No to Pens and Yes to Pizza
The Pharmaceutical Research and Manufacturers of America (PhRMA) Board of Directors have adopted a new code of ethics on interactions with healthcare professionals (bioethics.net News, July 12, 2008). This change in the code would further restrict pharmaceutical reps and other industry professionals in regard to their interactions with doctors, nurses, and other healthcare industry workers. While these changes might seem like a step in the right direction, a closer look suggests that it may be at best a half-step.
The proposed changes to the Code on Interactions with Healthcare Professionals include the complete prohibition of distributing small gifts to healthcare providers and their staff, including pens, post-it notes, and other such gifts. PhRMA acknowledged by releasing this statement that such gifts "may foster misperceptions that company interactions with healthcare professionals are not based on informing them about medical and scientific issues" (PR Newswire, July 12).
This argument has been one advanced by articles published in AJOB (All Gifts Large and Small, Katz, Caplan, and Merz, AJOB 3:3) in which it was made clear that the impact of these small gifts upon practitioners was significant.
The fact that pharma is realizing that gifts have an effect on physician's prescribing practices is a significant acknowledgment--but does not go far enough to ensure that reps will have the "adequate training" required by the Code to educate doctor's when they come in for their noon-time lunches to talk about the latest drugs. Moreover, the pharmaceutical industry did not totally buy into the argument about small gifts because their new code does not prohibit bringing meals to doctor's offices--yet disallows dinners with docs. This half-step (the lunch vs. dinner distinction) would appear to be a step in the right direction, but the broad clause of "occasional meals" for "informing [doctors] about medical and scientific issues" allowed in physician's offices are clauses so vague as to leave enormous discretion for the industry to continue to woo healthcare providers over pizzas and paninis.
The key to making this Code stick is to ensure that this half-step forward does not result in two-steps back as a result of the vague language and loopholes existing in this Code. Time will only tell--but let's hope that this is the end of the pharmaceutical industry's free lunch, even if they still can give free lunches to healthcare providers.
Summer Johnson PhD, guest blogger
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