Doctors refuse to take bitter no-gift medicine Drugmaker freebies can
lead to harm for patients, some say

By Bruce Japsen Tribune staff reporter Published April 26, 2007

Whether it be Subway sandwiches for the office staff or reimbursement for
continuing education, gifts showered upon doctors by drug- and medical
device-makers have become so pervasive that they are a standard part of
virtually every U.S. physician's practice.

Despite self-policing initiatives launched by organized medical groups
and the drug and device makers to curb the cozy relationship between
physicians and industry, 94 percent "or virtually all" physicians have
at least one type of relationship with the drug industry, according to
a study scheduled to be published Thursday in the New England Journal
of Medicine.

The study indicates that those self-policing initiatives are not always
followed.

Consumers should care about such relationships because drug companies tend
to market the latest and most expensive brand names, and gift-giving can
influence prescribing behavior and therefore how much Americans spend
on prescriptions, the authors said.

Drug marketing and conflicts of interest between doctors and medical
product companies have come under congressional scrutiny because of their
impact on costs and because of safety issues involving heavily promoted
drugs, including Vioxx, the painkiller that was pulled from the market
in 2004, nearly two years after studies showed it increased risks of
heart attacks.

"Relationships with industry are a fundamental part of the way medicine
is practiced today," said the study's lead researcher and co-author, Eric
Campbell, an associate professor of medicine at the Institute for Health
Policy at Massachusetts General Hospital and Harvard Medical School.

Campbell said consumers have reason to be concerned about the study's
findings.

"Would you care if this person was managing your 401(k) and you found
out that they had financial relationships with mutual fund companies,
or if an umpire was calling the World Series between the Cubs and White
Sox would anybody care if the umpires were being paid by either of those
two teams?" he asked. "If people would be very concerned that it was
happening in a baseball game, you would be even more concerned if it
was something like your health."

The findings arise from a survey of more than 1,600 practicing physicians
in late 2003 and 2004. The survey was conducted at least two years after
the American Medical Association launched a high-profile educational
campaign for doctors to reinforce ethics guidelines that recommend that
any gifts be of nominal value and benefit patients.

The AMA guidelines, which are voluntary, say any gifts should
"primarily entail a benefit to patients and should not be of substantial
value." Subsidies should not be accepted to pay for the "costs of travel,
lodging or other personal expenses of physicians attending conferences
or meetings, nor should subsidies be accepted to compensate for the
physician's time."

If physicians accept gifts, they should be worth less than $100 and
"benefit patients," the guidelines say. Acceptable gifts include textbooks
or drug samples.

The study suggests that many doctors do not always follow the AMA
guidelines. It notes, for example, that 35 percent of respondents accept
reimbursement for continuing medical education or for travel, food or
lodging for medical meetings.

The drug industry lobby, Pharmaceutical Research and Manufacturers of
America, said its member companies have worked to eliminate certain
relationships and in 2002 established guidelines to curb such sales
tactics as golf outings, entertainment and "dine and dash" dinners that
drug companies order at restaurants for doctors to pick up for essentially
doing nothing. Modest meals for the doctor at his office, however, are OK.

"The meals are recognition that the physicians are extremely busy [and]
maybe the only time they have to meet is over a working lunch," said Scott
Lassman, senior assistant general counsel for the lobby, which includes
Abbott Laboratories, Pfizer Inc. and Merck & Co. in its membership.

Some doctors say, though, that free samples are needed, particularly
in practices where there are a number of uninsured patients who cannot
afford drugs.

Take Dr. Kristin Coyle, a family physician in Sterling, Ill., who said
her patients have been hit hard by unemployment.

"We definitely have not only a physician shortage and a lot of people
who cannot afford things like drugs -- we are a community trying to
rebuild," said Coyle, who has accepted Subway, Applebee's and other
drug-company-ordered lunches for herself and her office staff.

Coyle said she allows reps to drop off free samples and that they are
also allowed to make an educational presentation, such as explaining
how a new drug or device works. "Basically, they are not allowed to
interrupt my patient activity," Coyle said.

Some say, however, that doctors should at least let it be known to their
patients that they have a relationship with drugmakers and why it exists.

"People have no clue about this," said Jamie Reidy, a former Pfizer
sales rep who wrote a book about his experiences selling Viagra and
other Pfizer drugs.

"They should care," Reidy said. "If they are getting a drug simply because
the doc just got back from an advisory board and is pumped full of drug
propaganda, that's a problem. But if the doc truly believes Drug X is
best for that patient, fine."  ---------- bjapsen@tribune.com


Copyright © 2007, Chicago Tribune