No Gifts Please

By Malcolm Fleschner

Giftgiving has long been a part of the relationship between pharmaceutical companies and physicians, although there were instances in the past where the practice got a little out of hand: Drug Rep: “Thanks for your time, Doctor. Here are the keys to the brand new Bentley parked outside.”

With such excesses in mind, just a few years ago the Pharmaceutical Research and Manufacturers of America adopted a voluntary code requiring that all gifts from drug reps to physicians be valued at less than $100 and be directly related to the doctor’s practice.

Nevertheless, some physicians’ organizations argued that this step is not sufficient to curb what they view as questionable ethical relationships between the pharmaceutical industry and the medical profession.

In late January, a group of influential physicians from leading academic institutions published an article in the Journal of the American Medical Association calling for a ban on all gifts, free samples and other promotional incentives, arguing that these freebies negatively affect the quality of medical care and undermine physician-patient relationships.

Other recommendations, as reported by the Website include:

  • Restricting doctors with financial relationships with pharmaceutical companies from serving on panels affecting prescription decisions
  • Prohibiting medical school faculty from participating in company speaker bureaus or publishing articles ghostwritten by the industry
  • Disallow pharma companies from funding continuing medical education classes by creating a central account to which companies would contribute blindly
  • Develop a voucher system or central distribution program for drug companies to provide samples to low-income patients.

“We’ve become overly dependent on these kinds of blandishments to support our core activities, and it is jeopardizing public trust and scientific integrity,” suggests coauthor Jordan Cohen, president of the Association of American Medical Colleges. quotes Sharon Levine, the associate director of Kaiser Permanente’s Northern California group practice, going on record in support of the proposed standards. “The industry is spending $13 billion per year on direct-to-physician promotion,” she says. “That wouldn’t be happening if it weren’t resulting in changing patterns of utilization. It doesn’t necessarily mean patients are getting bad care, but it does mean doctors are being influenced.”

Former FDA chief of counsel Daniel Troy responds that there remains the distinct possibility that these promotional activities may, in fact, mean better care. “I subscribe to the crazy view that more information is better,” he says. “This very sweeping proposed ban would really choke off an important flow of information to physicians.”

So far there has been no mass movement afoot to adopt the recommendations, but it clearly is an option under consideration for many groups. How the pharmaceutical industry will respond, and what effect this will ultimately have on front line reps, remains to be seen.