Drug company's bouquet comes with ethical thorns
Pens and Needles
February 21, 1999
By Mark Somerson
An item in the pile of mail waiting for me Monday morning caught my
attention. It was a flier sent by a reader announcing a "Flower & Flee''
promotion sponsored for doctors by TAP Pharmaceuticals, the makers of
the popular prescription antacid Prevacid.
The flier was apparently an invitation to area doctors to attend a brief
presentation about Prevacid on Feb. 9, just before Valentine's Day.
"You are cordially invited to join your Prevacid representatives for a short
detail at (an area flower shop),'' it read. "Afterward, choose a flower
arrangement or a gift certificate to be used later.''
A few months ago, I wouldn't have even received this mail. But I wrote a
story last month about the often-sticky relationship between doctors and
pharmaceutical companies.
Medical ethicists say questionable promotions that benefit doctors more
than patients are a growing problem. This is going on despite rules for
doctors created by the American Medical Association nearly a decade
ago to deal with gifts. Critics cite a resurgence of incentives that teeter on
an ever-narrowing ethical tightrope.
"Now, before they will even see a pharmaceutical representative, some
physicians expect something in return,'' said Dr. Victoria Ruff, a critical-
care specialist at Riverside Methodist Hospitals and a member of the
medical association's Council on Ethical and Judicial Affairs.
Walk into nearly any physician's office, and you'll find wall clocks,
notepads, pens and paperweights bearing the names of Prozac, Viagra,
Claritin or Meridia. According to the AMA, these small tokens are fine.
It's the biggies that bother the association. And these biggies are growing
even larger, officials say. They include golf excursions, scarce Broadway
show tickets, trips to Hawaii and $1,000 honorariums to attend an
all-expenses-paid weekend conference in Florida.
"Gifts should not have a significant value and should have a benefit to
patients,'' said Dr. Robert M. Tenery, a Dallas ophthalmologist and
chairman of the ethics council. "These companies are simply buying access
to that doctor.''
Because of changes in managed care, doctors say they are busier than
ever, seeing double the number of patients they saw years ago to make
the same money.
All this makes the pharmaceutical companies work even harder to get the
physicians' attention. Most drug companies voluntarily follow the AMA
ethics rules, but some don't.
One Westerville dermatologist got an offer in December from a company
promising a free Beanie Baby for every prescription he'd write for its
drugs.
"Doctors on the whole are good judges of what is appropriate and what is
not,'' Tenery said. "But there is a lot going on out there that is
questionable.''
Tenery said the ethics council is considering creating a task force to
re-examine the issue.
Ruff said most of the small gifts are fine.
"For the most part, we are talking about things under $50,'' she said. "The
council doesn't want to be hysterical. But while a Beanie Baby doesn't
sound like much, when do you stop? It can become absurd.''
The pharmaceutical industry spends billions of dollars every year
promoting its drugs to doctors and now patients through direct advertising.
It also spends billions researching and developing life-saving drugs.
But who pays for marketing and promotions? Chances are the consumer
does.
As for the Prevacid/Valentine's promotion, I called a woman listed on the
TAP Pharmaceuticals flier. She wasn't eager to talk.
"I was within AMA guidelines,'' the rep said. "We didn't even come close
to spending $100 per doctor.''
Mark D. Somerson is medical reporter for The Dispatch. He can be
reached at or 461-8521.
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