Our view: Gifts from drugmakers damage
doctors' integrity
Wed Feb 8, 7:01 AM ET
USAToday
For decades, pharmaceutical companies have showered physicians
with meals, tickets to shows and sporting events, ski and beach
vacations disguised as medical education seminars, and consulting
"jobs" for which doctors do no work.
The companies aren't being charitable. They expect a return on their
investment, namely that doctors prescribe their newest expensive pills.
That's why an army of 88,000 pharmaceutical representatives, many of
them young and beautiful, provides freebies to doctors and their staffs.
After embarrassing publicity about abuses - including cash payments
(bribes) to doctors and ghostwritten research papers for medical school
faculty - the pharmaceutical industry adopted guidelines in July 2002
to clean up the worst excesses. Gifts of less than $100 are allowed but
must be related to the doctor's practice.
The voluntary guidelines don't go nearly far enough to reassure
patients that their physicians' decisions aren't being influenced by
freebies. That's not just our opinion. It's the conclusion of a team of
leading doctors who, in a recent article in the Journal of the American
Medical Association (JAMA), called the pervasive gift-giving an
indefensible conflict of interest that diminishes the integrity of the
medical profession. The authors found:
• Even small gifts such as pens, pads and meals
significantly influence a doctor's prescribing.
• Doctors who request additions to standard hospital drug
supplies are far more likely to have accepted free meals or travel
funds from drug manufacturers.
• The rate of drug prescriptions by physicians increases
substantially after they see sales reps or have other ties to
drugmakers.
• The gifts contribute to the rising cost of care and
spending on drugs. Newer, expensive drugs are prescribed when older,
cheaper ones or generics may be just as effective.
To restore integrity, the authors ask academic medical centers to
forbid all gifts, prohibit drugmakers from directly financing medical
education, ban suspect consulting arrangements, and exclude doctors
with financial ties to pharmaceutical companies from serving on panels
that decide what to prescribe. Bad habits begin in medical school, so
we agree that's a good place to start.
(We're not as sure about another of the JAMA authors' ideas: to stop
doctors from accepting free samples. True, samples are an inducement to
rely on newer, expensive medicines, but they also allow physicians to
help uninsured or underinsured patients. And they can allow busy
patients to get immediate relief without a separate trip to the
pharmacy.)
Beyond the medical schools, managed-care groups can help enforce rules
for their participating doctors. More than a year ago, California-based
Kaiser Permanente banned physicians' gift-taking and other suspect
practices. Its doctors prescribe heavily marketed drugs far less
frequently than average, without affecting quality of care.
Drug companies support many educational programs and provide doctors
with vital information about new products. But the gifts and unseemly
practices taint the profession and undermine patients' trust. Doctors
are sufficiently well-compensated that they can live without
pharmaceutical freebies.
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