By Peter Lurie, MD, MPH, Deputy Director, Public Citizenâs Health Research Group
Dr. Lurie is a contributor to Public Citizenâs drug newsletter, available at www.worstpills.org. He will present testimony on state doctor gift disclosure laws before the Senate Special Committee on Aging on Wednesday, June 27, 2007.Â This article originally appeared in the May 2007 issue of Public Citizenâs Health Letter.
The life of a doctor must be tough.Â To judge by most of their offices, doctors are unable to afford pens, mugs, refrigerator magnets, or pads of paper.Â Even lunch is beyond their reach, it seems.Â And dinner at a fancy downtown restaurant?Â Fuhgeddaboutit.
Fortunately, thereâs a group willing to step into the breach and supply these missing morsels and amenities.Â You guessed it: the pharmaceutical industry.
Despite the growing prevalence of direct-to-consumer advertising on television ($4.2 billion in 2005), the pharmaceutical industry continues to lavish the lionâs share of its advertising budget on physicians ($7.2 billion, excluding the ubiquitous free samples).Â After all, it is the physician who wields the power of the prescription pen.
Somehow, doctors operate under the delusion that the pharmaceutical industry is misguided enough to squander close to $20 billion on promotion annually even though, according to many doctorsâ reasoning, all this largesse has no influence upon their prescribing habits.Â Much research suggests otherwise.Â When doctors were sent on expensive junkets to exotic locales, purportedly to receive objective education on a drug or disease, researchers noticed that prescribing of the sponsoring drug companiesâ products went up in those doctorsâ hospitals upon their return.Â Doctors accepting gifts from drug companies are more likely to request that their hospital add drugs to the hospitalâs formulary, its list of preferred drugs.
Some people have had enough.Â Recently, a number of prominent medical schools, including Stanford, Yale, and the University of Pennsylvania, have sharply limited interactions between their physicians and pharmaceutical representatives.Â And now states are getting in on the action.
In 1993, Minnesota passed a law that required drug companies to report to the state all gifts to doctors exceeding $100.Â Five other states followed suit between 2001 and 2005, and in 2006, 11 more states considered such bills.
In March, Public Citizen published the first evaluation of these programs in the Journal of the American Medical Association, focusing on the only two states that have so far made doctor gift data publicly available: Minnesota and Vermont.Â Actually, âpublicly availableâ would be a bit of a stretch.Â In Minnesota, we had to literally go to the state agency housing the records, dust off boxes containing the companiesâ paper reports, and arrange for copies to be made.Â In Vermont, the legislation permitted drug companies to decide for themselves if the reports were trade secrets â and then unilaterally withhold the information from the public (they still have to provide the data to the state).Â And withhold them they did; in dollar terms, two-thirds of the records reported to the state were kept from public scrutiny.Â Public Citizenâs Litigation Group then sued the state of Vermont and obtained additional records through a settlement agreement.
Still, the records told a compelling tale.Â In Minnesota, there were 6238 payments of $100 or more to physicians for a total of $22 million over three years.Â In Vermont, despite data withholding by the larger companies, 2416 payments of $100 or more to physicians were publicly disclosed, totaling $1 million over two years.Â The purposes of the gifts ran the gamut from speakersâ honoraria and research studies to detailing and marketing.
Taking a leaf from the book of courting couples, who know that the path to loves passes through the stomach, pharmaceutical companies seem to pay as much attention to the alimentary tract as they do to cranium, where most patients would hope prescribing decisions are being made.Â The voluntary guidelines of both the pharmaceutical industry and the American Medical Association suggest a $100 limit on gifts and require that gifts be educational in nature.Â (This is no coincidence as drug company executives sat on the AMAâs task force on gift-giving.)Â Yet, in Minnesota there were at least 164 payments of over $100 to physicians for food, totaling $25,685.Â In Vermont, nearly 68% of such payments were for food, for a total of $381,455.Â Until such time as someone can show us that the educational content of these meals approached their fat content, weâll believe that many of these meals violated the guidelines.
Our study demonstrates that in these two states the efforts of legislators to make doctor-gift data available to the public have been thwarted by loopholes, industry non-compliance, lack of standardization in reporting, and lackluster enforcement.Â These are valuable lessons for states currently considering similar legislation.Â
I used to work as an EMT and I was amazed by the amount of medication people are put on. I would routinly ask patients what medication they were on and they would hand me in upwards of 30 pill bottles, sometimes even more. What concerned me even more was that many of these perscriptions were written by the same doctor, and upon investigating the side effects of mixing these drugs turned up some dangerous and scary results.
It annoys me that doctors do not take more then 5 minutes, generally, meeting with a patient, and in most case after 5 minutes have the "perfect" drug to hand out. Why is it that doctors do not spend more time looking for the best drug for the patient and really go over what medications that person is on.
Yes sometimes the effects of these drugs the P. Companies sell have good effects, but do they have the best effect.
I thought the first rule of medicine was to Do No Harm? Are they really following that by taking bribes and gifts by P. Companies in order to convince them to sell their medication?
Listening to the radio the government has launched a campaign on the 10 questions you need to ask your doctor- i dont have the address handy im sure some people do, but how about we get a centralized database so that PATIENTS can check what doctors claim they can(on drugs that harm eachother)- lets open source medicine already.
(If it exists then sorry, it obviously isn't being promoted well)
It's not just the Pharmacuetical companies that engage in this behaviour. The medical and surgical device companies are also heavily marketing to physicians and surgeons. Senior physicians in my field are regularly on advisory panels for companies and receive direct research support in kind or in cash.
Admittedly I've also got a few free dinners out of these companies. I presume because they can't necesarily tell I'm a PhD and not a Physician from the program and erroneously invite me. Then again they may deem me as useful for the purpose of convincing the physicians to recommend more of their product?
Does anyone care that doctors are paid less then $0.27 on the dollar.. In order to cover malpractice and office and staff.. they have to see too many patients..
The oversight shouldn't be over pens and pads provided by drug companies, but rather scrutiny of the insurance and drug indutires for ruining medicine and health care in our country.
There is no oversight. and.. if you are concerned about a few pens and a lunch and a disclosure of over $100... try hundreds of thousands of dollars to our elected politicians.. who are supposed to serve the electorate and instead serve the lobbyists..
Get your priorities in order!!!
Good post. We wrote about this on Shrink Rap (www.psychiatrist-blog.blogspot.com) on 6/27/07 "I still presecribe seroquel but I don't get paid to do it."
I'm an Internist. The reps are "Barbies" and "Kens" these days (in case I go both ways??) LOL
My patients get the generics unless they REALLY NEED/insist/can pay for the brand name drugs.
and they have NO business advertising on TV in ballparks or on stock cars.
Hillary and Obama will just have to socialize the whole thing.
But patients need to exercise not supersize and stop smoking so they dont NEED a dozen meds!
I'm working in a hospital, but I'm not a physician. I've open a blog which constantly posting those gifts given by drug companies to healthcare workers.
Feel free to leave your comments.
Janbaran - It is, in fact, possible to achieve oversight on multiple levels at once. Shocking, I know.
And your 27 cents on the dollar figure probably doesn't take into account the fact that the fees used in the calculation are being set by said physicians and do not reflect their actual costs, so I am not crying a river for anyone. The fees are inflated. Period. Now, if they were being paid 27 cents on the dollar for every actual dollar, they would all be going out of business and I would cry a river. But that simply is not the case.