New Voluntary Guidelines On Physician Gifting Practices

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New guidelines by the Pharmaceutical Research and Manufacturers of America to address conflicts of interest that "illuminated the once-shadowy financial dealings" between pharmaceutical companies and physicians took effect Thursday, the Boston Herald reports. Compliance with the set of guidelines, which the lobbying group titled, "Code on Interactions with Healthcare Professionals," is voluntary. PhRMA plans to produce a directory of companies that comply with the guidelines, according to the Herald (McConville, Boston Herald, 1/2).

Under the new code, pharmaceutical companies are barred from distributing office supplies, clothes and other gifts with company logos or product brand names to physicians and clinics, the Houston Chronicle reports. The new code also prohibits the companies from paying for physicians' meals, including those during medical education events, and requires that all grant money allocated for continuing medical education programs be handled by personnel who are not from sales and marketing departments.

The new code does not address the issue of the "amount drugmakers pay doctors to hit the speaking circuit for their products," according to the Chronicle. The amount has not yet been capped but the companies have been told to keep a record of the consulting fees they pay to each physician (Cook, Houston Chronicle, 1/1). According to the New York Times, the voluntary moratorium on supplying branded gifts and trinkets to physicians seeks to "counter the impression that gifts to doctors are intended to unduly influence medicine."

However, while some physicians "applaud the gift ban, others seem offended by the insinuation that a ballpoint pen could turn their heads," the Times reports, adding that "skeptics deride the voluntary ban as a superficial measure that does nothing to curb the far larger amounts drug companies spend each year on various other efforts to influence physicians" (Singer, New York Times, 12/31/08).

Editorials

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* Las Vegas Sun: "Although the new guidelines are a step in the right direction, there is reason to believe pharmaceutical manufacturers exert considerable influence over physicians in a bid to get them to prescribe certain drugs," a Sun editorial states. The editorial continues that "drug companies still ply doctors with free meals, often expensive ones, while delivering their sales pitches" and "many manufacturers also pay doctors tens of thousands of dollars annually to serve as consultants." According to the Sun, "There is nothing wrong with physicians seeking information from manufacturers to learn as much as they can about a drug," but "it is unethical when doctors prescribe certain medications simply because a pharmaceutical company encouraged them to do so" (Las Vegas Sun, 1/5).

* New York Times: "The updated rules are the [pharmaceutical] industry's latest attempt to restore public confidence that doctors are prescribing medicines in the patient's interest," but the code "still has too many loopholes," a Times editorial states. According to the Times, "Congress needs to pass legislation that would force all drug and medical device companies to report a wide range of payments to doctors through a national registry so that all conflicts are known." The editorial states, "This is a reform that the industry itself now seems willing to accept," adding, "Better yet, the medical profession needs to wean itself almost entirely from its pervasive dependence on industry money" (New York Times, 1/5).

Letter to the Editor

The Times article published on Dec. 31, 2008, "portrays the pharmaceutical industry's voluntary moratorium on 'goodies for doctors' as an honest effort by drug manufacturers to curb doctors' 'deep financial ties with the drugmakers,'" but "[n]othing could be further from the truth," David Edelson, an assistant clinical professor of medicine at Albert Einstein College of Medicine, writes in a Times letter to the editor. According to Edelson, the "simple fact" is that the practice of giving gifts is "not cost-effective."

He continues, "Furthermore, industry leaders realize that doctors don't even determine what drugs are prescribed to their patients anymore -- managed care formularies have taken over that function." Edelson adds, "Having done the math and realizing that $1 billion could be better spent elsewhere, they cleverly packaged this ban as a step to the higher moral ground." Edelson concludes that gifts from the pharmaceutical companies "is the least of our worries" because physicians "will be facing a significant increase in office supply costs on top of already skyrocketing office overhead, malpractice insurance costs and 15 years of falling reimbursements" (Edelson, New York Times, 1/4).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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