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Friday, April 27, 2007

Dispensing Under the Influence

A recent study of pharmaceutical industry gift givinig caught my attention. Here's the background.

A new study released by the New England Journal of Meddling (NEJM) revealed some interesting statistics:
"Eighty-three percent of all pharma bloggers who responded to the NEJM survey said they received free food and beverages from pharmaceutical companies."

"About one-quarter of all pharma bloggers said they received full or partial reimbursement from the industry for attending blogging conferences, and 18% of pharma bloggers said they were paid consultants to drug companies."

"Seven percent of pharma bloggers said they received tickets to cultural or sporting events."
One pharma blogger, who is also a physician, defended his choice to accept dinner this way: "It takes a lot more than a steak and fries with strangers on a precious night off of work to corrupt me and buy my influence..."

Nevertheless, these are staggering statistics!

More and more pharmaceutical companies are reaching out to bloggers in the Pharma Blogosphere. As reported in the April 2007 issue of Pharma Marketing News, Johnson & Johnson recently invited several prominent pharma bloggers to a lavish dinner at a New York City Restaurant (see "Should Bloggers Dine at Pharma's Table?").

Not until now, however, have we had any data to suggest how prevalent this influence peddling is.

Of course, there is no such study of the extent to which pharma bloggers are wined and dined and influenced by the pharmaceutical industry. But if the numbers quoted above really represented what was going on in the Pharma BlogosphereTM, I am sure readers of these blogs would be a lot more skeptical of pharma blogging credibility than they are (for more on that, see "How Readable, Credible & Useful are Pharma Blogs?"; You can get a FREE copy of this report by filling out this Reprint Request Form. This offer ends Saturday, April 28, 2007 at midnight Eastern US).

Actually, as many of you undoubtedly know by now, the REAL NEJM (ie, New England Journal of Medicine) did publish a report of a PHYSICIAN survey. Just substitute "physician" every place you see "pharma blogger" in the above quotation and that would be the reality.

Dispensing Under the Influence
Of course this is nothing new about physicians accepting freebies from drug companies as many industry people will gladly point out. "It is one of those 'duh' studies," says Bob Erhlich, Chairman of DTC in Perspective and author of a recent e-mail OpEd piece entitled "The Physician Factor."

My point is this: What's "duh" for physicians would be "wha?" for any other group under similar influence of drug companies.

According to Ehrlich, many physicians are guilty of "DUI" - dispensing under the influence:
"Most of the time doctors reward their favorite rep with some extra market share points since many drug choices are me-toos anyway." (DTC Perspectives #258, April 27. 2007).
I find that an incredible statement for someone who is generally considered an ally of the industry to make. It's akin to the infamous Zubillaga "buckets of money" statement (see "The Zubillaga Affair: Effect on the Prospects for Pharma Blogging"). Don't expect Mr. Erhlich to be fired any time soon. He's the Chairman of his company!

What's the harm of a little influence peddling?

Let me give you a personal example to make my point.

The real NEJM study found that "Cardiologists were more likely to receive direct payments from drug companies in the form of consulting fees or lectureships. Researchers surmised cardiologists were targeted by industry because their opinions influence the prescribing patterns of nonspecialists" (see "Doctor freebies common, study says").

Could it be that my cardiologist may have prescribed 80 mg/day of Pravachol for me because of a favor or "reward" to a drug rep?

No problem, says Erhlich:
[Media critics of gifts to physicians] "forget that some people who get side effects for one me-too do not get them for another. Therefore, the availability of multiple drug options allows more people to get successful treatment." (DTC Perspectives, May 26, 2006).
Pravachol is one of those "me-too" drugs. Perhaps BMS -- who markets Pravachol -- was owed more favors by my cardiologist than was Pfizer -- which markets the "me-too" anti-cholesterol drug Lipitor.

The problem is that lately I've been having some "side effects" from Pravachol that worry me -- muscle cramps. Luckily, I've heard this mentioned several times in DTC ads, so as a precaution, I have stopped taking Pravachol until I can talk to my cardiologist.

My little antidote -- true or not -- illustrates that a little "favor," which in this world of "me-too" drugs may not seem important in the large picture, is very important to me!

Doctors Need to Be More Transparent About Conflict of Interest
I think it's about time for physicians to come clean! Take the free food, take the free samples, take the money, take the tickets... But let me know about it, just like you let me know my privacy options. Hand out a "Conflict of Interest" notice with that HIPAA notice when I first sign up as a patient. Then I can better make my own decision.

Please note that I am NOT advocating that physicians STOP receiving freebies from the drug industry. I am not even advocating that they list in detail every slice of pizza or dime in cash they receive. Just a statement whether or not they occasionally accept free meals, free samples or work as consultants to the industry and a pledge that this does not unduly influence their prescribing behavior (despite what Mr. Erhlich says).

What I am advocating is transparency and letting the market forces between physicians and patients decide the outcome.

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