Healthy Skepticism Library item: 14902

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

Fleg A.
Unbranding the doctor’s office
The New Mexico Independent 2009 Jan 13
http://newmexicoindependent.com/14749/unbranding-the-doctors-office

Abstract:

No more pens and trinkets from big pharma

Full text:

Imagine walking into your doctor’s office and seeing no signs of pharmaceutical paraphernalia. No tissue boxes branded with the latest cholesterol drug. No coffee mugs advertising an expensive sleep aid. And when your doctor gets out the prescription pad, she scribbles pseudo-legibly with a bland, unbranded pen.

With the pharmaceutical industry’s recent decision to temporarily end the practice of gifting clinicians with trinkets and gifts, this scenario may become more common here in New Mexico. As of Dec. 19, the Pharmaceutical Research and Manufacturers of America had 38 pharmaceutical companies signed on to its new code of conductfor interactions between drug salespersons and health care professionals. In this revised code, signees agree to a voluntary moratorium on the gifting of “non-educational” items to clinicians, a stricter version than the PhRMA code in 2002 that prohibited more expensive gifts (e.g. vacations, tickets to sporting events).
Should we care?
Democratic state Sen. Dede Feldman of Albuquerque thinks so:
“I think that quality medical care is affected when doctors make their decisions on what to prescribe based on marketing or PR from companies rather than clinical, non biased academic research. With the cost of health care skyrocketing, we just can’t afford non-evidence based practices.”
In a state where one out of four lacked health insurance before the economic downturn began, where the mean income is one of the lowest in the country, and where even SCI, our safety net health insurance program, has had to cap its rolls because of lack of funding, the disappearance of these small gifts from doctors’ offices is actually big news, with a potential to save the citizens and state of New Mexico millions of dollars.
It is well known that pharmaceutical companies spend far more on their advertising of drugs than they do on the research to develop novel agents. What is less known is that the majority of that advertising money – in the order of $7 billion annually in the United States – is spent on physicians, since they hold the ultimate decision regarding which medication to prescribe. The gifts given to doctors by drug detailers, big and small, are given in hopes that newer, more expensive drugs will be prescribed. The additional costs are then passed on patients in the form of co-pays and public programs such as SCI.
How will this affect the public health of New Mexico?
I spoke with a local community health center family physician, Laura Gottlieb, to get her thoughts on the new code. She felt that, while this was a good step, pharmaceutical advertising is still ubiquitous and “the paraphernalia is just one little piece.” Larger change to the health care system is necessary to achieve greater equity in health and health care, Gottlieb says.
Jamal Martin, public health consultant and University of New Mexico professor, echoed this sentiment, pointing out that optimal interactions between clinicians and the pharmaceutical industry will spring forth from health systems change.
Some of that change involves a shift at all levels from the current procedure- and treatment-oriented health system to one where preventing disease is the focus.
Martin’s prescription for change?
“Pay attention to our collective malady, prevention deficit disorder, and begin addressing the social determinants of health such as education, employment, housing, and racism,” he says.
Eve Espey, associate dean of students at the UNM School of Medicine, is enthusiastic about this change from both an educator’s and clinician’s point of view.
“I think it will be great for patient care and health care in New Mexico,” she said. ”Reducing direct marketing to physicians will remove physician incentives to prescribe promoted products, allowing physicians to focus on the best and most cost effective medications for their patients.”
Is PhRMA’s moratorium enough?
The American Medical Student Association, whose PharmFree initiative helped work to get UNM to adopt a comprehensive conflicts-of-interest policy in 2008, including the elimination of gifts and lunches, said this is small step in the right direction. NMI covered the story last June.
Mary Sieler, the UNM PharmFree coordinator for AMSA, said, “We are glad to see that PhRMA is taking steps to improve the incredibly flawed system of pharmaceuticals, but this policy only brushes the surface of the problem.”
Feldman said she will be introducing two bills in the legislative session that starts next week to address other aspects of eliminating conflicts of interest in medicine and moving toward evidence-based medicine:
“Pennsylvania has just initiated a program whereby the state dispatches nurses and pharmacists to doctors offices and clinics to give such clinical information. There will be a bill this session to study this approach, and I’ll have one to disclose the value of gifts given by the hundreds of drug reps [to clinicians] in New Mexico.”

To be sure, some people may think the movement toward eliminating gifts, particularly small ones like pens and coffee mugs, is unnecessary. I know that many physicians do not believe that such items influence their decisions when they pull out the prescription pad – though the scientific and marketing research suggests otherwise.
So take note the next time you visit your doctor, as we watch the trinkets fade away. And if you feel the urge, bring a coffee mug, paperweight, tissue box or just some pens from the dollar store to the office to fill the void. Make sure, however, that you let your doctor know that this gift comes with no strings attached.