Doctors under the influence?

A report from Business Week looks at concerns that financial ties between pharmaceutical companies and doctors are influencing the advise that smokers are getting.



The report focuses on two doctors who wrote a report in Annals of Internal Medicine suggesting that smokers could be put on prescription drugs for life as a way to help them quit. Both doctors received funding from Pfizer, the maker of Chantix, a controversial drug that is designed to help smokers quit, but has also been associated with side effects including suicidal thoughts and other psychiatric symptoms.

Due to its popularity US sales of Chantix in 2007 reached $681.6 million, vastly outselling other remedies such as gums, nasal sprays or patches.

Although the doctors disclosed their financial links to Pfizer in the article, many of their patients were unaware of the financial links between the makers of Chantix and the doctors prescribing their medicine.

How to reduce extravagant hospitality at medical events?

As drug companies come under pressure to reduce doctors' perks, some industries are having to adjust. Previous entries on this blog have already referred to sandwich makers and the promotional gifts industry!

Now - according to Der Speigel, 5 star hotels in Berlin are considering dropping one of their stars in order to make themselves appear less luxurious and therefore more acceptable to clients in the pharmaceutical industry. However the article notes that the rates and facilities will remain exactly the same.

Missing the point
Such initiatives clearly miss the point, so before 'spas' start to be renamed 'conference centres' and 'a la carte' becomes 'fast food,' it might make sense to adopt a more sensible approach that would give a proper indication of what is going on.

Australia's new system of disclosure certainly fits the bill. Drug companies in Australia now have to publicly disclose how much they spend on medical education events. This gives a fair indication of the sort of event and identifies events where the hospitality may have been extravagant. The mere fact that companies know they will have to disclose the amount spent on each event should also reign in the more extravagant proposals.

US citizens want to know about physician's payments

A majority of Americans (64%) want to know about their physicians’ financial ties to pharmaceutical companies, and 68% would support legislation requiring pharmaceutical companies to disclose of gifts and payments to physicians, according to a survey released today by the Prescription Project. The poll also found that Americans disapprove of many types of gifts and payments to physicians.

The survey was conducted in support of the Physicians Payments Sunshine Act currently being considered by US lawmakers.

If you are a US citizen you can show your support for the Act by adding your name to an online petition.

Opinion leaders or sales reps?

The practice of drug companies paying doctors to talk about their products comes under further scrutiny in this week's BMJ.

In an interview with Ray Moynihan, Kimberley Elliot who was a drug company sales representative for almost two decades in the United States says, "key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations." In the interview she describes how the doctors were tutored to stay 'on message' during their presentations by extolling the benefits of the product that was being promoted, not talking about the 'failures' and not speaking highly about any other products.

In a separate interview with the BMJ, the medical director at the Association of the British Pharmaceutical Industry, Richard Tiner, agreed key opinion leaders play an important role for drug companies. "Companies will employ consultants to help advise on marketing strategies . . . and present and speak at conferences," he said.

The article also highlights the fees that doctors can earn for speaking at events and the elaborate machinery that companies can use to identify influential doctors and monitor their impact on sales.

US companies adopt new policies on DTCA

Advertising Age reports that, under pressure from a US House of Representatives committee, three US companies have agreed not to advertise new medicines to consumers for the first six months. This is to allow time for physicians to get acquainted with the drugs first. The companies have also committed themselves to changing the way that doctors, or actors pretending to be doctors, are used in the ads.

The companies involved include Merck, Johnson & Johnson and Pfizer.

Pfizer had already stopped using artificial heart creator Dr. Robert Jarvik to push Lipitor after some members of Congress challenged the appropriateness of Jarvik as a spokesperson for the drug.

The companies haven't acceded to all the committee's requests which included a two year moratorium on the advertising of new products and the inclusion of black box warnings on ads if the Food and Drug Administration requested them.

European Commission proposals criticised in The Lancet

The European Commission's proposals to give the pharmaceutical industry a greater role in providing information to patients have been described in The Lancet's editorial as 'effectively DTCA under a different name.'

The Lancet editorial highlights the 'obvious financial conflicts of interest' and points out that companies will only be sanctioned retrospectively and in the event of 'serious and repeated' offences.

A recent consultation by the EC showed that the proposals lack support from health care professionals, patient organisations, regulators, research organisations, consumer organisations and social insurance organisations. The fact that the proposals are still seeing the light of day can maybe be put down to the fact that the EC directorate making the proposals is the Directorate General of Enterprise and Industry operating on behalf of the pharmaceutical companies - one of only two categories that actually supported the proposals.

Researchers fail to disclose support from drug companies

Two influential researchers in the US have failed to reveal the extent to which they are supported by drug companies. The revelations were made by Senator Chuck Grassley who is sponsoring the Physicians Payments Sunshine Act calling for a public registry of the payments that drug companies make to physicians.

Research produced by one of the researchers helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder.

The story has been covered widely in many papers and websites including the Wall Street Journal and the New York Times.

With friends like these...

This time it's the branded gifts industry that is worried about the impact of a ban on drug companies giving gifts to doctors. (see previous blog 'the pharma gravy train')

But you have to ask whether the drug industry welcomes these messages of support from businesses that have benefitted from their past practices.


For instance, in this message we discover that the drug industry is the 'largest user of promotional products.'

The thought of sales reps showering pens, pads and mugs on physicians does nothing for the image drug companies would like us to have of them, as the source of carefully thought through scientific data and analysis.

The pharma gravy train

A US website has got its hands on a letter from a Massachusetts businessman that calls on local lawmakers not to ban gifts to doctors - as his sandwich company will suffer as a result!

Apart from the fact that doctors will surely still have to eat, the letter raises an interesting issue. Due to drug companies' history of extravagant hospitality there is now a sizable lobby that is opposed to any reduction in the wining and dining.

Medical conferences apparently account for an incredible 50% of international conferences each year - a market that the flash resorts and tourist destinations don't want to say good bye to. Apparently in an effort to make themselves acceptable some resort hotels are now adding 'and conference centre' where it once said 'and spa'!

Some medical organisations are apparently also worried that they may no longer be able to entice doctors along to their annual get-togethers by laying on various extra curricula activities to break up the more sober educational events.

A ban on gifts would resolve confusion - and be the right thing to do

This article from CNN money highlights the confusing state of US regulations covering gifts from drug companies to doctors. At one recent event signs on the Eli Lilly booth explained which doctors can receive free yogurt and which can't, depending on which state they are from.

But the absurdity of the situation only gets worse if you look across across international borders. A survey carried out in Pakistan by The Network and referred to Consumers International's report Drugs, Doctors and Dinners showed that companies in Pakistan were offering doctors computers, club membership and even a buffalo as gifts.

Consumers International maintains that the best policy is simply to ban the giving of gifts. Whether it is a buffalo or a branded ball point pen the practice of giving gifts should be an embarrassment for the companies involved. This gimmickry just underlines the fact that the relationship that companies are seeking with doctors is still based on marketing, rather than evidence based education.