Fw: Drug Firms Still Lavish Pricey Gifts On Doctors

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Subject: Drug Firms Still Lavish Pricey Gifts On Doctors

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Drug Firms Still Lavish Pricey Gifts On Doctors

Ethics Debated As Freebies Flow

By Bill Brubaker

Washington Post Staff Writer

Saturday, January 19, 2002; Page E01

A week ago last night, about two dozen doctors gathered for cocktails and

dinner at the Plaza Hotel in New York, guests of a pharmaceutical company

that planned to solicit their " advice " and " feedback " on the treatment and

management of depression.

The doctors didn't have to rush home after dinner. Forest Laboratories Inc.

treated them to an overnight stay at the Plaza, where even the least

desirable rooms -- those without Central Park views -- go for about $250 a

night.

Saturday morning, after a free breakfast, the doctors participated in a

four-hour discussion about depression, which can be treated with Forest's

best-selling product, Celexa. Then, after a free lunch, each doctor was

offered a token of Forest's appreciation: a check for $500.

The Plaza event, and a more modest one that Pfizer Inc. sponsored Jan. 11

at the Improv comedy club in downtown Washington, illustrate how the

pharmaceutical industry spends an estimated $2 billion a year on events for

doctors in the United States.

Despite a barrage of direct-to-consumer ads for drugs, only doctors can

write the prescriptions needed for a sale.

Drugmakers have been wining and dining physicians for years, and the

practice has been controversial enough to prompt periodic reviews by

Congress and the American Medical Association. The issue was raised again

Wednesday when board members from the AMA and the Pharmaceutical Research

and Manufacturers of America, an industry trade group, met in Washington.

T. Flaherty, a Wisconsin radiologist and chairman of the AMA's

board of trustees, said he's satisfied with the association's 12-year-old

ethical guidelines on gifts. But, he said yesterday, " this is an issue that

may be reopened. "

The guidelines say physicians should accept gifts worth only " in the

general range of $100 " and that serve a " genuine educational function " and

" entail a benefit to patients. "

Last summer, the AMA launched a campaign -- funded largely by the

pharmaceutical industry -- to reeducate the nation's 700,000 doctors on

ethics.

The guidelines offer some wiggle room. Doctors who have been deemed

" advisers " to drug companies, if only for a few hours, can accept

honorariums and travel perks, for example. Forest Laboratories calls its

advisers " advertising/marketing consultants " in the confidentiality

agreements they are asked to sign.

Rep. Fortney " Pete " Stark (D-Calif.), who introduced a bill that would

eliminate corporate tax deductions for perks given to doctors, called the

AMA guidelines " window dressing. "

" It's 'how to play golf often without having to call attention to the fact

that the pharmaceutical companies are paying your greens fees,' " Stark

said.

A study published in 2000 in the AMA's journal concluded that doctors who

have regular interactions with drug companies are influenced in their

prescribing behavior by the gifts and perks they accept.

" From a business point of view, the drug companies do this because it

works, " said , a Washington psychiatrist.

Critics say the practice helps drive up the use of expensive prescription

drugs, a major factor in the escalating cost of health insurance.

Pharmaceutical company executives say frequent interaction with doctors is

necessary to gain insights into how their drugs can be more effective.

" We don't have -- on staff -- doctors with all of the expertise in the

areas that we work, " Forest President E. Goodman said before the

meeting at the Plaza. " When we have a product where we are designing

clinical studies . . . we go to outside experts to seek their advice.

" We might share with them clinical data and talk about . . . how could this

be positioned in the market? You know, is this good data from a marketing

standpoint? Is there something that would cause you to prescribe this

product for your patients? "

Ultimately, drug company executives say, the perks and gifts they give to

doctors can boost corporate profits.

