Saturday, May 19, 2007

PhRMA Blusters On

Q: What do you do when the old stuff you have been saying seems not to be working so well any more--but you don't have anything new to say?

A: Say the old stuff over again, only louder.

At least that seems to be PhRMA's plan. Whenever something happens that challenges the main lobbying group for the nation's big pharmaceutical companies, you can count on a highly placed individual in the organization to appear in the media with a prominent opinion column, reciting the PhRMA party line.

The latest challenge was the Campbell et al. survey of physicians in the New England Journal ( The industry took quite a beating in the way the media covered that news. That 94 percent of physicians have contact with industry representatives is good, because those contacts provided valuable information about drugs, but don't unduly influence scientific prescribing--well, nobody was buying that story.

So PhRMA trotted out Scott Lassman, its senior assistant general counsel, whose op-ed, "Does a drug firm's free lunch influence doctors?" appeared in the Boston Globe on May 18. Lassman started off by briefly summarizing the Campbell survey, and added a point "ironically and rarely noted in the subsequent media coverage"-- that the investigators paid each physician $20 for participating in the survey. A standard measure these days as fewer and fewer folks respond to mailed surveys; but apparently in Lassman's eyes, it amounted to something sinister. After all, PhRMA gives physicians nice stuff, and then expects them to do what the drug industry wants them to. It only stands to reason that if somebody else is paying the physicians, they might go over to the enemy.

Lassman then proceeds to trot out all the familiar war horses:

"Who knows better about the scientific complexities of prescription medicines than the companies that create them?"

" seems to me to be insulting...[to say] that a meeting, a pizza, or a pen would inappropriately influence a physician's prescribing decisions."

A bit off the point, but have you noticed that whenever PhRMA is talking about gifts from drug reps being powerless to sway the scientific practitioner, the gifts always appear in the singular and never in the plural? A pizza. A pen. A doughnut. I guess that old ad was wrong; you can eat just one potato chip. No doubt if the doc ever took two pens, the industry could have its way with him. But the doc, being an abstemious sort of fellow, always takes only one pen, so everything is all right.

Back to Lassman. "This debate is really about trust." Yes, he got that part right. But whereas the media have for the most part drawn the logical conclusion that physicians become less trustworthy when they get their drug information, as well as a bunch of freebies, from biased commercial sources, Lassman wants to stand this idea on its head: "Just as patients trust their physician, it is equally important that physicians trust their pharmaceutical representatives."

Now, you might say that there is no reason on earth why physicians should trust a person who has one and only one job, who has been trained to do that job, and who is paid bonuses strictly based on whether or not he does that job--get the physician to prescribe more of the firm's drug, and push whatever physician's buttons have to be pushed to make that happen. But Lassman is now full of this trust thing, and so proceeds to tell us once again about the "strict" code of ethics imposed by PhRMA "more than four years ago" and that is in keeping with the AMA code of ethics. Now, referring to the PhRMA code of ethics is odd in relation to the Campbell et al. survey, since that survey is one of the most striking pieces of information to date on how widespread may be violations of the PhRMA code of ethics. If gifts are supposed to be modest and related directly to patient care, and some gifts are completely prohibited (such as tickets to sports events), then it would have been very hard for Campbell and company to come up with some of the figures that they came up with.

A few days before Lassman's op-ed appeared in the Boston Globe, a Seattle family physician, Steve Dudley, published a short essay in the Los Angeles Times ("The gifts that keep on giving," May 14). It's a bit hard to track what Dudley is actually saying in this ambiguous narrative. At the end, you don't know whether he has had an "aha" moment regarding how he is being corrupted by the free samples and free lunches the reps shower him with, or whether old habits rise up and drown out the "aha." But my point in bringing Dudley into this is that he has to hurry up to finish his clinic that day because he's due at the ballpark where box seats and free beer and brats await him, courtesy the drug rep. That is as clear a violation as you could wish of the PhRMA and AMA codes of ethics, and here's a doc writing about it in the LA Times as if it's the most normal thing in the world.

Just how well are the PhRMA guidelines being followed? If PhRMA would give us some hard data, instead of warmed-over smoke and mirrors such as Lassman's op-ed, we might actually know something. And don't tell me that the industry that manages to track every prescription written by every doc in the nation has no hard data.

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