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Sorry! See article in full below Alan

Posted by ZeeZee on November 4, 2002, at 8:52:52

In reply to Re: Influence of Pharm. Co's and their reps on doc's ZeeZee, posted by Alan on November 3, 2002, at 23:20:38

Sorry Everyone,
Forgot about the date changing your link to articles. Had to access this through the archives and couldn't copy and paste the link. So here it is in full.


HOUSTON CHRONICLE ARCHIVES

Paper: Houston Chronicle
Date: SUN 20021103 20021103 20021103 02/00/00
Section: BUSINESS
Page: 1
Edition: 2 STAR

Doctors examine ethics of drug industry gifts

By DARRIN SCHLEGEL
Staff

LAUREN Oshman prepares for battle against the influence of the pharmaceutical industry every morning before she goes to medical school. Her weapons: a 12-pack of Bic pens and an organic burrito.

If she wanted, the fourth-year Baylor College of Medicine student could grab a free lunch almost every day at the Texas Medical Center, collecting complimentary pens, calculators and other knickknacks along the way for her studies and clinical work.

Drug companies, armed with marketing budgets worth billions and a sales force that rivals the population of Tyler, eagerly sponsor and pay for lunchtime seminars and promotional items in an effort to persuade doctors to prescribe their drugs.

They're willing to bet that hungry, on-the-go physicians - and students like Oshman - will spare 20 minutes to listen to a sales pitch while wolfing down pizza and sandwiches.

But to Oshman's way of thinking, there are no free lunches. So she brings her own to the meetings and eschews freebies branded with drug names in favor of her Bics.

"From my point of view, free pens and calculators don't help you learn about the side effects of drugs or the cost of drugs - things that would actually help you help your patient," Oshman, 26, said. "In fact, they may contribute to the rising cost of drugs because for every lunch that gets put on in the medical center . . . it's coming out of the pharmaceutical companies' advertising budgets."

Like Oshman, a growing number of medical students and physicians are beginning to place restrictions on the marketing practices of the drug industry.

Some doctors adhere to guidelines set forth by industry groups like the American Medical Association. Others, like officials at Kelsey-Seybold Clinic in Houston, take matters into their own hands.

Doctors say their efforts are largely a reaction to the rising cost of prescription drug spending, which is increasing annually in double digits. But exposure of the excessive and often embarrassing gift-giving of years past has also played a role.

For years, drug companies have funded educational seminars and conferences that were - and continue to be - much valued in the medical community for the information they provide.

But it also was not uncommon for doctors to receive cash, frequent-flier miles or weekend trips to luxury resorts from the industry.

Now, even the most inexpensive gifts are scrutinized by some.

"In the hierarchy of things that are acceptable or not, I think we all agree that accepting a notepad is a lot less egregious than accepting a free dinner or two tickets for a Houston Texans football game," said Dr. Eugene Boisaubin, a professor of medicine and clinical ethicist at the University of Texas Health Science Center at Houston.

"On the other hand, there still is a problem with a logo that is plastered on everything you touch. When you're holding a pen and 84 times a day you're glancing at a drug name, that has an impact on you."

At Kelsey-Seybold, many efforts are made "to keep an arm's-length distance between drug representatives and physicians," said Dr. Patrick Carter, chairman of the clinic's department of family practice.

Sales reps, for example, are prohibited from peddling drugs that are not on the clinic's formulary, a broad list of medications considered by Kelsey-Seybold to be appropriate for use and cost-effective for patients by using scientific, evidence-based research.

"Our logic is to try and make drug representatives talk about things that are medically indicated and not just a way for the drug companies to make more money," Carter said.

Perhaps the clinic's most extreme measure is a ban it placed two years ago on the distribution of free samples, a widespread practice used by drug reps to foster the future sale of medications that are typically new to the market or still protected by patents.

Many doctors still accept the practice, viewing it as a way to provide drugs for patients who may have access problems. Even the AMA's guidelines accept the distribution of free samples as long as it benefits patients.

But Carter said the tactic eventually increases the cost of drugs to patients when the physician can no longer provide them free of charge.

