A Prescription for Trouble

April 10, 2000 (San Francisco) -- Once upon a time, the perks were scandalous.

During the 1980s, drug companies offered physicians gifts of all kinds, from penlights to personal computers and plane tickets, to promote their medications. Of course, these freebies telegraphed a not-so-subtle message to doctors: Prescribe our drug, and the perks will keep coming.

All that changed in 1991: Pressured by Congress, the American MedicalAssociation (AMA) adopted ethics guidelines calling on physicians to refuse any gift of "substantial value," including meals, entertainment and cash. Thus ended some of the more egregious practices, such as awarding frequent flyer miles based on the number of prescriptions a doctor wrote.

But a recent editorial in the January 19 issue of the Journal of the American Medical Association (JAMA) brings bad news: "Many of the troubling practices have returned," says Robert Tenery Jr., MD, a past chair of the AMA's Council on Ethical and Judicial Affairs. Instead of plane trips, Tenery says drug companies are now handing out honoraria and free lunches, and sponsoring "educational" seminars at which drug companies control everything from the choice of salad to the setting, the science, and the speakers.

To make matters worse, physicians often attend these seminars in order to satisfy the continuing medical education (CME) requirements that they must fulfill to keep their state licenses current.

"Industry money and influence has permeated virtually all levels of physician CME in the form of complimentary meals and entertainment, consultation fees, and pseudo-CME courses," Tenery writes.

Doctors, he said, are part of the problem. Because they are so pressed for time, drug reps often resort to paying for fancy meals in order to see them. "Industry representatives have found themselves unable to gain access to physicians without providing something in return," Tenery writes.

A spokesman for DuPont Pharmaceuticals said the company follows a strict code of ethics in approaching doctors. But he noted, "their time is expensive. [And] there are cases where physicians may seek a higher level of honoraria" than those already offered.

Blockbuster Drugs and Subtle Sells

Although the AMA managed to slow the practice of perks for a time, drugcompanies began to accelerate their efforts in the late 1990s in order to compete with generic drug makers as well as the young upstarts of the biotechnology industry. Sales gimmicks used today, however, are subtler than the blatant gifts of the 1980s.

Tenery, a Dallas ophthalmologist, was recently invited to Newport Beach, Calif., to attend a conference sponsored by Allergan to provide information about its new allergy eye medicine, Alocril. The invitation included round-trip airfare to California, accommodations at a luxury hotel, and a participation fee of $1,000, as well as the promise of participation in more such programs later this year.