More rules are needed to curb drug firms' attempts to influence physicians

(Michael Austin For The Washington Post)
By Manoj Jain
Special to The Washington Post
Monday, November 15, 2010; 2:52 PM

Nearly a decade ago when I was newly settled into private practice in Memphis, a drug representative for a new and powerful antibiotic stood in my office and asked whether I would like to attend a consultants' meeting about the drug in Washington.

He said I was a "thought leader" in the field and had been selected for his company's speakers bureau. Flattered, I agreed, if my wife had no conflict with her on-call schedule.

The pharmaceutical company would pay for my flight, a two-day stay at the Ritz-Carlton, meals and $750 honorarium. It was an attractive invitation since my in-laws lived in Sterling, and a family trip was overdue. The drug rep told me, though, that his company would not be able to pay for my wife's and kids' flights.

But then his eyes brightened. "Is your wife a doctor?"

"Yes," I said.

She could be a consultant, too, he said. The company would pay for her flight and give her an honorarium, and "then you can have two rooms at the Ritz and invite your in-laws!" When I pointed out that, unlike me, she was not an infectious-disease doctor and had little cause to prescribe an antibiotic of this kind, he replied, "That's okay. I will talk with my manager." Sure enough, we received two flights and two rooms at the Ritz.

The relationship between doctor and drug industry has long been a cozy one. By offering up such perks as a trip to Washington, drug reps have easy access to physician's offices and can influence what doctors prescribe. But things are changing.

Under pressure, PhRMA, the pharmaceutical industry trade group, published rules in 2002 prohibiting drug reps from giving doctors lavish trips and tickets to entertainment events. Meals and speaking fees were not banned.

In 2007, senators Charles E. Grassley (R-Iowa) and Herb Kohl (D-Wis.) introduced a bill requiring large pharmaceutical companies and medical device manufacturers to disclose the value of dinners and of speaker and consultation fees they provide to doctors. (The bill finally was adopted this year as part of the health-care overhaul.)

Two weeks ago, the nonprofit investigative news organization ProPublica published online the names of 17,000 doctors who together received $250 million since 2009 for speaking engagements and consultations from seven leading drug companies. Looking through the list, I saw names of many friends and mentors. Two of the three doctors who got the most money - more than $250,000 each - work near me.

When I shared the ProPublica Web site with colleagues, they were startled by the amount those two doctors received. One became defensive about taking speaking fees himself. Another told me sincerely, "I do it for the money, and I also provide community service."

Mixed feelings

I have mixed feelings about my profession's relationship with pharmaceutical companies. I must admit something gnawed at me during my stay at the Ritz. The consultants' meeting turned out to be a group of 25 doctors being led through a slide presentation on the benefits of the drug, which belongs to a class of antibiotics called fluoroquinolones. I realized that I was not in the company of "thought leaders" but rather in a group of ordinary doctors who, like me, wanted a fun free weekend in Washington.

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