Ethics questions arise as doctors pitch to colleagues

ALBANY, N.Y. -- Dr. Daniel Carlat sank into a choice seat at Lincoln Center, surrounded by other psychiatrists, all staying at the same four-star hotel in Manhattan and attending the same show for free. His deal with a pharmaceutical company to provide testimonials to other doctors had paid off well.

"It just kind of gave me a feeling of euphoria," said Carlat, a practicing psychiatrist and assistant clinical professor of psychiatry at Tufts University in Boston. "Sort of like you've made it into the upper crust of society."

The practice of using doctors to pitch products to other doctors is legal, though several states — including New York — are trying to curb it. They are opposed by the pharmaceutical industry, which argues the practice is a kind of professional consultation.

Carlat was on the "speakers' bureau" for the pharmaceutical companies, speaking to large groups of doctors, or holding intimate, expenses-paid meals with a pharmaceutical representative and one or two doctors. In one year, he earned $30,000 — about one-fifth of his salary. Ultimately, his conscience started nagging him and he quit.

"My role in the company was not by any means to serve as a source of unbiased medical information," he said. "But my role was really simply to be a part of their marketing machinery and that was the value I had for them."

Pharmaceutical companies argue that doctors are an essential part of educating colleagues as new drugs are developed.

"The information about medicines provided by technically trained company representatives, some of whom are health care professionals themselves, is important education for physicians who must understand side effects and the proper use of potent prescription pharmaceuticals," Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturing of America, said in a written statement.

At the end of January, PhRMA, the drug industry's lobbying arm, said it is considering scaling back on smaller gifts to doctors, including pens, coffee mugs and other items. Johnson said the idea is not a response to pressure about its marketing practices.