Saturday, November 3, 2007

Are We at a Turning Point on Drug Company Gifts/Bribes to Docs?

Eric G. Campbell, PhD, of the Institute of Health Policy, Massachusetts General Hospital/Harvard Medical School, has published two major surveys of relations between physicians and pharmaceutical companies so far this year--first, on individual physicians (, and then on medical school departments and department heads ( In the latest issue of the New Enland Journal, Campbell summarizes the current scene:

Campbell first notes legislative efforts at both Federal and state levels to require reporting of all company gifts to physicians. Then, after reviewing the reasons why marketing influence can harm patients' interests, he notes the increasing number of academic medical centers that have enacted strict policies banning drug reps and their gifts. He offers the opinion that maybe we are coming to a turning point when more and more physicians and medical centers will choose to divest themselves from the industry gravy train, and that either new laws, or the threat of them, might stimulate more aggressive internal measures by medical groups.

In the end Campbell offers some suggestions to individual practitioners, to "maximize the benefit for patients and minimize the risks associated with their own industry relationships."It may be worth assessing the value of these recommendations by comparing to material discussed in HOOKED:

  1. Recognize that relationships with industry have one goal, to influence their prescribing behavior in industry-friendly directions, and assess the impact of these relationships on one's patients-- this is certainly good basic advice. I would add--all practitioners need to be regularly sensitized to the prevalent rationalizations that their colleagues use to justify the status quo and that industry sources are only too happy to reinforce vigorously: "it's education, not marketing"; "others may be influenced but I am a scientific reasoner and cannot be influenced"; "it's insulting to think that I can be boiught for a donut or a coffee mug"; and so on as we have extensively reviewed in this blog. After a while, no physician should be able to repeat these rationalizations without blushing.
  2. Be familiar with policies and codes of ethics of one's medical institutions and professional societies-- this will be good advice for docs who happen to work for the forward-looking centers that have banned reps and their stuff. If the doc works for one of the majority that are not yet that enlightened, instiitutional policy won't help much. Ditto, as HOOKED shows, for most association codes of ethics. Most are based on now-discredited ideas that gifts are OK so long as they are of low monetary value, are "modest" meals, are aimed at patient care, and so forth.
  3. Remember that ultimately the patients pay for all this junk--This also seems like good advice, and indeed, based on purely anecdotal evidence, this realization has provided the "aha!" moment for at least some physicians who ended up dissociating themselves from the reps' grip.

1 comment:

Anonymous said...

When I was a rep for big pharma, we called it gifting, and reciprocity was expected, and not presumed. Quid Pro Quo was common, with occasional episodes of extortion, regardless of the nature of the gift. An obligation to a rep for such inducements clouds the objective judgement of the doctor when considering the best treatment for the patients.