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Group Calls on Doctors to Stop Accepting Gifts

Posted on: Tuesday, 24 January 2006, 21:00 CST

PHILADELPHIA _ A group of national health leaders are calling on the medical community to stop accepting free pens, high-end meals and open-ended grants given by the drug and medical device industries, saying that the cozy relationship undermines patient care and the profession's reputation.

The article, published Tuesday in the Journal of the American Medical Association, was co-authored by the Association of American Medical Colleges and the Philadelphia-based American Board of Internal Medicine, among others. The "manifesto" comes as doctors are being lobbied like never before, with device companies offering $400,000 for a few days of consulting.

"It's one thing if the jeans that you buy have been influenced by gifts that the store buyer received, but it's another if the drugs that the doctor prescribes you have been influenced by a gift," said David Rothman, article co-author and president of the Institute on Medicine as a Profession.

"Medicine is a profession that we hold to a higher standard."

Some doctors say the JAMA suggestions are too stringent. Eliminating medical education funding and grants would cause serious financial problems, and they questioned how tiny freebies could affect patient care.

"Pens and pads, I don't think anyone feels like those things have an impact, those are a convenience factor," said Dr. P.J. Brennan, chief of Healthcare Quality and Patient Safety for the University of Pennsylvania Health System.

But studies have shown that doctors who accept gifts tend not to prescribe alternative or generic drugs that would do just as well, opting instead for the more costly new drugs.

In fall 2004, the school considered banning pharmaceutical reps from talking to doctors and outlawing freebies altogether, but hasn't yet made a decision.

While Brennan said the school frowns upon physicians being wined and dined, "it's difficult for us to regulate beyond these four walls," he said.

The companies can be quite aggressive, doctors said. Studies estimate that as much as $13,000 is spent on each physician by pharmaceutical companies.

A few months ago, Dr. Marvin Schatz received a call. It was a pharmaceutical company offering dinner and a drug talk at a local restaurant. He said no. How about if his wife came? He said no. What if the drug rep didn't come? No. Well, what if the company just sent him $500?

"I said no," said Schatz, a hospitalist at Albert Einstein Healthcare Network.

But the doctor said he did accept money from Sanofi-Aventis S.A. to bring a Harvard blood clot expert to speak at Einstein.

"I had nowhere else to turn for the $5,000 for a lecture plus the plane fare," said Schatz. "I thought his lecture might change something fundamental in the way we approach things. And he didn't even mention the drug in his lecture."

Contact from companies often starts with medical school students and grows exponentially as their careers progress.

The pharmaceutical industry spends $21 billion on marketing, about 90 percent directly aimed at doctors, including paying for 314,000 events for physicians, according to the JAMA article.

The article, which specifically addressed academic medical centers, suggested banning all gifts, barring direct drug samples and eliminating open-ended grants, which tend to run in the thousands of dollars and can be used at the researchers' discretion.

Natalie DeVane, a spokesperson for Wyeth, said the company and doctors have similar goals _ to develop effective medicines and educate others on how best to use them.

"We don't believe a pen is going to change the course of how a physician treats their patients," she said, adding that the company follows the guidelines set by the American Medical Association, among others.

But doctors aren't the only ones wooed. A recent pharmaceutical invitation to one of Philadelphia's most expensive restaurants extended the offer to doctors, residents, pharmacy managers, physician's assistants and nurse practitioners.

Doctors said it was easy to turn down dinners and notepads, but sometimes it's hard to know where to draw the line.

Dr. John McShane, a sports medicine physician at Villanova University, speaks a couple of times a year to local doctors about an arthritis drug he uses, and said the JAMA article was "a bit of an over-reaction."

"I certainly see the potential for conflict, but I also see the potential for it to be a good thing," he said. "I know a lot about the topic, and I've written about it, but I don't go there to endorse the product. I talk about how I use the product to manage a condition along with a whole variety of other things."

Rothman, one of the co-authors, said part of the reason the article targeted academic medical centers was to encourage a different relationship with industry _ at least for the next generation of doctors.

But the culture may already be changing. As a medical student in St. Louis, Mark Stover often ate at "pharma lunches."

"You're busy and you're poor and free food wasn't looked down on," he said. But there was always a drug rep at the beginning of the line handing out literature on the latest drugs.

Now a third-year emergency medicine resident at Penn, Stover turns down invites and freebies.

"To draw a line in the sand and say they shouldn't have any role, that's really hard because there's so much research that's dependent on the funding," he said. "For me, it's a conscious choice, but there are plenty of people who don't see too much harm in having a pen.

"Everyone has boundaries."

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Source: The Philadelphia Inquirer

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