Healthy Skepticism Library item: 14718

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Publication type: news

McQuaig L.
MDs using Squibb drug in study receive computers for office use
The Globe and Mail 1988 Dec 13

Full text:

One of Canada’s largest pharmaceutical companies is offering doctors the use of a personal computer in their offices, but denies that the equipment is a perk to encourage physicians to use one of their products.
Squibb Canada Inc. is providing computers, which have a market value of more than $2,000, to doctors who put 10 of their patients on Squibb’s Capoten, one of many drugs on the market used in the treatment of hypertension.

Company vice-president Dan Burns said in a telephone interview yesterday from Montreal that about 2,000 doctors across the country are participating in Squibb’s study, which involves approximately 15,000 patients who are taking Capoten.

Although Squibb retains ownernship of the computers, doctors will be permitted to keep them after the study is completed, Mr. Burns said.
“We have no intention, for example, of putting the computer in only for the study.”
He denied that this might have the effect of encouraging doctors to prescribe Capoten over another drug for patients suffering from hypertension.
“I know what you’re getting at,”’ he said. “I’m trying to be as candid as possible. We don’t look at it that way.” .
It is possible that a few doctors might be influenced in that way, he said, but the majority would not be.
Dr. Joel Lexchin, who practices emergency medicine in a downtown Toronto hospital and has written extensively on the drug industry, said he believes the computer program is a “very attractive bribe.”
“While Capoten is a very useful product in certain circumstances, there are also other drugs that in some patients are equally effective and less expensive,” said Dr. Lexchlzt, author of The Real Pushers: A Critical Analysis of the Canadian Drug Industry. “The worry with this kind of program is that doctors will put patients on this product not because it’s necessary, but because they want access to the computer.”
Anti-hypertensives are among the most widely prescribed pharmaceuticais, partly because once started on such drugs, patients generally remain on them for the rest of their lives.
As a result there is considerable competition among pharmaceutical companies for a share of the market.
Capoten, which has been available for six years, is among the more expensive anti-hypenensives. Some of the older ones are now being produced in no-name generic forms, which are considerably cheaper.
Mr. Burns said he is confident that doctors participating in the Squibb computer program will be prescribing Capoten only to patients for whom it is appropriate medically.
Squibb deliberately did not impose tight time constraints on the study, Mr. Burns said, so doctors would not feel under pressure to come up with the patients.
He said the company did not want doctors to be in the position of saying, “ ‘Oh my god, I have to get 10 patients within a month.’ We don’t think that’s a proper way to conduct a trial.”
Mr. Burns said the company is concerned that the study be done properly and does not want to be associated with “giveaways.”

For this reason Squibb does not pay the doctors or give the computers to them outright.
Although Mr. Bums said the study involves 15,000 patients, a company letter to doctors describing the program says 25,000 are involved.
Data about the patients’ response to the drug is led into the computer, to be analyzed electronically as part of the Squibb program.
Asked whether patients are aware they are part of a study, Mr. Burns said patient consent is not strictly necessary, as the drug is alreadly approved for sale in Canada.
“There’s no experimental aspect, so it does not necessarily require patient consent.”
He said, however, that a doctor would generally inform patients. “Professionally, he’s obliged to do that.”
Squibb, a subsidiary of Squibb Corp. of Princeton, N.J., also provides software programs to participating doctors showing how various drugs interact.
Mr. Burns said this kind of computer study might be used in the future to meet some of the requirements of Canada’s new drug patent legislation, under which pharmaceutical companies have promised to double their spending on drug research and development in Canada.