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[Guest guest]

Are you taking an expensive new drug? If so: Why?

 

Your Dr. may have been getting a reather fancy " free lunch " from the drug

maker.

 

From Lorenzo, credits follow.

 

 

 

From Disclose the Truth.

 

 

PROFESSIONAL ISSUES

 

 

Pharmacy group details what drug reps can give physicians

The new guidelines, which take effect July 1, also define consulting

relationships.

 

By Andis Robeznieks, AMNews staff. May 27, 2002

 

 

 

 

Box scores and opera boxes are out. Pizzas and boxed lunches are in.

 

Leaving no room for ambiguity, a new professional code of conduct for

drug-company " detail men " (and women) prohibits using free tickets to

entertainment venues to market pharmaceutical products.

 

" We now say all sporting events and theater tickets are out, " said Jeff

Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers of

America, a group representing about 80 leading drug and biotechnology

companies. " The main focus [of a physician-pharmaceutical representative

meeting] has to be on the product and not how the Cubs are doing. "

 

According to Trewhitt, many people won't notice the difference.

 

Drug companies spend more than $12 billion a year marketing to doctors.

 

" The two most common approaches are the office visit where the doctor says

'You have five to 10 minutes, make it good' -- that will continue, " Trewhitt

said. " And the 35- to 45-minute session over a pizza or hoagie lunch with

all the health care professionals at the clinic discussing the product and

asking questions, that will continue, too. "

 

PhRMA's executive committee unanimously approved the marketing code in

April. It takes effect July 1.

 

The code spells out how sales reps should interact with physicians and other

health care professionals.

 

Sticking to the science

 

The code's main thrust is that the interaction must focus on the product and

occur in a place conducive to the exchange of scientific information. This

means no more " dine and dash, " entertainment, sports tickets or spa visits.

Also, gifts must be of minimal cost and have some value to patients.

 

" It may mean, in a few cases, doctors won't get fancy dinners, " Trewhitt

said. " They'll get a modest meal and serious discussion about a product. ...

You're not going to buy a doctor's soul for the price of a pizza. "

 

Although he downplayed what's been called the " entertainment arms race, " the

amount of money spent gently twisting the arms of doctors to prescribe

certain drugs is staggering: between $12.5 billion and $15 billion,

according to ImpactRx, a Mt. Laurel, N.J., company that tracks how

pharmaceutical products are marketed.

 

12% of the drug industry's marketing costs are for entertaining physicians.

 

In a Kaiser Family Foundation poll released in March, 61% of the 2,608

doctors surveyed said they received meals, tickets or free travel from a

drug company detailer, and 92% said they received free drug samples.

 

ImpactRx President Timothy A. Margraf said most doctors average one to 1.5

pharmaceutical-industry meetings or events a month and 12% of these are

" entertainment based. "

 

" This is not how they want to promote their product, " Margraf said. " You'll

see a zero-tolerance policy from most of the major companies, and that 12%

will go away. "

 

Those skeptical of the new PhRMA effort point to similar guidelines adopted

by the AMA on Dec. 4, 1990, and by the PhRMA board two days later.

Nevertheless, Alan R. Nelson, MD -- who served as AMA president from

1989-1990 -- remains optimistic, and said these developments have to be

looked at as the latest steps in an ongoing process.

 

" I don't think that it's realistic to expect abrupt change. This kind of

change takes place gradually, " Dr. Nelson said. " Adherence to the guidelines

is going to be an ongoing challenge for the profession. "

 

Dr. Nelson said compliance with the original guidelines was strong at first,

but eroded over time.

 

He said the world is also a much different place than it was when the AMA's

Council on Ethical and Judicial Affairs drafted the guidelines more than 10

years ago. " When the CEJA guidelines were developed, there were gifts of a

less-creative nature than in the late '90s. "

 

Dr. Nelson spearheaded an AMA campaign in September to educate physicians on

the Association's ethical guidelines concerning gifts. With more than

100,000 pocket editions of the guidelines distributed, he considers the

effort to have been a success.

 

CEJA Chair Frank Riddick, MD, sees last fall's physician education program

and this spring's pharmaceutical sales guidelines as links in the same chain

-- a chain forged by the medical profession and drug industry talking to

each other.

