Stanford: No More Small Gifts
New York Times reports on the dramatic embrace by Stanford of the principles at the heart of the AMA report recommending against acceptance of even small gifts from pharmaceutical companies. AJOB's own David Magnus helped his institution create the policy, which has teeth:''Gift giving creates a reciprocal obligation that is a powerful force, and pharmaceutical companies know this very well,'' said David Magnus, director of the Stanford Center for Biomedical Ethics who helped write the new policy. ''So we're discouraging it from happening anywhere at the medical center.''No free samples. No ghost authorship of articles. No coffee mugs, drug reps dropping in without appointments, not even any pens. It's all over for pharma trinkets, folks. The old line, nicely delivered in the AP piece, just doesn't fly anymore:
...if I was concerned that my doctor was influenced by a pen or a slice of pizza, I would find another doctor.Pens do influence physicians. The key study proving that small gifts have a big effect was published in The American Journal of Bioethics in 2003, and though you may be thinking "but obviously small gifts work, or drug companies wouldn't spend tens of millions on them, or more, every year," the data confirming that fact somehow remained a matter of advertising research, and then of bioethics conversation, until the JAMA report - and even then nothing really changed until a few schools picked up the mantle.
But Stanford, which is per capita (with its tiny but hyperproductive faculty) easily the most engaged in relationships that transfer research into technology, well, when Stanford locks out the drug companies it is a sea change.
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Doctors who can be trusted to circumcise your son, perform a pelvic on your wife or a genital exam on your husband and rectal exams on all can't be trusted to hand out free samples of drugs? I can hold your liver in my hands or break and reset your bones, and even give you a drug that was developed as a rat poison because it's patented by WARF, but I don't have the medical judgement necessary to discern whether the brand name is better for you or not?
How many of you have accepted a post-it note or free pen from the University bookstore or publisher where your students buy those required and very expensive textbooks? Do you buy your own copy of every book you review?
Or, for that matter, do you accept free samples from *your* doctor?
- by Beverly on Sep 13, 2006 at 4:13 AM | link
It's a question that research can answer better than rhetorical questions. And so far, it has, though I wasn't aware smaller gifts such as pens or free samples had a significant effect on prescriptions (though it seems plausible).
Now, not every physician might be influenced that way. But what are you giving up? Free pens? I mean, I know physicians are compensated less these days, but I'm pretty sure you can still afford them.
Otherwise what the %$#@ am I doing in medical school? I can afford pens now as a broke student!
I really do have a weakness for free food, though. I bet docs can afford food, too.
So really, the point is, I don't see why extreme advertising and gift-giving is even necessary. The benefit of advertising seems primarily to be in letting physicians (and with DTC ads, consumers) know of new medications. But isn't it their job to investigate that and keep up to date?
Yes, people trust physicians in all sorts of risky situations. But if they were picking between two medical therapies, I wouldn't want anything influencing them but their medical judgment. And the studies show gift-giving does have an influence on prescribing habits, thus scrapping the theory that pharmaceutical companies just love giving stuff away.
Beverly, I'm not saying your judgment is consciously clouded by your free pens or food. But are the free pens worth the risk of that some physician out there might be?
- by Sunny on Sep 13, 2006 at 8:28 AM | link
One needn't argue that physicians are untrustworthy, acquisitive, or any of these other derogatory things to say that marketing is effective and influences prescribing patterns. We also don't have to say that it's amazing what cheap dates docs are.
Completely independent of the sense of obligation/reciprocity that receiving a gift may create in the recipient, the mere fact that a particular brand name is in front of one all the time keeps it top of mind.
This is the whole point of marketing. Why do you think politicians get so exercised about name recognition?
The problem isn't that docs are greedy. It's that the process of choosing the best medication for a particular patient's needs may be short-circuited by effective marekting.
- by Sparky on Sep 13, 2006 at 5:05 PM | link
Is there any evidence that doctors are prescriping inferior products due to these sorts of gift giving practices? That's what I'd really like to know, because if the influence is just effective when deciding between very similar drugs, who the heck cares. Let the doctors have a slice of pizza and a free pen, its one of the little pleasures in life, a tiny ego boast.
This is the sort of policy that happens when people are more concerned with the appearance of impartiality than with actual impartiallity, medical ethics written by the PR department. Sure doctors prescribe drugs more often when they're holding a pen from that company, but as long as the drug isn't any less effective than the other options, whats the difference? I mean, what do you expect?
- by Drekab on Sep 13, 2006 at 10:56 PM | link
When the generics start giving samples and running indigent programs, we may have a chance at a true test. Or, when the generics are truly as good - smoother peaks and troughs, easier to remember to take and equivalent absorbtion, as well as true efficacy.
If docs can interpret the literature enough to learn to treat in the first place, we can interpret the BS, too.
The free boxes of tissues, the posters on the walls, the models of the knee,etc. can come in handy when running an office, Sunny. The superspecialists may make huge amounts of money, but for most primary care docs, annual taxes, lease renewal and even malpractice renewal are triggers to reconsider a new profession.
Most of us didn't start all this to make money, but we hate the regulatory hassles that no one can meet, since the books are constantly re-written and re-interpreted. The constant little cuts like this one makes the profession seem less noble to the professionals, too.
Much to do about nothing.
- by Beverly on Sep 14, 2006 at 4:31 AM | link