Are Drug Makers Influencing Your Doctor?
Dec. 23, 2004 — -- When patients visit their doctor for medical care and advice, most believe they are getting unbiased medical attention that puts the patient's well-being first.
But most patients are unaware that some doctors' advice might be affected by expensive gifts, lavish trips to luxury resorts, gourmet dinners and high-priced tickets to Broadway shows and sporting events.
These pricey gifts come courtesy of pharmaceutical companies as a way of encouraging doctors to prescribe their drugs to patients, even when those drugs are not recommended for the patients' illness.
Doctor or 'Whore?'
"Some physicians become known as whores," said Dr. Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine. "This is a profession in which we're taking care of sick people who trust us, who trust us to do what's in their best interest and not in our own best interest."
In his recently published book "On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health," Kassirer describes the ways that big drug makers use the $21 billion spent each year on marketing their products.
"Almost all of that $21 billion, some, close to 90 percent of it, is directed at doctors," Kassirer told ABC News' "Good Morning America." "I don't believe the drug companies would be spending that kind of money on doctors if they didn't believe that it has an effect."
Industry analysts estimate drug companies spend $6,000 to $11,000 per doctor each year as part of their campaign to promote their drugs, including personal visits by drug company sales reps.
That money also permits doctors to travel to industry events in a luxurious style. According to one doctor: "They give you a room at the Waldorf-Astoria [hotel], pay for all your meals, fly you here. You get a limousine to take you from the airport and back to the airport, and give you $500 on top of that."
Other perks include free lunches for the entire staff of doctors' offices, trips to medical conferences at luxury resorts, golf clubs, tickets to sporting events and other gifts.
The single largest handouts, however, are free samples of medication. An estimated $11 billion worth of prescription drugs were given away to doctors in 2001.
Kickbacks and Illegal Promotions
But all this overzealous marketing has not gone unnoticed by government agencies.
Celebrex manufacturer Pfizer Inc. pleaded guilty in May to charges that it illegally paid doctors to prescribe Neurontin, an epilepsy drug, for bipolar disorder. A study had shown that the medicine was no better at treating bipolar disorder than a placebo.
Other ailments for which Pfizer illegally promoted Neurontin ranged from Lou Gehrig's disease, attention deficit disorder, alcohol and drug withdrawal seizures and restless leg syndrome.
Pfizer, the world's largest pharmaceutical manufacturer, agreed to pay $430 million to resolve the criminal and civil charges related to the case.
But smaller drug companies have also come under scrutiny for unscrupulous practices. In 2001, TAP Pharmaceutical Products Inc. paid $870 million to settle federal conspiracy charges that the company encouraged doctors to prescribe Lupron, a prostate cancer drug, by paying kickbacks to the doctors.
The company allegedly gave free samples to the doctors, then coached the doctors on how to bill Medicare and Medicaid at $500 per dose.
Ethical Guidelines Are Voluntary
As a result of these and other practices, industry groups have begun to implement guidelines for pharmaceutical companies and doctors.
The Pharmaceutical Research and Manufacturers of America, a drug industry trade group, adopted a voluntary code in 2002 to address public concerns over drug company marketing practices. The guidelines stress that any sponsored activities or gifts must be educational in nature and aim to benefit the patients.
The American Medical Association's ethics guidelines allow doctors to attend company-sponsored conferences and to receive textbooks or drug samples that will directly benefit their patients, but advise them against accepting individual gifts of more than minimal value.
These guidelines, however, are entirely voluntary and do not compel doctors or drug sales reps to follow them.
The government has also issued voluntary guidelines as a means of reducing drug company risks of prosecution.
In 2002, the U.S. Department of Health and Human Services' Office of Inspector General issued a 44-page document spelling out marketing activities considered "suspect" under the new standards.
Activities like "switching arrangements," in which drug companies pay cash to doctors for switching patients from a competing medication, and entertainment, recreation, travel, meals, and other remuneration of more than nominal value are considered suspect by the agency.
But Kassirer doubts these gifts and perks will cease. Real change can only come from an informed and outraged public, he says.
"One of the reasons that I wrote the book for the public is to alert the public that this is going on in medicine and in the hope that they would pressure the medical profession to do something about it," he said.