" Although Celexa is a product with a highly favorable profile for the

treatment of depression, product virtues do not produce sales unless

prescribers are informed and reminded of them, " Forest Chairman,

, wrote in a letter to shareholders, published in the company's 2001

annual report. " And in markets with powerful competitors with immense

budgets, it requires competitive budgets and super-competitive skills and

highly motivated representatives to convey product information. "

Forest reported profits of $215 million for its last fiscal year -- an

increase of 91 percent over the previous year, with Celexa its biggest

money-maker. The antidepressant competes against Eli Lilly's Prozac (now

available in a generic form) and Pfizer's Zoloft, among others.

Nothing in the AMA guidelines discourages doctors from accepting as many

free breakfasts, lunches or dinners as they want.

Typical is the " evening of education and fun " Pfizer offered

Washington-area doctors Jan. 11 at the Improv. Pfizer's invitation said the

evening would begin with a reception, dinner and lecture on " antimicrobials

and the treatment of respiratory tract infections. " Then the lights would

go down for Kathleen Matigan -- " voted female comic of the year. "

The AMA guidelines say free meals must be " modest " and have an educational

component.

How does the AMA define " modest " ?

" It's a meal that you would typically go out to on a Tuesday night with

your family, " said M. , a physician and Ohio State University

educator who is a member of the AMA's working group on ethical guidelines.

" Probably not something that's at a five-star restaurant. "

The guidelines do not rule out five-star treatment -- or honorariums -- for

doctors who provide " genuine " -- not " token " -- services as company

advisers.

" The drug companies have invented this terminology -- advisory committee --

to get around the AMA guidelines, " said J. Brown, a retired New

York psychiatrist. " Putting the doctors on an advisory committee avoids the

ethical issue. You know, it's like you're on board with them. "

Brown is a critic of freebies, yet he makes the free-dinner rounds. " I no

longer treat patients or write prescriptions so I am not influenced in that

sense, " he said.

He recalled a " summit " in southern California last year, sponsored by

Wyeth, at the Ritz-Carlton, Laguna Niguel in Dana Point, Calif.

" They paid for a weekend at this resort plus air transportation -- ah, the

whole schmeer, " he said. " They spared nothing. It was just outrageous. They

also gave me -- are you seated? -- $2,000 to attend. "

The summit was called to announce new clinical data on Effexor XR, an

antidepressant. All 120 guests were Wyeth " advisers, " though some didn't

serve in that capacity at the event, company spokesman Petkus said.

Petkus said that while Wyeth supports the AMA's ethics campaign, " the

guidelines are not specific enough to be a practical guide for everyday

practice in our industry. "

Some doctors say drug companies are more interested in promoting products

than gaining clinical insights.

" I don't think it's appropriate for doctors to even accept trivial gifts

from these companies, " said Dan C. English, a retired surgeon who taught

bioethics at the town and the University of land medical schools.

" These gifts are an attempt to influence physicians to prescribe and

overprescribe based on what the companies have done for them. "

Others say the perks don't influence them at all. " Doctors will do what's

best for their patients, " the AMA's said.

Stanley S. Moles, a Largo, Fla., cardiologist, doubts that many doctors

would prescribe a drug based on information they got over a prime-rib

dinner.

" The guy that's giving the talk has been paid by the company to give that

report, " he said. " These guys are biased. "

Moles said he routinely declines invitations to such events.

" I'm invited almost every day to a fine gathering to hear a 30-minute

talk, " he said. Thursday night, he had invitations to two dinners in Tampa

-- at Ruth's Steak House (Merck & Co. Inc.) and Fleming's Prime

Steakhouse and Wine Bar (GlaxoKline).

Moles chuckled. " Well, I did go to one about three years ago. They bugged

me and bugged me and in a weak moment with a pretty sales rep I told her:

'I'll only go if you send a limo with a bottle of champagne.' And Merck

sent a limo with a bottle of champagne and I took another cardiologist to

an Italian restaurant in Tampa. "

Reaves, a Merck spokesman, said such limo rides are not permitted

under the company's gift-giving policy.

What is permitted? " I can't discuss this, " Reaves said, " because of the

competitive and strategic activities that we deal with. "

© 2002 The Washington Post Company