More doctors rejecting drug company swag Posted by Rob Schneider at 03/15/06 11:41 AM

It seems like some doctors are taking notice of the growing concern about the influence of drug company marketing efforts -- and the swag they leave behind. A story in the Chicago Tribune, "New doctors are allergic to freebies," profiles a "Pharm-free" physician's attempt to remove the bias from the information he gets by refusing to see drug company sales reps and take the "free" stuff they bring.

A Chicago doctor doesn't see drug company sales reps, and doesn't take gifts or lunches from them:

He doesn't take the personal gifts they offer as part of the estimated $13,000 per doctor spent in marketing prescription drugs each year.

Same goes for the free lunches and office supplies, although his clinic in Chicago's needy South Shore neighborhood could probably use them. He won't go on junkets, pocket consulting fees or even accept brand-name drug samples the clinic could distribute for free.

There's been broad discussion about Pharma gifts influencing prescribing habits, a January JAMA Article is a recent, thorough analysis of the problem.

The more difficult problem is with free samples. It appears that free samples do influence prescribing practices -- if a doctor starts a patient on a brand-name drug and it works, she may hesitate to switch the patient to a generic or a cheaper therapeutic equivalent. Pharma touts these programs as pure, compassionate charity.

"He's probably doing a disservice to his patients," said Scott Lassman, assistant general counsel at PhRMA, the Pharmaceutical Research and Manufacturers of America. "What he's cutting himself off from is some very valuable, useful information that the sales representatives can provide. The companies are really in the best position to provide information about their products." Refusing free samples, in particular, denies a "very tangible benefit" to the needy population Mendoza professes to serve, Lassman said.

Pretty strong talk from an industry that's been accused of everything from hiding results from clinical trials from the public to jacking up prices for needed drugs.

Our hero, Dr. Mendoza, traces his interest back to medical school, where drug sales reps make regular presentations to students, buy lunches -- you know the drill.

In his final years of schooling, he remembers drug reps sitting just outside the door as the doctors reviewed active cases, waiting for the right moment to pitch their products. He enjoyed some good dinners at Roy's, the Chicago Firehouse and other swanky spots, but came to resent the reps who passed off what he considered bad advice as scientific gospel.
"I remember them specifically because they were wrong," he said. "These people were trying to get in bed with us as future physicians. The drug company was not giving you the whole picture."

Hats off to Dr. Mendoza who came to the realizaton early on that drug sales reps may downplay negative side effects and tout a drug's benefit. Just like any sales person, buyer beware. Only in this case, physician beware.

comments (4)

1 Posted by Helen at 03/31/06 07:33 PM

I wholeheartedly support doctors that refuse to take these freebies. A few years ago sales reps pushed gabapentin or Neurontin for bipolar disorder. It had not had independant scientific review.

Doctors need to ask tough questions about the research on drugs.

Some journalist refuse any kind of freebies because it will alter their story.

It bothers me when I go to a doctors office and there is all kinds of pharm gadgets and freebies.

2 Posted by rsimanski at 03/31/06 09:18 PM

My current doctor is the best I've ever had. I often see drug salespeople in his waiting room. I discussed this with him and noted that some people might get the wrong impression from this. The salespeople are required to visit a certain number of doctors each day. He told me that all that they are allowed to do is leave samples. He will sign their card but will not take time out to meet with them, and they are not allowed past the front desk. He gives the samples to needy patients, but only if it's the right drug for them.

3 Posted by mdmendoz at 04/18/06 07:38 PM

I'm glad to hear that consumers are becoming more aware of the conflicts of interest that befall the unsuspecting physicians. I encourage all of you to discuss this with your personal physician.

Good luck,
Michael Mendoza, MD, MPH
Chicago, IL

4 Posted by ionut at 07/03/08 10:06 AM

Our medical health care system needs an anorexia treatment because as we can see doctors are starting to refuse free samples for a good reason... They think that this rejection will prove beneficial in the long term plan. The young doctors are really people that want to make a difference.