Drug Company Gifts Are Bad Medicine

The Hartford Courant December 20, 2008
YOUR VIEW: STEPHEN R. SMITH, M.D.

One way to thank someone for giving you a gift is to say, "I'm obliged." That's exactly what drug companies want doctors to say for the gifts, large and small, that they bestow upon them. That feeling of obligation costs you, the patient, money and endangers your life. Drug company gifts to doctors must be banned.

Pharmaceutical companies curtailed lavish gifts to doctors, such as luxury vacations and Super Bowl tickets, in the face of public outcry and congressional scrutiny a few years ago. But the practice continues in the form of free food, sumptuous dinners under the guise of education, and free trinkets such as pens and notepads.

Although the dollar value of these gifts might be less than that of gifts in the past, the effect is the same: The gifts make doctors feel indebted for the kindness and, in turn, doctors feel an obligation to prescribe the company's drugs.

Social science studies tell us that the size of the gift doesn't matter. When you receive a gift, you feel obligated to reciprocate in some way to the gift-giver. The recipient of the gift doesn't even have to be conscious of this feeling.

Most doctors think their prescribing practices are not influenced by drug company gifts, though careful studies have shown the opposite to be true. Drug companies wouldn't spend billions of dollars on gifts if they weren't sure the investment would pay off.

Recently, I received an invitation from Genentech and Novartis to have dinner at a steak house to hear a doctor talk about their new asthma drug, Xolair. The thought of a big, juicy filet mignon was tempting, but I turned it down.

The drug is very expensive ($560 a dose). It has serious and sometimes fatal adverse effects, and should be used in only a few patients who don't respond to conventional therapy. I didn't need to hear a paid drug company spokesman tell me about it. I can easily obtain objective, unbiased information from other sources.

These gift-giving practices cost taxpayers money. Americans spent $217 billion on prescription drugs in 2006, up 8.5 percent from 2005. The share of that cost paid by Medicare shot up from 2 percent to 18 percent as the new drug plan for Medicare came into effect. The marketing practices of drug companies undermine efforts to get doctors to prescribe effective, low-cost generic drugs, even when scientific studies show that new, expensive drugs are no better.

Aggressive marketing also poses dangers to your health. Pharmaceutical company sales people pushed doctors to prescribe Vioxx, even though cheaper and older painkillers would have been fine for the vast majority of people given Vioxx prescriptions. Fewer deaths would have occurred by the time the drug was pulled off the market if it hadn't been marketed so aggressively.

Drug companies have proposed voluntary guidelines they would follow in response to recent scandals. They would limit educational gifts to less than $100 and prohibit noneducational gifts such as coffee mugs and pens, but would still permit free food for doctors and their staffs, free dinners to hear paid speakers, free samples and support of educational meetings. In other words, doctors would still be getting gifts and still be feeling obliged to the drug companies.

The American Medical Association, which received tens of millions of dollars annually selling prescribing information that drug companies use to target their messages to doctors, also supports these voluntary guidelines. The National Physicians Alliance supports a full ban on gifts from pharmaceutical companies and opposes the AMA's sale of prescribing data to marketing companies.

Pharmaceutical companies should be banned from giving gifts of any amount or size to physicians. Doctors should write your prescriptions based on the best science and your best interest, not the steak dinner they enjoyed on a drug company's tab.

• Dr. Stephen R. Smith of New London is a professor of family medicine at the Warren Alpert Medical School of Brown University. He serves on the board of directors of the National Physicians Alliance.

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Copyright © 2008, The Hartford Courant

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