Is a drug company running its own "Frequent Flyer Program" to reward doctors who prescribe its hypertension medication? One irate physician thinks it is, and the company's marketing tactic has aroused concern on Capitol Hill.
Referring to the free airline tickets and other gifts offered to physicians who prescribe the drug and answer a questionnaire on Ayerst Laboratories' drug Inderal LA, Dr. John Graves wrote, "I am very concerned about this form of marketing in medicine as I feel it creates a clear conflict of interest for the physician in their prescribing habits." The ploy, he said, "gives the appearance of impropriety."
The company denied that its gift program was a marketing device. Ayerst spokesman Joseph M. Mahady said the program is a "research tool," designed to help the company develop a "patient profile." Participating doctors are asked to fill out a seven-question survey form classifying the patients for whom they prescribe Inderal LA, according to age, sex, race, dosage and other medications.
According to Graves, an assistant professor at Bowman Gray School of Medicine in Winston-Salem, N.C., an Ayerst representative told him that doctors who submit questionnaires on 50 Inderal LA patients are given a free airline ticket anywhere in the United States. He said he was told there are other, more valuable prizes for filling out up to 200 survey forms.
Graves first raised his objections to the Ayerst free-gift program in a recent issue of the New England Journal of Medicine. Noting that the market for hypertension medication is clearly a competitive one, and aggressive promotion can be expected, Graves said he thinks Ayerst's technique reflected "questionable ethical standards."
The company spokesman implied that the free gifts were needed as an inducement for doctors to fill out the survey questionnaires. "Completion of survey forms and processing of paper work is required of participating physicians," he wrote, "and professional honoraria commensurate with these efforts are offered.
"Selections include diagnostic equipment, medical textbooks or air travel to attend medical meetings. The program is designed to enable physicians to attend the meeting of their selection rather than a prearranged symposium. The honorarium is modest when one considers it is offered in return for a full year of program participation and the completion of survey forms on at least 50 patients."
The company's written statement did not say whether it monitored the physicians' choice of airline tickets to make sure they were used to attend medical meetings. The company spokesman declined to comment beyond the written statement.
Rep. Henry A. Waxman (D-Calif.) told our reporter Gary Clouser he is concerned over such marketing practices, and suggested that they are linked to the drug companies' campaign to promote their profitable brand-name prescriptions over generic drugs.
The incentives offered to doctors to prescribe certain drugs "cloud their judgment," Waxman said. He also pointed out that the cost of the gifts to physicians is ultimately passed on to the customers. Waxman is chairman of the House subcommittee on health and the environment.