"We feel like sampling is sort of a wolf dressed in sheep's clothing," Carter said.

"Our policy comes across as `How could you be against giving patients free medicine?' But in reality, what it is, is a way to get patients started and maintained on newer, more expensive medicines that very often have no advantage over older, well-established and much cheaper medicines."

Drug companies spent $19.1 billion marketing and advertising medications such as Viagra and Lipitor last year. More than $15 billion of that amount was used to convince doctors to prescribe particular medications through various means, including $10.5 billion worth of free samples.

That war chest is used to fight generic competition and increase the sales of drugs shielded by patents.

And it works, for the most part.

Studies have shown that doctors who interact more with sales representatives are less likely to prescribe cheaper generic drugs for their patients.

Generic medications accounted for 41 percent of all prescription drugs dispensed in the United States last year, according to data from NDC- Health, a health care information services company.

"We all know from our own lives, once a salesperson develops a personal relationship with you, and you invest some trust in them, it's golden for them," said Steven Findlay, director of research at the National Institute for Health Care Management, a nonprofit research group founded by Blue Cross-Blue Shield. "That's what sells the product."

The industry's sales force numbers have grown to 81,532 last year from 34,847 in 1993, providing an ample army with which to approach physicians.

Those sales reps are a major source of detailed, technical information for doctors and other health care professionals, said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, the drug industry trade group with members such as Pfizer, GlaxoSmithKline and Merck.

"Many sales representatives are (former) nurses and pharmacists, and they really do understand medicines and how they work and what the potential side effects might be," Trewhitt said. "In the vast majority of cases, the relationship between sales representatives and doctors is absolutely appropriate and constructive."

Many doctors agree with that assessment.

"They do provide some education, and they do conduct legitimate conferences with reputable sources," said Dr. William Fleming, president of the Harris County Medical Society.

To answer critics who charge that the industry excessively buys its way into doctors ' prescribing practices, Trewhitt said the industry adopted its own set of voluntary guidelines on appropriate interaction in July.

The code generally stipulates that gifts should not exceed $100 and must be limited to educational and practice-related items that benefit the patient, such as anatomical models or textbooks.

But groups like the American Medical Student Association, of which Oshman is a national vice president, say those guidelines aren't enough.

The association urged medical students earlier this year not to accept promotional gifts, large or small, from the industry.

"It makes you think every time you go to a lunch, every time you get a pen: Is this going to change how I look at a subset or a class of drugs for my patients? Is this going to change my prescribing practices?" Oshman said.

But some doctors still enjoy pricey meals at the expense of drug companies.

Dr. Margaret Payne, a Houston pediatrician, said it's not unusual to receive invitations to dinners at Brennan's or other high-end establishments.

Drug companies foot the bill for the food and wine in return for an evening discussion about "antibiotics for ear infections" or some other general topic, she said.

The speakers are typically hired experts brought in by the company, Payne said, but they don't always push its product. Spouses are not invited.

AMA guidelines allow for "modest" meals and other gifts if they serve an educational function and primarily entail a benefit to patients.

Dr. Jeffrey Starke, chief of pediatrics at Ben Taub General Hospital and professor of pediatrics at Baylor College of Medicine, said he considers the AMA's guidelines reasonable and hands them out to his students.

Although gift-giving is common in other industries as a way to enhance sales, Starke thinks physicians should be held to a different standard.

"Patients get better because they believe in us," he said. "They believe in our honesty because they believe we have their best interests at heart.

"And so anything that harms that perception, whether it's real or just perception, is ultimately harmful to the therapeutic process."

Copyright notice: All materials in this archive are copyrighted by Houston Chronicle Publishing Company Division, Hearst Newspapers Partnership, L.P., or its news and feature syndicates and wire services. No materials may be directly or indirectly published, posted to Internet and intranet distribution channels, broadcast, rewritten for broadcast or publication or redistributed in any medium. Neither these materials nor any portion thereof may be stored in a computer except for personal and non-commercial use.



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poster:ZeeZee thread:126333
URL: http://www.dr-bob.org/babble/20021101/msgs/126389.html