Experts Say Drug Firms’ Gifts Harm Health Care

By JEFF NESMITH Palm Beach Post-Cox News Service

In a sweeping warning about the quality of medical care in America, representatives of medical schools and research centers said Tuesday that drug company gifts to physicians should be prohibited.

From providing free office drug samples to picking up the cost of travel to medical meetings, manufacturers of drugs and medical devices spend billions of dollars annually to promote their products to doctors.

In an article appearing today in the Journal of the American Medical Association, 11 medical leaders said those practices affect which drugs doctors prescribe and are undermining the quality of medical care.

“The data are overwhelming. Gifts, travel grants, consulting contracts, support for continuing medical education and speaking fees affect which drugs doctors prescribe for their patients,” said David Rothman, president of the Institute on Medicine as a Profession.

He said pharmaceutical companies spend an average of $13,000 per physician annually to promote their products.

The group called on medical schools and research hospitals to “provide leadership” and cap gifts at “zero dollars,” and expressed the hope that all doctors would follow.

“Marketing and market values should not be allowed to undermine physicians’ commitment to their patients’ best interest or to scientific integrity,” the group stated.

It added that previous efforts by drug companies, medical societies and the federal government to restrict product promotion have been largely ineffective.

Broadly adopted, the recommendations would transform doctors’ day- to-day lives and shut off the focus of drugmakers’ biggest expenditures. But Dr. David Blumenthal, an author of the article, said it was “not very likely” that many in medicine would listen to the group.

“I’m not very optimistic,” said Blumenthal, a professor at Harvard Medical School who, like many of the article’s 10 other authors, has studied conflicts of interest in medicine for years.

Federal law forbids companies from paying doctors to prescribe drugs or devices, but gifts and consulting arrangements are almost entirely unregulated. Voluntary professional guidelines suggest that doctors refuse gifts of greater than “modest” value. Sanctions against doctors who accept gifts of great value are extremely rare.

The drug industry spends tens of billions of dollars a year to woo doctors, far more than it spends on research or consumer advertising. Some doctors receive a significant part of their income from consulting arrangements with drug and device makers. Others take regular vacations and golfing trips that companies pay for.

A recent lawsuit involving the device maker Medtronic revealed that one prominent Wisconsin surgeon received $400,000 under a consulting contract that required him to work just eight days. Although such rich arrangements are often restricted to specialists, most physicians routinely accept small gifts from drug salespeople, including pens, mugs, pads and food.

The group recommended that medical centers impose the following restrictions on their faculty members and affiliated physicians:

– Ban all gifts, including meals, travel expenses and other costs of participating in medical meetings.

– Prohibit acceptance of direct drug samples and replace them with a system of vouchers for low-income patients.

– Prohibit speaking fees from drug company “speakers bureaus.”

The article did not recommend a prohibition against research grants by drug companies, which now underwrite a large portion of new-product development.

However, it called for greater “transparency” in grant agreements and said no-strings-attached research grants should be prohibited because they amount to “outright gifts.”

Pharmaceutical company promotion practices have been criticized by consumer advocate groups and some members of Congress.

Sen. Charles Grassley, R-Iowa, chairman of the Senate Finance Committee, wrote this month to 22 national and international drug companies, seeking information on how continuing medical education grants are used to push the companies’ products.

A sampling of practicing physicians in several cities indicated that many doctors do not agree that the drug companies’ practices harm patients.

“I think physicians are able to make their decisions on the basis of what is the correct indication for a particular patient,” said Dr. Maria Gutierrez, an Austin, Texas, allergist.

Office drug samples often make it possible for a patient to try a particular medication without having to pay for a full prescription, she said, and drug industry support for medical meetings helps doctors stay abreast of new developments.

Plastic surgeon Dr. Gregory Lange of Palm Beach Gardens said the problem is overblown, especially in recent years as pharmaceutical manufacturers cut back on the gifts.

“About the most we get now is a bagel lunch in the office,” Lange said.

Dr. Aaron Hurowitz, an Atlanta family practice specialist, expressed resentment at drug company promotion of medications such as the pain reliever Vioxx that have been found to pose undisclosed dangers to patients.

However, he said deception by pharmaceutical companies in such cases was unrelated to the way they promoted drugs to individual doctors.

He said the promotions “are a form of lobbying, but this is not like some Tom DeLay thing.”

Hurowitz remarked on one subtle aspect of the industry’s promotion activities.

“One thing I always said is that those drug company representatives look like runway models,” he said. “Maybe there should be a rule that the doctor’s wife has to be in the office when they call.”

The New York Times contributed to this story.

– jeffn@coxnews.com