Healthy Skepticism Library item: 8652

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Publication type: news

Kosmetatos S.
Are freebies for doctors bad medicine or benefit?
The Detroit News 2007 Feb 21
http://www.detnews.com/apps/pbcs.dll/article?AID=2007702210341

Full text:

Handouts prompt some area health systems to impose stricter rules

Nancy Bentivolio has seen pharmaceutical sales representatives plenty of times in the waiting room of her doctor’s office. They come in smartly dressed, lugging briefcases and samples, and are often ushered right in while patients wait.

For Bentivolio, 72, their presence is part and parcel of the business of a doctor’s office, and one that has helped her get free samples.

“They benefited me so much,” she said of the samples that helped treat her rheumatoid arthritis when she didn’t have insurance.

But for an increasing number of doctors and medical institutions in southeast Michigan and across the country, the relationship between pharmaceutical sales representatives and physicians are too cozy, with gifts, lunches, drug samples and even travel expenses flowing from drug companies to doctors. From coast to coast, hospitals have adopted or are considering policies that strictly regulate what doctors can and can’t accept from pharmaceutical reps and other vendors.

“We’ve got to be careful about the appearance of impropriety,” said Dr. Paul Farr, president of the Michigan State Medical Society. “We’re in the public eye.”

Supporters say patient care is at risk, citing recent studies that show doctors’ prescribing habits are influenced by gifts and samples. The supporters say drugs should be prescribed based on the patient’s condition and medical science and not on the samples in the doctor’s cabinet. They also say that samples encourage the use of brand-name drugs and not cheaper generics, driving up health costs.

The pharmaceutical industry is defending its practices, arguing that free samples are a godsend for patients who can’t afford the drugs, and allow other patients to try out new medications. They also say that product literature and other information — which often comes with their visits, lunches and small gifts — can help physicians make informed decisions.

“America’s pharmaceutical research companies — which generated tens of thousands of pages of scientific data as they researched and developed new drugs — naturally have the most thorough information and they make sure their representatives are well-prepared to explain medicines and their features,” said Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA) in a statement.

U-M banned gifts in 2002

The move toward tough oversight of the financial relationships between doctors and drug companies gained momentum last year, after a group of scholars and doctors published an article in The Journal of the American Medical Association. The article called for academic medical institutions to take the lead in imposing more stringent regulations to eliminate conflicts of interest and safeguard patients’ interests.

This month, a national campaign calling for restrictions and urging doctors to base prescriptions on medical factors was announced. The campaign is being funded by a $6 million grant from The Pew Charitable Trusts.

The University of Michigan Health System was ahead of the trend when it banned the use of prescription and nonprescription samples of drugs in 2002. The following year, U-M banned gifts from salespeople, from food to pens and notepads.

Henry Ford Health System got tough with vendors in January, banning free lunches, gifts and other perks and requiring drug companies to be certified by the system before they can conduct business. The certification, which costs $100, is the nation’s first such policy, according to the system.

Henry Ford has been flooded with phone calls from hospitals that want more information about the new policies, said Dr. Kathy Yaremchuk, vice president of practice performance for Henry Ford.

Detroit Medical Center President and CEO Mike Duggan said he has scheduled a meeting with the DMC’s medical leadership and Henry Ford to learn more. “It was a great initiative on Henry Ford’s part,” said Duggan, noting he is particularly interested in restricting salespeople’s access to DMC facilities. “We do not do that here, and it’s something we need to do.”

Critics: Freebies sway doctors

Dr. Joseph Weiss, a Livonia-based rheumatologist who has been practicing for 40 years, can remember more extravagant times in the ’60s, ’70s and ’80s, when representatives took doctors out to expensive tablecloth lunches and sponsored lavish trips. “They did all kinds of stuff,” he said.

No more. Nowadays, lunches are less frequent and usually catered. In hospitals with restrictions, lunches tend to coincide with an educational seminar that isn’t just about one manufacturer’s drug.

But gifts still abound. And whether it’s a pen, a drug sample or a speaker’s fee for a presentation, critics say that gifts do influence doctors’ prescribing habits.

“They wouldn’t be doing it if it didn’t work,” Yaremchuk said of the drug companies.

Doctors get exposed to drug freebies from the time they are in school. “On a daily basis there is someone in the hospital,” said Dr. Mike Stellini, an assistant professor of medicine at Wayne State University’s School of Medicine and vice president of medical affairs at Detroit Receiving Hospital.

To change what he calls a culture of entitlement, Stellini talks about physician interaction with salespeople in a course required of first- and second-year medical students.

Physicians set own rules

While health systems can set guidelines for their hospitals and outpatient facilities, most doctors in private practice usually set their own rules about what they will accept from vendors, and if they will see them at all.

“When I see a drug representative, it’s very limited to the drugs that I already use,” Weiss said. He welcomes visits, because the reps usually come with samples he can take to a Detroit clinic for the uninsured.

Not all doctors welcome the face time with drug reps, even if they deliver much-coveted samples. Kristin Prentiss Ott, a former Novartis rep in Grand Rapids, said she was hard-pressed to get face time with busy physicians in the six months she did the job before heading to medical school at Michigan State University in 2005.

Ott noted that drug reps have a legitimate educational role in the medical field. “For doctors to think they know everything is silly.”

You can reach Sofia Kosmetatos at (313) 222-2401 or skosmetatos@detnews.com.

Strict rules

Just over a year ago, a group of influential physicians proposed that the nation’s 125 university medical centers adopt strict regulations on doctors’ ties to drug makers. Writing in the Journal of the American Medical Association, the group called for seven regulations:

All gifts, of any value, from company to doctor should be banned.

Free drug samples should be banned and replaced with a voucher system for low-income patients.

Doctors who have financial relationships with drug companies should be excluded from committees that select which drugs are used.

Drug companies shouldn’t directly sponsor continuing medical education.

Drug companies shouldn’t directly pay for doctors to travel to meetings, but travel grants through a central account are acceptable.

Doctors shouldn’t serve on drug companies’ speaker bureaus or publish articles ghostwritten by industry employees.

Consulting contracts and research grants from drug companies are acceptable, but they should focus on science, not marketing, and the details should be made available on a public Web site.
Source: Journal of the American Medical Association