Gifts from pharmaceuticals influence providers prescription choices - metastudy

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Gifts from drug companies do influence when and how much a medication is prescribed, reported an article in the Jan 19, 2000,  Journal of the American Medical Association.

The article presented the research of Dr. Ashley Wazana of McGill University in Montreal, Canada who reviewed 29 other research studies concerning the relationship between the drug company representatives and health care providers (out of 538 studies considered).  The studies observed how actions on the part of the drug company representatives affected the prescription habits of the providers.  Actions studied included things like accepting gifts, free travel, meals or samples from the drug companies.

Wazana stated that pharmaceutical company promotions increased the number of prescriptions written in several ways.  Following drug company overtures, health care providers prescribed a drug manufactured by the sponsor of a medical education program more frequently, hospitals increased their prescribing of a conference travel sponsor's drug, resident physicians increased "nonrational" prescribing of a drug following a meeting with by a company representative,  and attitudes about drug company representatives became more positive.

Drug companies initiate meetings with health care providers while they are still in school, reported Dr Wazana and those meetings continue after graduation about four times a month.

Although education of health care providers in the treatment of complex illness was a positive effect of interactions with drug companies, most results of those meetings were negative, noted Dr Wazana.  After meetings, health care providers seemed to prescribe more of the drugs being promoted at the meetings.

An example of this, was the promotion for Xenical, the fat blocker.  Drug companies began meeting with health care providers, offering fancy dinner presentations of the drug, long before the public heard much about it.  In a story reported by this writer, those meetings resulted in "a record number of Xenical prescriptions".

Here is an excerpt from my article, written June 1999:

There hasn't been much in advertisement about Xenical. No
infomercials, no TV ads, no magazine ads and only a short
blurb here and here on the news.So I was surprised to read:

..."IMS HEALTH (NYSE:RX) today reported that 136,863 Xenical
prescriptions were dispensed in the U.S. in the five weeks
since the product's launch."

Where are people finding out about this when
it's not on TV?  Well, about 6 weeks ago, a seminar was
given in Phoenix, to health care providers by the
pharmaceutical company. Each attendant (and guest) was fed
a fancy dinner and then, told about Xenical.  Packets were
distributed including cutsie pill boxes (I got one from my
favorite health care provider... makes a nice pill box for
half pills), colorful brochures etc.

Presumably, health care providers all over the country were
being wined and dined (and instructed about Xenical) in
much the same manner.

And now, six weeks later, just in the US, 136,000 plus
prescriptions? WOW!

(article by SueW, CIN HEALTH, June 6, 1999)

Having worked in a doctor's office, I observed that gifts from drug companies included attractive items such as clocks, pens and desk accessories and that several drug company representatives kept us well supplied in samples of their company's products.

The American Medical Association has attempted to police certain interactions and gifts, stated Dr. Robert M. Tenery, Jr., of the American Medical Association's Council on Ethical and Judicial Affairs in an editorial in the same issue of JAMA and some progress has been made.  The Physician noted that practices such as awarding airline miles for prescribing certain drugs has been greatly decreased if not stopped,  but recently the need for  continuing medical education (CME) has driven a resurgence of drug company-sponsored junkets, he says. CME credit is a requirement for licensing in most states.

Tenery states:

"drug company 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."

He noted that health care providers and pharmaceutical companies need to develop new industry wide standards which will discourage abuse of the system.

UPDATE: 2009: the Pharmaceuticals have greatly curtailed the gifts of pens etc to medical providers however are still giving free dinners and CMEs which advertise their drugs.  Since they are allowed to run ads on TV, they have found it even more effective to go directly to the consumer.  Although they are required to state the side effects and disclaimers on the ads, a recent survey found that most consumers do not hear the side effects and disclaimers.

As for Xenical, the pharmaceutical has managed to get a weakened version of it approved to sell over the counter.  In our fat obsessed society, it has proven to be a hot seller.

Reuters Health Service
The Journal of the American Medical Association 2000;283:373-380, 391-393.