blog.bioethics.net

One more time -- should docs take freebies from drug companies?

By James Fossett

In an article in the most recent New England Journal of Medicine, Eric Campbell has some new data on an old question -- how many doctors take things from drug companies and what effects does taking things have on prescribing patterns? (free access). Campbell reports these connections are pervasive--a recent survey which he co-authored found that over 90 percent of physicians take something from drug companies. By far the most common freebies are food and drug samples, which around 80 percent of physicians report receiving. Smaller, but still significant numbers of physicians (in the 25-35 percent range) report more substantial payments---reimbursement for professional travel, consulting, and serving on speakers bureaus or advisory boards.

Campbell is careful to note the potential benefits of relationships between physicians and drug companies. Patients may well benefit from physicians participating in clinical trials and advising on drug development, and marketing may lead to greater use of underprescribed drugs--though why such activities require trips to Hawaii or expensive meals to happen isn't really clear. Relationships with drug companies, however, may also induce doctors to cost their patients money by overprescribing brand names rather than generics, ignore evidence based practice guidelines that don't feature the drugs being touted, and possibly encourage off-label use and novel treatments which may present risks for some patients. As they have in these pages, individual physicians angrily and adamantly deny that their prescribing behavior is influenced by drug company largesse, but an increasing amount of empirical work suggests that it is. Campbell cites some of this work, some of it's been published in AJOB, and more can be found on the web site of the group No Free Lunch. Campbell quotes an estimate that drug companies spend in the vicinity of $20 billion per year on marketing to physicians, which strongly suggests that they believe they're getting something for all this money.

Campbell notes an increased tendency in several states towards requiring disclosure of these payments and a federal law mandating transparency and disclosure has recently been introduced in the Senate. Past evidence suggests that disclosure by itself is unlikely to change much, except increase the vehemence of physician denials that their actions are influenced by the money they get from drug companies. More likely to actually change things are policies being adopted by a number of hospitals, health systems and medical schools that ban free food or accepting drug samples, and educate physicians through means other than industry presentations over expensive lunches at tropical resorts.

Campbell also encourages individual physicians to understand the benefits and risks of drug company freebies for their own patients. What physicians appear to see as perks to which they are entitled--free meals and trips and resources for their kids college funds---are commercial transactions intended to change the way they prescribe, and physicians might wish to consider if in fact these payments aren't having that effect.

James W. Fossett co-directs the Rockefeller Institute of Government/AMBI states and bioethics program. He is also responsible for the Rockefeller Institute's health and Medicaid studies and is Associate Professor of Public Administration and Public Health at the Rockefeller College of Public Affairs and Policy, University at Albany.

earlier on blog.bioethics.net:
+ OK, who hasn't taken money from drug companies?
+ Stanford: No More Small Gifts
+ No More Free Lunch