movement to
convince doctors not to take freebies from drug companies, launched a
Web
site called nofreelunch.org. “The industry knows it works,” said
Goodman.
“They wouldn’t spend billions of dollars doing it if they didn’t.”

While noting that most doctors insist they aren’t influenced by drug
company
gifts, Goodman said: “They actually think that they are having the
laugh on
the reps by taking gifts and not prescribing their drugs. But it’s the
reps
who are having the last laugh because they’re pretty sure it works.”