[Ip-health] NYT: No more goodies for doctors from drug makers

[Suerie Moon]

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[ Picked text/plain from multipart/alternative ]
Hi everyone,
Has any one seen any good studies on whether/how branded goods (pens, mugs,=
 etc) may influence prescribing behavior? Hard to believe that a $1 billion=
/year industry (promotional goods) rests on no evidence whatsoever.
-Suerie
____________________________
Suerie Moon, MPA
Doctoral Candidate and Giorgio Ruffolo Doctoral Research Fellow
Sustainability Science Program, Center for International Development
Kennedy School of Government, Harvard University
suerie_moon@ksgphd.harvard.edu


December 31, 2008
No More Goodies for Doctors From Drug Makers By NATASHA SINGER
To Lehman Brothers, Linen =92n Things and the blank VHS tape, add another A=
merican institution that expired in 2008: drug company trinkets.
Starting Jan. 1, the pharmaceutical industry has agreed to a voluntary mora=
torium on the kind of branded  goodies  =97 Viagra pens, Zoloft soap dispen=
sers, Lipitor mugs =97 that were meant  to foster good will and, some would=
 say, encourage doctors to prescribe more of the drugs.
No longer will Merck furnish doctors with purplish adhesive bandages  adver=
tising Gardasil, a vaccine against the human papillomavirus. Banished, too,=
 are black T-shirts from Allergan adorned with rhinestones that spell out B=
-O-T-O-X.  So are pens advertising the Sepracor sleep drug Lunesta, in whos=
e barrel floats the brand=92s mascot, a somnolent moth.
Some skeptics deride the voluntary ban as a superficial measure that
does nothing to curb the far larger amounts drug companies spend each
year on various other efforts to influence physicians. But proponents
welcome it as a step toward ending the barrage of drug brands and logos
that surround, and may subliminally influence, doctors and patients.
=93It=92s not just the pens =97 it=92s the paper on the exam table, the
tongue depressor, the stethoscope tags, medical calipers that might be
used to interpret an EKG, penlights,=94 said Dr. Robert Goodman, a
physician in internal medicine at Montefiore Medical Center in the Bronx.
In 1999, Dr. Goodman started No Free Lunch,
a nonprofit group that encourages doctors to reject drug company
giveaways. =93Practically anything you can put a name on is branded in a
doctor=92s office, short of branding, like a Nascar driver, on the doctor=
=92s white coat,=94 Dr. Goodman said.
The new voluntary industry guidelines try to counter the impression
that gifts to doctors are intended to unduly influence medicine. The
code, drawn up by Pharmaceutical Research and Manufacturers of America,
an industry group in Washington, bars drug companies from giving
doctors branded pens, staplers, flash drives, paperweights, calculators
and the like.
The guidelines also reiterate the group=92s 2002 code, which
prohibited more expensive goods and services like tickets to
professional sports games and junkets to resorts. And it asks companies
that finance medical courses, conferences or scholarships to leave the
selection of study material and scholarship recipients to outside
program coordinators.
Diane Bieri, the executive vice president of Pharmaceutical Research
and Manufacturers of America, said the updated guidelines were not an
admission that gifts could influence doctors=92 prescribing habits.
Instead, she said, they were meant to emphasize the educational nature
of the relationship between industry and doctors.
=93We have never said and would never say that a pharmaceutical pen
or notebook has influenced any prescription,=94 Ms. Bieri said.
But some critics said the code did not go far enough to address the
influence of drug marketing on the practice of medicine. The
guidelines, for example, still permit drug makers to underwrite free
lunches for doctors and their staffs or to sponsor dinners for doctors
at restaurants, as long as the meals are accompanied by educational
presentations.
=93Pens or no pens, their influence is not going to be diminished,=94
said Dr. Larry M. Greenbaum, a rheumatologist in Greenwood, Ind. He has
made a point of collecting ballpoint pens advertising formerly heavily
promoted medications, like the painkiller Vioxx, that were later withdrawn =
after reports of dangerous side effects.
Last year, besides giving away nearly $16 billion in free drug
samples to doctors, pharmaceutical companies spent more than $6 billion
on =93detailing=94 =97 an industry term for the sales activities of drug
representatives including office visits to doctors, meal-time
presentations and branded pens and other handouts, according to IMS Health,=
 a health care information company.
The industry code also permits drug makers to pay doctors as
consultants =93based on fair market value=94 =97 which critics say means th=
at
companies can continue to pay individual doctors tens of thousands of
dollars or more a year.
=93We have arrived at a point in the history of medicine in America
where doctors have deep, deep financial ties with the drug makers and
marketers,=94 said Allan Coukell, the director of policy for the
Prescription Project, a nonprofit group in Boston working to promote
evidence-based medicine. =93Financial entanglements at all the levels
have the potential to influence prescribing in a way that is not good.=94
About 40 drug makers, including Eli Lilly & Company, Johnson & Johnson and =
Pfizer, have signed on to the code.
Representatives of several pharmaceutical makers said their companies
intended to comply with the guidelines, but they declined to discuss
past marketing programs involving branded gifts.
The restrictions come as a blow to the makers and distributors of
promotional products, an industry with an annual turnover of about $19
billion, according to Promotional Products Association International, a
trade group. Such companies, accustomed to orders of up to a million
pens a drug, stand to lose around $1 billion a year in sales as a
result of the drug industry=92s voluntary ban, the group said.
The sudden scarcity of free goodies, though, could enhance the
cachet of collections that some doctors have assembled over the years
as a mocking countermeasure to drug marketing. Dr. Nathan Anderson, a
resident in internal medicine at a hospital in Texas, has posted
photographs of the various items he has received on his blog, drugreptoys.b=
logspot.com.
Dr. Jeffrey F. Caren, a cardiologist at Cedars-Sinai Medical Center
in Los Angeles, has collected more than 1,200 pens and mounted them on a pi=
llar in his office.
While some doctors applaud the gift ban, others seem offended by the
insinuation that a ballpoint pen could turn their heads. =93It seems
goofy to us; we like getting our pens,=94 Dr. Susan B. Hurson, an
obstetrician and gynecologist in Washington, said in a telephone
interview.
Dr. Hurson said she paid no attention to the logos on the  pens she carries=
 around in her doctor=92s coat.
Prompted by a reporter=92s question, she pulled out a handful of pens
from her pocket and read off the drugs advertised: Clindesse, a cream
for vaginal infection; Halo, a system for detecting breast cancer, and Evam=
ist, an estrogen spray. =93It=92s hard for me to believe it influences what=
 you prescribe.=94
But Dr. Phillip Freeman, a psychiatrist in Boston, said that
physicians who contended that the giveaways were benign might be
suffering from denial.=93The need to deny influence is damaging to the soul=
,=94 Dr. Freeman
said. He suggested that doctors would feel less conflicted if they
simply wore drug company patches on their white coats.