Doctors Urged to Stop Accepting Bri- —Oops, Make That Gifts—From Big Pharma

Linda von Wartburg
Jun 12, 2009

Drug companies spend billions of dollars on research, and it's obvious that they spend more billions on advertising. Well, according to the New York Times, they spend the most billions on giving nice things to doctors: pens, samples, banquets, trips, and educational opportunities among them. For doctors, in fact, there is a free lunch: Pharma companies spend as much as a billion a year just on lunches for doctors. And over 90 percent of doctors have accepted at least some of this largesse from the industry.

But Big Pharma doesn't give away all that stuff without expecting something in return, and what they expect is to influence prescribing behavior. The unspoken assumption is that the doctors will use their nice free pens to write prescriptions for the company's product. Does it work? Apparently it works a lot better than the physicians themselves realize, because they often underestimate the effect that it does have on them. Social scientists have found that people can't really assess their own bias, especially if that bias is financially beneficial to them. Even free pens exert an influence, and the free lunches are especially effective because people are apparently more receptive to information when enjoying a good meal.

This is not really news: Between 2001 and 2008, there were at least 16 prominent reports calling for change in the financial relationship between medicine and Big Pharma, and DH commented on the practice back in 2007 ("Hey Doc, Let's Fly to Maui to Talk About Drugs"). But it is attracting even more notice lately, most recently from the Institute of Medicine (IOM) of the National Academy of Science, an extremely prestigious nonprofit organization that provides "unbiased, evidence-based, and authoritative information and advice concerning health and science policy."

In April, the IOM issued a report that told doctors in no uncertain terms to lay off the free stuff. In particular, the report emphasized the need to regulate the complex relationships between medicine and industry. In 2007, industry footed nearly half of the $2.54 billion bill to provide doctors with required refresher courses, known as Continuing Medical Education (CME), as well as funding over half of all American biomedical research. And in the April Journal of the American Medical Association, a group of doctors themselves expressed their concern about taking corporate money to fund the development of "practice guidelines," which are considered the final word on how to treat patients. They also came out against allowing doctors with industry ties to serve on practice guideline committees.
The IOM report recommended that Congress force Pharma to publicly disclose all payments made to doctors. There is already legislation pending to do just that, sponsored by Iowa Republican Senator Charles Grassley and Wisconsin Democratic Senator Herb Kohl, both of whom are clearly pleased with the IOM's blessing.
The largest drug makers (but not device and biotech companies) did agree last year to stop pushing the pens and other little gifts, but they are still underwriting the meals, refresher courses, and practice guideline committees. And of course, the companies are not convinced that keeping their fingers out of the medical pie is such a good idea. With regard to the practice guidelines, a spokesperson for the Pharmaceutical Research and Manufacturers of America told JAMA that such policies would disallow the input of all the experienced doctors, most of whose research is industry-funded, leaving the decision-making to "very junior people who have no experience."

What do you think? Can medicine extricate itself from business sufficiently to prevent conflicts of interest? Or is Big Pharma right? Use the Comments box below to voice your opinion.

Sources: The Prescribing Project
The New York Times
The Institute of Medicine
The New England Journal of Medicine
Journal of the American Medical Association

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