Do Free Gifts Dictate Your Medical Care?

Some doctors say drug sales practices cross line. Do they affect patient care?

March 29, 2008— -- A peek into the office of Dr. Jeffrey Caren reveals he's not only a cardiologist, but also a collector of pop art.

Over the years, the Los Angeles doctor has amassed more than 1,000 pens given to him by pharmaceutical sales representatives who come to push their products. Displayed prominently in his office, Caren said his pillar of pens illustrates an institutional practice in which drug reps make the case for expensive, newer products that haven't been broadly tested, potentially risking patient health.

"I started collecting pens about six years ago when I noticed how many pens I was getting on a weekly basis," said Caren, a cardiologist at Cedars-Sinai Medical Center. "I think the purpose of the small gift is something that's in your hand all the time. And it's more subliminal. That, you know, I'm holding a Lipitor pen and I'm thinking 'Lipitor.'"

Watch Lisa Stark's report on pharmaceutical sales representatives tonight on "World News." Check your local listings for air time.

Doling out pens, coffee cups, clocks and free drug samples, drug companies spend about $7 billion a year to convince doctors to prescribe their medicines. The pharmaceutical industry says its sales reps arrive well-informed and with good intentions, but many doctors say the practice is dangerous and needs to stop.

"The information that drug representatives give to physicians is never objective," said Adriane Fugh-Berman, associate professor in the department of physiology and biophysics at Georgetown University. "Drug reps are trained to emphasize the benefits of their drugs, trivialize any risks, and to emphasize the shortcomings of competing drugs."

But representatives follow strict guidelines on gift giving and sales pitches, according to Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America.

"The pharmaceutical representative's job is to make sure the doctor knows what the medicine can be used for, when it should be used, and the patients for whom it should not be used," Powell said. "They are conveying medical and scientific information to the physicians and to the other people in the physician's office. And, yes, they are there to sell a product, but they do that by conveying medical information."

In a statement to ABC News, pharmaceutical company Eli Lilly said it sells its products responsibly and complies with tough Food and Drug Administration requirements in the process.

"Meetings with technically-trained Lilly marketing representatives -- some of whom are healthcare professionals themselves -- are one of several important ways for physicians to receive the scientific and educational information they need to make sure medicines are used properly and patients are safely and effectively treated," Eli Lilly's statement said.

Congress is so concerned about pharmaceutical sales practices that it is now considering using taxpayer dollars to give doctors more objective information about new drugs.

Several years ago, the pharmaceutical company Merck pulled painkiller Vioxx from the market for increasing the risk of heart attacks and strokes. Internal company documents revealed the Merck sales force was told to "dodge" doctors' questions about the drug's link to heart problems.

At a recent on Capitol Hill, a former Eli Lilly sales rep, Shahram Ahari, gave lawmakers an insider's glimpse into the world of pharmaceutical sales. He said pharmaceutical companies go to extremes to sell their drugs -- from hiring attractive, young salespeople to familiarizing themselves with doctor's prescribing patterns.

"The fact of the matter is, we don't just give a doctor a pen," Ahari said. "We give them bucket loads of pens, pads, we take them out to fancy dinners, we give them samples, we give them medical equipment. Everything we do generates this sense to return the favor. And what better way to return the favor to your drug rep than to prescribe their medications?"

ABC News' Marcus Baram contributed to this report.