These Gifts Are Bad for Our Health

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By Stephen Cha
Sunday, July 24, 2005

NEW HAVEN, Conn.

When it comes to accepting gifts from the marketing reps of pharmaceutical firms, the American College of Physicians-American Society of Internal Medicine suggests that its members apply a simple litmus test: "What would the public or [our] patients think of this arrangement?"

Most patients never find out. If they did, they'd probably go into shock over the goodies doctors accept, like meals, travel, gift certificates or parties. The pharmaceutical industry estimates that it spends about $5.7 billion a year on marketing directly to physicians, which works out to about $6,000 to $7,000 per doctor.

Three years ago, Vermont enacted a groundbreaking law intended to remedy the situation by requiring the drug companies to publicly report promotional gifts and payments to physicians. As in many areas of government and business, the law was tailored with the idea that sunshine is the best cure for the ethically questionable practices that thrive in secret. If shame alone fails to curtail excesses, then at least information about gifts and contributions can empower voters, investors or consumers to make more educated choices, aware of potential conflicts of interest.

Yet in the world of medicine, this is a new concept and, judging from Vermont's experience, legislation about it may require further surgery. Not only have pharmaceutical companies and doctors circumvented the disclosure rules, but it's virtually impossible for patients to find the information.

"It's not surprising that this extraordinarily well-financed industry circumvented the law," says Peter Shumlin, the former Vermont legislator who sponsored the bill. "The surprise is that we consumers still take it."

The scope of the problem in medicine is well known -- at least among doctors.

As a medical student, a colleague of mine once walked into the offices of a practice where she was working and unexpectedly found herself at a party. Food, trinkets, pens and coffee mugs were being handed out to the whole office staff, about 20 people including med students and doctors -- all courtesy of Merck & Co. And to the physician who was the number one prescriber of Vioxx in the entire region that year, a marketing rep of the company awarded a pair of Philadelphia Eagles season tickets.

That was almost five years ago, and the party for Vioxx has ended -- the painkiller got yanked from the market because it could cause heart problems. Recent congressional investigations revealed that Merck marketers had misled physicians, wrongly suggesting that Vioxx was better for the heart than other pain relievers, even after research suggested possible dangers.

Did Merck's perks encourage that doctor to prescribe a drug that he might otherwise have avoided? It's difficult to judge. Like political contributions, these gifts are not necessarily improper, and some industry-physician collaborations can lead to important advances. But research shows that such largess affects physicians' prescribing practices and may compromise their objectivity.

Certainly if I knew that my doctor was getting $5,000 to $20,000 a year from the maker of Vioxx, I would wonder why the doctor was prescribing it.


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© 2005 The Washington Post Company

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