 

" I hadn't heard a lot of news about the education program, except by

outsiders who expressed skepticism. But if this is the result, I think that

will go a long way to allay that skepticism, " Dr. Riddick said.

 

Still, Dr. Nelson said, not all physicians belong to the AMA and not all

drug companies are part of PhRMA, so " compliance will never be 100%. "

 

" After all, " Dr. Nelson noted, " this is voluntary. "

 

 

The skinny on consulting

 

The new code also addresses the issue of " consulting, " a term that can hide

all sorts of abuses, and Dr. Riddick said he's heard plenty of stories about

" sham consulting. "

 

" Sometimes physicians tell me 'X company invited me to be their consultant

and invited me to go down to U.S. Big City and stay in a hotel, but they

never asked me my opinion and I just heard the glories of their drugs,' "

Dr. Riddick said.

 

Despite these misgivings about consulting, he praised PhRMA's new guidelines

that define what a legitimate consulting arrangement should consist of: a

defined goal, an appropriate number of physicians for any given project and

the ability to measure and monitor the services provided by a consulting

physician.

 

" They spelled it out better than we ever did, " Dr. Riddick said.

 

Although ImpactRx's Margraf said 12% of the industry's multibillion-dollar

marketing budget " will go away, " that still leaves a lot of money to be

tossed around, and he doesn't expect it to go unspent.

 

" You can never save your way to prosperity in any business, " Margraf said,

adding that much of it may go toward continuing medical education programs.

 

Dr. Riddick said he would like to see funds diverted from promotion go

toward lowering drug prices or increasing research and development. But he

added that lower prices or increased CME and R & D would just be byproducts

created while working toward a separate goal.

 

" The main thrust is ethical behavior on the part of physicians and ethical

behavior on the part of pharmaceutical companies, " he said. " If doing the

right thing has [beneficial] spin-off, then so much the better. "

 

Dr. Jones noted that, even though the practices of educating doctors and

marketing pharmaceutical products may overlap, the intentions behind the two

are distinct.

 

Dr. Riddick agreed.

 

" I think we have to be [aware] that the driving force behind these things is

not solely to provide education for the physicians, " he said. " But to see

that the products sold by pharmaceutical companies get prescribed. "

 

 

ADDITIONAL INFORMATION:

They can't take you out to the ball game

 

New guidelines from the Pharmaceutical Research and Manufacturers of America

spell out the rules for gifts to physicians and their staffs.

 

WHAT'S ACCEPTABLE

 

Free stethoscope

Free meal, if it is " modest by local standards, " and accompanied by

educational or scientific exchange

Lunch for staff, if provided during an information presentation

Free medical books, provided the cost is not " substantial "

Modest buffet meal accompanying scientific or educational meeting

 

WHAT'S NOT

 

Golf balls and sports bags

Free meal, if it's of more than modest value and is not accompanied by

exchange of information

Lunch for staff, if not connected to an information presentation

Gift certificate from a bookstore

Scientific or educational meeting held before an athletic event or

entertainment performance

Reimbursement for gasoline expenses

 

Source: PhRMA, " Code on Interactions with Healthcare Professionals "

 

 

Consultant do's & don'ts

 

Consulting arrangements can serve legitimate needs, but they can also be

fronts for ethical abuses. The Pharmaceutical Research and Manufacturers of

America's new marketing code attempts to preserve the positive aspects of

these arrangements while clearly defining what should not be tolerated.

 

Companies can retain physicians as consultants based on their expertise, not

as a reward or inducement for prescribing.

Companies should not retain more consulting physicians than needed for a

specific program.

Before creating a consulting arrangement, companies should identify a

legitimate need for consulting physicians.

Consulting arrangements should include a written contract specifying

services and basis for payment.

Consulting physicians should be chosen for identified purposes.

Companies should maintain records concerning services provided by

consultants and make appropriate use of those services.

It is appropriate to offer consulting physicians " reasonable compensation "

and reimbursement of travel, lodging and meal expenses incurred while

providing a service.

It is not appropriate for companies to pay honoraria or travel and lodging

expenses to nonconsultant attendees at company-sponsored meetings.

 

 

Source: PhRMA, " Code on Interactions with Healthcare Professionals "