Health Care & Prescription Drugs In the News

WITH ALL the slick television and print ads put out by drug companies, it is hard to avoid being influenced. Who doesn't want lower cholesterol, or a good night's rest?

While consumers certainly face a lot of drug marketing, doctors are truly inundated with it. They're frequently visited by sales representatives, who provide information about their company's drugs along with free drug samples, office supplies with drug logos, complimentary lunches and more substantial gifts.

 

New Jersey Attorney General Anne Milgram recently announced the formation of a task force to address pharmaceutical gift-giving, illuminating the pervasiveness of this practice. The task force will examine these gifts and how they may influence doctors, and assess whether policy reform is needed to ensure unbiased patient care.

NJ Public Interest Research Group studies show that while doctors may only be looking to acquire information about new drugs, visits from gift-bearing sales representatives are quite often biased and influential and, therefore, not in the best interest of patients and consumers.

$4.8 billion on promotions

Giving gifts to doctors is a prevalent, well-documented strategy used by pharmaceutical companies to influence the prescriptions doctors write in order to generate larger profits. In 2004, the pharmaceutical industry employed 90,000 sales representatives -- twice as many as just a decade earlier -- to call on doctors, and it spent upward of $4.8 billion that year on one-on-one promotion to doctors.

Much of this money is spent on fancy dinners, trips, tickets to the local sporting event or concert, CDs and the like. Unavoidably, these costs are passed through to the health care system and its consumers.

Research by Dr. Mary-Margaret Chren at the University of California at San Francisco reveals that doctors are more likely to prescribe a drug from a specific company if they have met with or accepted money from the company. A study by Drs. J.P. Orlowski and L. Wateska showed that pharmaceutical firms that provided all-expenses-paid trips for doctors saw a significant increase in doctors' prescribing pattern of that company's drugs.

Influence alone may cause no harm; however, NJPIRG's research shows that many of the marketing messages that accompany these gifts are misleading.

Between 2001 and 2005, 85 drug companies received 170 notices from the FDA explaining that the marketing for 150 different drugs was false and/or misleading. For deceptive messages targeting doctors, 37 percent misrepresented a drug's risk, 24 percent promoted unproven uses and 36 percent made unsupported, misleading claims. Sales representatives' statements accounted for 30 of the 539 deceptive messages aimed at doctors.

It may seem insignificant, but this is an enormous amount given the minute chance that the FDA will detect such statements.

Understandable

Tom Ricker, a retired pharmaceutical executive from North Jersey, explains that his own experience as a sales representative did not entail deception, but he "can see how it could happen in other companies."

Ricker says that while "some drug companies might [deceive] intentionally, others train employees not to do that."

It would be great if all sales representatives were well-trained professionals, but it is hard to determine this when nearly all of the promotional activity between sales representatives and doctors occurs without scrutiny of the FDA or any other regulator.

Fortunately, with the state's new task force investigating the practice of drugmakers' gifts to doctors, New Jersey is in a great position to address these concerns through policy change. Congress has already taken great steps toward consumer protection by passing a bill, championed by Rep. Frank Pallone, D-Long Branch, which enables the FDA to crack down on the drug companies that put out misleading ads.

New Jersey should complement this by better regulating the practice of one-on-one promotion to doctors, which the FDA rarely has access to. Drug companies know they're treading murky waters, which is why they've adopted voluntary guidelines for giving gifts to doctors.

Guidelines are not enough. New Jersey should adopt policies similar to those in Maine, Vermont and West Virginia, requiring disclosure of gifts by drug makers or doctors, and, as Minnesota has done, restricting the price tag on these gifts.

Influence over prescription-writing is bound to follow gifts from drug companies. By recording gift-giving or limiting the gifts, patients and consumers can be aware of the potential influence, and the most significant influences can be eliminated.

Trusting our doctors is important. However, it doesn't hurt to ask them about the benefits and risks of the drugs they're prescribing, or to find out if there are cheaper alternatives that are just as effective.

Ultimately, to avoid the negative influences of gift-giving and deceptive drug marketing, we must demand that our legislators promote stronger policies to protect patients and consumers.

Rebekah Scotland is legislative associate at NJ Public Interest Research Group.