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

[chan park]

Hi Suerie.

There is a recent article in the New York Review of Books by Marcia
Angell that may be of some relevance.

http://www.nybooks.com/articles/22237

chan

On Dec 31, 2008, at 8:14 AM, Suerie Moon wrote:

> --
> [ 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 American institution that expired in 2008: drug company
> trinkets.
> Starting Jan. 1, the pharmaceutical industry has agreed to a
> voluntary moratorium on the kind of branded  goodies  =97 Viagra
> pens, Zoloft soap dispensers, 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  advertising 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 whose 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
> that
> 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.blogspot.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 pillar 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 Evamist, 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.
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