April 25, 2007 - Most American doctors have some relationship with drug companies, according to results of a national survey released Wednesday.
The survey found that 94% of doctors report having some type of relationship with drug manufacturers, usually through sales representatives that make frequent rounds to doctors’ offices promoting drugs. The most common form of enrichment comes in the form of free drug samples and food in the workplace but also includes tickets to entertainment events, paid travel, and cash for consulting work, speeches, or board memberships.
Drug companies have for decades used large sales forces to regularly visit directly with doctors in offices and hospitals in the hopes of promoting the companies’ products. But Wednesday’s survey, published in the New England Journal of Medicine, is the first attempt to measure the extent of the relationships manufacturers forge with individual physicians.
Eric G. Campbell, PhD, the study researcher, says the survey did try to determine the impact of gift and financial relationships on doctors’ prescribing judgment.
“We know for sure that these relationships benefit drug companies. And we know they benefit physicians. What we don’t know is if they benefit patients and the care they receive. And that’s really the issue,” Campbell, a researcher at the Institute for Health Policy at Harvard Medical School, tells WebMD.
Gifts Are the Norm
Of the 1,662 doctors who were included in the surveyed results, roughly 8 in 10 said they receive free drug samples or free food and from companies. Almost 3 in 10 acknowledged payments for serving on drug company advisory boards, promotional speeches, or consulting.
More than one in seven said drug companies have reimbursed for travel, food, or lodging to “continuing medical education” seminars. The sessions, known as CME, are often held in upscale hotels located in vacation spots.
Drug companies have traditionally highlighted the educational aspect of doctors’ relationships with sales representatives, saying the contact is key to helping busy physicians keep up on the latest scientific data.
“The companies -- which researched and developed the drugs and generated tens of thousands of pages of scientific data about them -- have the most thorough information about treatments and they make sure the representatives are well-prepared to explain the characteristics of medicines, including side effects,” Ken Johnson, spokesman for the Pharmaceutical Research and Manufacturers of America (PhRMA), said in a statement.
Johnson said the group maintains a code of ethics that forbids perks like sporting event tickets and limits gifts to those that aide medical practice, such as pens or stethoscopes.
Effect of Sales Visits
The actual influence of promotions on physicians’ prescribing behavior is unclear. But overprescribing, in large measure do to aggressive promotion, has been partly blamed for the impact of drugs like Vioxx. The drug was pulled from the market because it elevated the risk of heart attacks after millions of doctors prescribed it.
A study released yesterday in PLoS Medicine, an online medical journal, found that drug industry sales visits influenced doctors to report their intent to boost their prescribing of an epilepsy drug in about half the doctors. The study also found that nearly 40% of such visits focused on unapproved uses of the drug, which goes against federal regulations.
Moves to Limit Promotions
But the report comes as more and more medical institutions move to limit or ban pharmaceutical sales activity, especially promotions targeted at students or doctors-in-training.
Major academic medical centers, including Stanford University in California and the University of Pennsylvania in Philadelphia, have made such moves. Kaiser Permanente of Northern California, one of the nation’s largest HMOs, has also imposed limits.
Very few patients are aware of the depth of the likely relationships between their physicians and drug companies, says David Rothman, PhD, associate director of the Prescription Project, a group that pushes medical institutions to limit contact with drug promotions.
Rothman is also president of the Institute for Medicine as a Profession, which funded Tuesday’s study. Focus groups run by the organization show few patients challenge their doctors about possible promotional relationships.
“They are not going to say, ‘Look, are you writing the prescription for this company rather than another company because you’re involved with that company? Are you doing this for me or are you doing this for you?’ It’s a question they should ask but they’re afraid to ask it,” says Rothman, a professor of social medicine at the Columbia University College of Physicians and Surgeons.
Arthur Levin, director of the Center for Medical Consumers, says his group is promoting legislation in states to require companies to identify doctors by name who receive gifts.
“If [education] is what we want to do, there has to be a better way than relying on the industry who profits to do it,” Levin says. “We think that sunshine will make some of it go away because physicians will say, ‘Gee, if the public knows I’m doing it, I may not want to do it any more.’”
‘Calling Balls and Strikes’
Campbell, the study author, says his research team is analyzing a similar survey of medical center department chairs in an effort to understand institutional relationships between drug companies and universities.
He likened the role of patients in the issue to that of spectators at a baseball game.
“Imagine the umps were calling the balls and strikes,” Campbell says. “Would it matter to you that they were getting gifts from the owner of one of the teams? If the public cares about that then they might care about relationships that have a potential to influence their health care.”