There’s an old adage that cautions to beware of strangers bearing gifts. But according to a recent report by the Institute of Medicine, that warning extends beyond strangers and includes representatives from pharmaceutical companies and medical device manufacturers. The report strongly recommends that doctors refrain from accepting much of the money, gifts, and free drug samples they routinely receive from drug and device companies.
“Drug companies will say [that having samples available] is good for patients who can’t afford medications,” says Chris McCoy, MD, an internist from Rochester, MN, and chair of the policy committee for the National Physicians Alliance. “But most samples are not given out in clinics that feed uninsured populations. Instead, they tend to be given to the populations that have insurance coverage, or used by the physicians and their staff.”
And supporters of the IOM’s stance say that physicians and their practices can benefit in several ways by adhering to the medical advisory group’s advice.
Howard Brody, MD, PhD, director of the Institute for the Medical Humanities, University of Texas Medical Branch in Galveston, Texas, says that most practitioners don’t stop and add up the amount of time they spend with representatives from the pharmaceutical field. Forgoing those meetings and becoming an unbranded doctor, as Brody has done, can free up more time than physicians realize. “Some doctors have found that they can work in three or four extra patient visits a week just from the time they save, and that’s revenue,” says Brody.
The time factor aside, Winifred Hayes, MS, PhD, RN, president and CEO of Hayes, Inc., a health technology research and consulting firm, says that the distraction of what the gifts and samples mean would disappear. Physicians, she says, would be more likely to focus on the scientific evidence regarding the effectiveness and safety indications of a new drug or procedure. “I think gifts are a distraction,” Hayes says, “and I think there’s good scientific evidence now to say they do influence behavior.”
McCoy echoes those thoughts. He points out that, without the gizmos and trinkets, a physician’s “approach to medicine is a little more systematic, because you’re thinking about what you want to prescribe based on evidence-based guidelines and unbiased reference sources as opposed to what comes to mind as the last drug that you talked about.”
Beyond the scientific evidence, attorney Robert Wolin, a partner with the national law firm Baker Hostetler, says that pharmaceutical and medical device companies are rational players in the economy, and they would not have significant marketing budgets if they didn’t think the gift-giving tactic worked. “They wouldn’t buy the prescribing data of the physicians if they didn’t think it was useful information to target specific prescribers.”
The Patient Factor
Are patients aware of the gift-giving practice that exists between physicians and pharmaceutical companies? Do they recognize that the free samples doctors receive influences practice behaviors? Many believe that there isn’t nearly the awareness that there should be among the average patients, but some doctors think patients notice more than they’re given credit for. And what they notice can impact a physician’s image.
Brody agrees that some patients are still in the dark regarding this process but adds that he has been struck by the patient anecdotes he’s heard over the years; stories from patients who have been kept sitting in a waiting room while “well-dressed people seem to get right in the door as soon as they show up. Patients figure out that these are drug reps, and they get resentful. Why are these people taking up my doctor’s time?”
And according to Brody, patients notice the subliminal messages as well. He recalls a story from one physician who was writing a prescription for a patient, and the patient asked, “Doctor, are you writing that prescription for me because that company gave you a pen?” The doctor had not realized he was writing a prescription for a medication and the name of the medication was on the pen he was using. “At that moment, through the patient’s eyes, it looked like [the doctor] was being bought,” says Brody. “The doctor told me it was a life-changing moment for him.”
McCoy explains that with any process of change, the first step is to make the decision and recognize that becoming an unbranded doctor is something you want to do. The next step is to look around your office and determine what you’ll need to replace. That could include everything from pads and pens to the clocks on the wall. And as you work through the process, says McCoy, communicate with your colleagues and staff about what you’re doing and why.
“Consider the impact it might have on them in terms of having to provide lunch for themselves,” he says, referring to the point that pharmaceutical reps will no longer be bringing in catered lunches. “You may want to replace [the catered lunches] with lunches the providers pay for to maintain that goodwill with your staff members.”
Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at firstname.lastname@example.org.