July 11th, 2011
Big pharma and patient care
The Commercial Appeal
About a decade ago when I was newly settled into private practice in Memphis, a representative for a drug company marketing 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 told me I was a “thought leader” in the field and had been selected to join his company’s speakers’ bureau. Flattered, I agreed to go if my wife, who also is a physician, 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 a $750 honorarium.
It was an attractive invitation since my in-laws lived in the Washington suburbs and we were overdue for a family trip.
The drug rep warned me that his company would not be able to pay for airline tickets for my wife and kids. But then his eyes brightened. “Is your wife a doctor?”
“Yes,” I said.
Well, then, 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 the kind of antibiotic he was marketing, he replied, “That’s OK. I will talk with my manager.” Sure enough, my wife and I received two airline tickets and two rooms at the Ritz and enjoyed our stay in Washington.
The relationship between doctors and the pharmaceutical industry has long been a cozy one. By offering up perks like my weekend trip to Washington, drug company reps have easy access to physicians’ offices and the opportunity to influence the medications that doctors prescribe for their patients. But things are changing.
Voluntary pharmaceutical code
Under pressure from professional organizations concerned about possible conflicts of interest, the Pharmaceutical Research and Manufacturers of America (PhRMA)—the industry’s trade group—published a voluntary code in 2002 that sets out guidelines for the companies’ marketing staffs to follow in their interactions with doctors. The code, which was updated in 2009, says PhRMA is “concerned that our interactions with health care professionals not be perceived as inappropriate by patients or the public at large ... (Such interactions) are professional exchanges designed to benefit patients and to enhance the practice of medicine.”
The code now prohibits giving physicians vacation trips or tickets to entertainment or sporting events, but allows drug company reps to provide “modest, occasional meals ... in the appropriate circumstances” to doctors and their office staff. It also allows pharmaceutical companies to compensate physicians who act as their medical consultants and pay “reasonable” travel, lodging and meal expenses for their consultants.