Healthy Skepticism Library item: 14719

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Zablocki E.
Drug Company Gifts May Affect the Way Doctors Practice Medicine
WebMD 2000 Jan 18
http://www.webmd.com/news/20000118/drug-company-gifts-may-affect-way-doctors-practice-medicine

Full text:

Physicians’ prescribing practices do change based on gifts such as meals, conferences, and other perks received from drug companies, according to a just-published study in the Journal of the American Medical Association.

“Interactions between physicians and the pharmaceutical industry are not as innocuous as they seem,” says author Ashley Wazana, MD. Wazana is a resident in the postgraduate psychiatry program at McGill University School of Medicine in Quebec.

Pharmaceutical companies spend more than $11 billion each year to promote and market drugs — an estimated $8,000-$13,000 per physician per year. This money is often spent in the form of meals and entertainment as physicians listen to discussions about a particular medication, or as money for books or medical supplies, for example.

“Physicians are human; they are not exempt from the usual standards when it comes to receiving gifts,” says Linda Golodner, president of the National Consumers League, a Washington-based consumer advisory group. “Many other industries have explicit principles saying, ‘No one in this company accepts gifts from suppliers or contractors.’ Why should doctors be different?”

Golodner draws a distinction between gifts on the one hand and educational lectures and seminars on the other. “We do need some way to help doctors stay up-to-date on the latest developments in pharmaceuticals, so I have no problem with pharmaceutical companies educating them on those issues, but I do have problems with gifts and perks,” she says. “You don’t have to hold your educational conference at some fancy resort, either; you can hold it at a Holiday Inn in Des Moines.”

“Consumer organizations like ours should question doctors about their interactions with the pharmaceutical industry,” Golodner says, “because it would be so difficult for an individual patient to directly question their own doctor.”

Physicians are in a strange position, says Wazana, “because we write prescriptions for other people to purchase. We’re making decisions that affect their expenses, not our own. It’s what you might call a fiduciary relationship. We need to be extremely careful to make those decisions in a rational, unbiased way.”

Wazana reviewed 29 studies that addressed the interactions between physicians and the pharmaceutical industry. Most of the articles showed that physicians’ prescribing practices are, in fact, affected by these relationships with drug companies. For example, they tend to prescribe fewer generic medications and more new, expensive drugs even when the drugs don’t have any advantages over cheaper medications.

“Just because something is the most recent and most costly medication doesn’t mean it’s the most effective,” Wazana tells WebMD. “But … we all tend to believe in the myth of progress. Many physicians are at a loss on how to keep up with so much information about new medications, so talking with the pharmaceutical representative is very convenient.” He praises the use of independent newsletters and “academic detailing,” in which a hospital hires a pharmacist to objectively evaluate new medications and share this information with its physicians.
While Bristol-Myers Squibb Co., a well-known health/personal care company based in Princeton, N.J., has not had time to fully review Mazana’s article, “the company does periodically review its pharmaceutical promotional practices and continuing medical education programs to ensure that we adhere to the highest ethical standards,” says company spokesperson Patrick Donohoe. “Bristol-Myers Squibb voluntary complies with guidelines regarding gifts for physicians set forth by organizations such as the American Medical Association and the Accreditation Council for Continuing Medical Education.”

Wazana is aware of drawbacks in the studies he has reviewed. For example, they look at effects on physician behavior, but don’t look at possible effects on patients’ health. He plans to write another paper highlighting gaps in current research on physician/pharmaceutical industry interactions.

However, some observers are impatient with the need for further research. “Conflict of interest has been — and as this study shows, continues to be — a mountainous moral mess for medicine,” says Arthur Caplan, PhD, professor at the University of Pennsylvania Center for Bioethics, in Philadelphia. “It is long past time to end the studies and begin crafting solutions.”