NEWS: HEALTH- Curbed contact makes new docs wary of drug sales pressure

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Curbed contact makes new docs wary of drug sales pressure

By Adam Marcus

HealthScoutNews Report

November 1, 2001 4:52 AM

 

Keeping drug marketers away from doctors in training makes them more

skeptical of pharmaceutical industry marketing later, a new study said.

 

The findings are based on a survey of doctors in Canada, some of whom

trained at a McMaster University Medical Centre in Ontario that in the

1990s imposed strict no-contact rules between drug company

representatives and certain residents studying there.

 

The researchers said the policy gives young doctors the sense that

regular and close contact with drug companies is unhealthy.

 

" By banning drug reps, it sends a message to your residents that these

aren't people you should be spending your time with, " said study

co-author Dr. Allan Detsky, chief of physicians at Toronto's Mount Sinai

Hospital. The findings appeared in the Oct. 24/31 issue of The Journal

of the American Medical Association.

 

On the other hand, the study didn't address whether it's better for

patients if doctors are skeptical about drug company pitches, said

Detsky, who also is an economist. " How much of their marketing is not

helpful, how much is really helpful, it has never been studied, " Detsky

said. " It may be that what they do in McMaster is prevent doctors from

getting information that really helps their patients. I don't know that. "

 

Whatever the case, one thing is certain: Pharmaceutical firms are waging

an all-out information war for the eyes and ears (and ultimately the

prescription pads) of physicians.

 

The industry spent more than $13 billion last year marketing their wares

to doctors in America, according to IMS Health, a research firm in

Plymouth Meeting, Pa. That includes nearly $8 billion in free samples,

free lunches, company-sponsored junkets and promotional materials,

including pens, caps and tote bags.

 

At least one group of Ohio doctors has exploited the eagerness of drug

company reps to get a hearing by charging them for the privilege: $65

for a 10 minute interview.

 

Earlier this year, the American Medical Association, whose flagship

journal published the latest study, announced stepped-up efforts to

educate its members about the ethical perils of accepting gifts from the

pharmaceutical industry.

 

Dr. Herbert Rakatansky, a gastroenterologist at Brown Medical School in

Providence, R.I., and past chair of the AMA's council on ethical and

judicial affairs, said gift-taking is " getting out of hand " after

falling off in the early 1990s.

 

Rakatansky said drug reps " have a motive, and there's nothing wrong with

their motive. But our motive is different. "

 

Wary of the growing influence of drug reps on campus, the department of

medicine at McMaster implemented a policy in 1992 to reduce contact

between the reps and internal medicine trainees in residency there. The

new rules banned drug reps from educational events, ended firm-sponsored

free feeds and rejected pharmaceutical industry funding linked to

specific diseases.

 

To learn if the 1992 policy altered the opinions of McMaster-trained

doctors about drug company information, Detsky and his colleagues

surveyed 57 former McMaster residents who attended the program both

before and after the policy went into effect, as well as 242 trainees

from the University of Toronto, which doesn't have such restrictions.

 

Nearly 90 percent of doctors in each group who responded said drug reps

had visited their office in the last year, so the McMaster policy didn't

seem to influence the amount of contact between the industry and physicians.

 

However, internists trained under the restrictive policy tended to have

somewhat fewer contacts than the other doctors. And those trained after

the policy began were much less likely than the others to say the

information they received from the drug reps was helpful in guiding

their treatment choices.

 

" There was a difference, and the difference was not small, " said Detsky.

 

The McMaster policy did not prohibit contact between drug reps and all

doctors in training, Detsky said. And the study found that doctors who

had the most contact with drug reps were much more likely than those

with the least contact to say the information they got from drug company

reps was useful.

 

Detsky said he's amazed that doctors continue to insist that they're

above the influence of marketing. " It's unbelievable to me the extent

that they can deny that they can be biased in some way, " he said.

 

Dr. Ron Wright, a University of Arizona psychiatrist who has studied the

effects of marketing on physicians, said two well-known psychological

forces help explain the influence drug company reps have in the doctor's office.

 

Although the so-called " buy-off " problem is the most hotly debated in

medicine, Wright said another factor, which he called " cognitive

accessibility, " is at play. Given a choice of which medication to

prescribe, said Wright, " You think of the one that's the most in your

face. " So, he said all those sticky notes and calendars that shout a

brand serve as a constant, soft voice whispering a name that's bound to

be the first to appear on a doctor's prescription pad.

 

The second force is somewhat more subtle and involves a concept called

cognitive dissonance, Wright said. In essence, cognitive dissonance

theory argues that people will be more willing to believe a lie when

they're paid less, not more, to listen to it.

 

If a drug company offers doctors an all-expenses paid trip to Hawaii,

" I'm on my guard about that, " Wright said. But if the " bribe " is instead

small favors, " I'm not on my guard, but I am positively inclined toward "

the company's representatives and their products. " They tend to give you

things that are extremely useful that you really are going to want to

keep around. And every time you see that you see that drug name. "

 

As a result, Wright said, " Small gifts may in fact be more dangerous

than large gifts, and all of the regulations go in the other direction. "

Wright said he doesn't accept drug company marketing paraphernalia to

avoid biased prescription choices for his patients.

 

He said advertising drugs to doctors is different from selling

televisions to the masses. " In normal advertising you make decisions and

suffer the consequences. But with [drug marketing] I decide what you're

going to get, your insurance company or you are the one that pays for

it, and you take it. "

 

The Pharmaceutical Research and Manufacturers of America, a drug

industry group, did not respond to a request to comment on the study.

 

What to do

 

Try the American College of Physicians-American Society of Internal

Medicine for a look at how direct-to-consumer advertising affects

doctors, as well as the ethics of taking gifts from drug companies.

 

Click here for ethics rules from the AMA.

 

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