Doctors and Drug Makers: A Move to End Cozy Ties

By STEPHANIE SAUL

More Hippocrates, less Hunan hot sauce. Free lunches for doctors are under attack yet again.

Free lunch deliveries to medical offices, along with those ubiquitous drug company logo pens, have come to symbolize the extensive financial ties between doctors and the drug industry. And there is evidence they influence which drugs are prescribed.

But pressure is building against the widely reported gifts and other potential conflicts, an effort that took hold last year when a group of influential doctors condemned financial arrangements between doctors and drug companies in The Journal of the American Medical Association.

Tomorrow, a new push is scheduled to be announced by Community Catalyst, a health care consumer advocacy group based in Boston, and the Institute on Medicine as a Profession, a research group at Columbia University.

With a $6 million grant from the Pew Charitable Trusts, the organizations plan a national campaign calling for restrictions on the interactions between doctors and drug companies, and urging doctors to base their prescription writing more on medical evidence than on marketing.

“If you’ve been in the waiting room when these Chinese lunches are taken into the back office, it may raise the question whether the decisions are based on the best scientific evidence about medication or whether or not those Sichuan shrimp have something to do with the prescribing patterns,” said Jim O’Hara, the managing director of policy initiatives at Pew.

The pharmaceutical industry spends $12 billion a year marketing to doctors, and much of that money is in the form of free samples delivered to doctors’ offices, often accompanied by lunch for the entire staff. When the University of Michigan health systems banned such lunches in 2005, they calculated that the lunches had been worth $2.5 million a year.

The free drugs are samples of the newest and most expensive branded products. The drug industry hopes that by starting patients with free samples, they will remain on the more expensive medication rather than using a cheaper generic. And there is evidence that doctors who have relationships with the pharmaceutical industry prescribe more of the expensive drugs.

The new initiative, called the Prescription Project, is an outgrowth of an article published in January 2006 in The Journal of the American Medical Association in which a coalition of scholars and doctors proposed that academic medical centers across the country take the lead in restricting interactions between doctors and the health care industry.

Several medical centers, including those at Yale, the University of Pennsylvania and Stanford, have announced such restrictions.

The Prescription Project aims to spread those restrictions to other academic medical centers, doctors’ organizations and third-party payers.

Some medical school deans are reluctant to impose such restrictions, fearing that they will lose research money, according to David J. Rothman, an author of last year’s journal paper who is also president of the Institute on Medicine as a Profession.

“They say, ‘If we did this, we would lose a third of our faculty. They’ll go to places with less stringent requirements; if we did this, we’ll tick off the drug companies and there’ll be payback,’ ” said Professor Rothman.

One of the group’s plans is to document the impact of changes at Yale, the University of Pennsylvania and Stanford. “Did the drug companies stop giving Penn research money?” he said. “I don’t for a minute believe that is going to happen.”

The organization’s goal is not to prohibit research grants or consultancies, but to limit gifts, travel fees, speakers’ bureaus and ghostwriting while at the same time encouraging prescriptions based on a medical evidence.

“Gifts bring with them the felt need to reciprocate,” said Professor Rothman, who teaches social medicine at Columbia.

“We’re not saying you’re being bribed,” he added. “We’re saying you’re being gifted. Some of it could be raw monetary hustling. But some of it is this psychological — ‘Well, they just sent me out to Las Vegas, their drug is as good as anybody else’s, why not just say thank you.’ ”

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