Doctors' gifts cut

The Baltimore Sun

WASHINGTON - Under pressure from critics in Congress and elsewhere to curb expensive marketing to doctors, the leading drug-industry lobby recommended yesterday that companies stop treating physicians to restaurant meals and other handouts.

The industry group, Pharmaceutical Research and Manufacturers of America, said it was revising its voluntary marketing guidelines in order to make sure that sales efforts focus on giving doctors the latest, most accurate information about drugs.

However, the new recommendations take aim at practices that are already losing favor and would eliminate only a small fraction of the estimated $20 billion a year the companies spend on marketing to doctors.

To persuade doctors to prescribe their medicines, drug makers offer free samples, meals and payments for continuing medical education. Companies say this informs physicians about valuable new treatments, but critics say it leads doctors to prescribe medicines that may not be in the best interests of their patients.

In announcing the new guidelines, the industry group acknowledged criticism leveled by, among others, doctors, ex-sales representatives and members of Congress.

"Although our member companies have long been committed to responsible marketing of the life-enhancing and life-saving medicines they develop, we have heard the voices of policymakers, healthcare professionals and others telling us we can do better," Billy Tauzin, PhRMA's president and a former congressman from Louisiana, said in a statement.

Many drug companies have stopped providing the dinners and trinkets, such as pens, clocks and notepads, and some doctors have stopped accepting gifts and payments.

In recent years, shrinking profits have forced drug companies to slash their sales forces. Leading pharmaceutical executives told Roland Berger Strategy Consultants, which advises the drug industry, that they would be shifting their marketing efforts from individual physicians and would focus on insurers and others who decide whether health plans will pay for certain drugs.

"This announcement is a P.R. ploy. It really is a meaningless gesture," said Dr. Jerome P. Kassirer, a Tufts University School of Medicine professor and author of On The Take: How Medicine's Complicity with Big Business Can Endanger Your Health. Kassirer said even small gifts persuade doctors to prescribe new drugs that cost more than older treatments and may have harmful side effects because they aren't well understood yet.

The 31 pages of revised guidelines don't curtail several promotional efforts that have drawn the particular ire of critics. Left unaddressed, for example, are the fees drug companies pay to physicians for speaking to fellow doctors about diseases and treatments or for advising the companies about products and medical conditions.

Nor would the recommendations advise against the widespread practice of having company sales representatives bring breakfast or lunch to doctors' offices and then pitch new drugs during the free meals.

"It's best for consumers if there's competition around price and not competition around influence, reciprocity and advertisements, and I don't think we see that here," said Dr. John Santa, director of Consumer Reports' health ratings center.

Major drug makers said they planned to implement the changes. "We fully support the recommendations," said a spokeswoman for AstraZeneca, which has more than 5,000 sales representatives.

The moves come as politicians around the country and in Washington are stepping up attacks on drug makers.

Several states and the District of Columbia have begun banning gifts or requiring drug makers to disclose payments to physicians. PhRMA recently backed a Senate measure, the Physician Payments Sunshine Act, which would require companies to disclose payments over $500 a year to doctors.

"I'm encouraged by the industry's attempt to clean up its act," Sen. Herb Kohl, a Wisconsin Democrat who sponsored the measure, said in a statement.

The drug industry last clamped down on sales practices in 2002, when it advised against such things as giving doctors free concert tickets or touting products while a physician waited for an automotive oil change paid for by a drug company.

The latest recommendations, effective Jan.1, 2009, do not apply to biotechnology companies or to medical device makers, who reported giving doctors in Maryland $4.6 million in payments and gifts last year.

The guidelines aren't binding on universities or doctors, who have their own codes. Critics say those rules also don't go far enough.

Officials from MedChi, the Maryland physicians' association, did not respond to requests for comment, saying they hadn't had time to read the new recommendations.

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