End Drug Company Gifts To Doctors

April 7, 2009

Each year drug companies funnel millions of dollars in gifts and payments to physicians in Connecticut — without any public disclosure or notice to patients. And it's all completely legal.

The companies that make prescription drugs invest heavily in marketing, because it works. Drug companies spend about $4.2 billion annually for the many "Direct-To-Consumer" advertisements for new drugs that we see. But they spend even more — $7.2 billion a year — on marketing directly to physicians through one-on-one sales visits. The result is sharply increased prescriptions for new brand-name drugs — even if those drugs aren't any safer or more effective than existing cheaper drugs.

Fortunately, there is a sensible solution to these shady marketing practices: Enact an outright ban on drug company gifts to doctors, to prevent inappropriate bias on prescribing decisions. Senate Bill 1049, just voted out of the General Assembly's Public Health Committee, would prohibit drug and medical device companies from making gifts to doctors, and require that notice of drug company payments for consulting services of more than $1,000 be made available to the public on the attorney general's website.

The pharmaceutical industry employs about 90,000 sales representatives across the U.S. — a ratio of one salesperson for every 4.7 office-based physicians. To promote their products, drug company representatives make many direct gifts to doctors, including expensive meals, entertainment, tickets to sporting events, honoraria and travel.

Based on giving patterns in other states, Consumers Union estimates that drug companies may give $7 million to $11 million in gifts to Connecticut doctors each year.

Aggressive drug company marketing emphasizes the latest and most expensive drugs, even though they may not be the best in their category, according to medical evidence. At the same time, drug company marketing to physicians drives up health care costs, and undermines the quality and safety of our care.

A startling example of how aggressive marketing undermines patient safety is the Vioxx pain medication campaign sponsored by Merck, Vioxx's manufacturer. An estimated 88,000 Americans experienced heart attacks related to their use of Vioxx, and 38,000 of them died, according to research published in the Lancet medical journal. After it was revealed that Merck had suppressed serious findings about Vioxx's safety, it voluntarily withdrew the drug from the market in 2004.

To promote Vioxx, Merck spent hundreds of millions of dollars on turbo-charged marketing campaigns. Sales representatives were instructed to "dodge" physician questions on coronary risks, according to company sales training materials.

The Yale-New Haven Medical Center, and many other academic medical centers around the U.S., have already enacted comprehensive rules preventing drug company gifts. Just as state law prohibits gifts from lobbyists to legislators, Senate Bill 1049 would stop drug companies from using their financial muscle to inappropriately influence physician prescribing decisions.

Patients want to have confidence that their prescriptions are based on the best medical evidence, not pharmaceutical company payola. Sadly, however, drug company gifts to doctors undermine the doctor-patient relationship by creating the appearance of impropriety.

Allowing uncontrolled drug company gifts poses a serious threat to the public health. Connecticut legislators should ignore the special interest pleadings of drug industry lobbyists, and vote to approve SB 1049. A comprehensive ban on drug company gifts to doctors will end the troubling financial conflicts of interest that undermine the quality of care to patients. The bill will also give consumers greater confidence that they will get the care and treatment they are supposed to get, based on the best medical evidence.

•Chuck Bell is programs director of Consumers Union, the nonprofit publisher of Consumer Reports and ConsumerReports.org. Jean Rexford is executive director of the Connecticut Center for Patient Safety.

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