By Lindsey Realmuto

As of January 1, 2009 we can all rest assured that pharmaceutical companies may voluntarily stop barraging our physicians and nurses with free mugs, pens, and trinkets carrying drug logos. PhRMA, the pharmaceutical industry trade group, has updated their industry marketing guidelines, and the companies that choose to comply with them will stop giving free logoed items to prescribers. Thank goodness! Now I feel safe that my doctor is free from the shackles of industry influence.

Returning to reality, what we as patients and consumers should be more concerned about is how the pharmaceutical companies are using this tiny concession to dodge the regulatory bullet of eliminating corporate financial entanglement within the healthcare system. And why wouldn’t they?! The marketing strategies of pharmaceutical companies over the past almost 30 years have skyrocketed them to the top of the global corporate ladder. Jacky Law in Big Pharma: Exposing the Global Health Agenda reports that the top ten pharma companies in 2005 had a combined income of more than $205 billion!

In 2002, the combined profits for the top ten drug companies on the Fortune 500 list exceeded the total profits of the remaining 490 companies on the list. I only mention these figures in order for us to attempt to wrap our minds around the enormous amount of money this industry has as manipulative power. This capital is effectively used to buy off doctors, nurses, professional organizations, clinics and hospitals, disease advocacy groups, state formulary boards, politicians, and our very own FDA officials. Not to mention the ever increasing pharma budget spent on Direct to Consumer (DTC) advertising in the U.S, the only country in the world beside New Zealand that allows such advertising practices.

It isn’t the small trinkets and mugs lying around the office that are tipping the scales here.  It is the hundreds of thousands of dollars paid to physicians for dinners and lunches, to do “consulting” work, for educational grants, or to be speakers at conferences. On the same day this new voluntary regulation was announced, The New York Times reported that once again a prominent physician, this time a Harvard child psychiatrist, is now under investigation by the Massachusetts General Hospital for not disclosing financial ties to the drug industry for many years. He has now had the incredible epiphany that he will no longer be accepting money by industry or be involved with pharmaceutical trials backed by drug companies.

Is this what it’s going to take for doctors across the country to pause and think about the ethical consequences of their lucrative relations with pharmaceutical companies – an investigation by the state? As late as 2004, several studies evaluating the effect of pharmaceutical influence on doctors reported that many physicians still do not view financial relationships with the drug industry as “ethically problematic.”

Time and time again it has been empirically demonstrated that doctors receiving money from pharmaceutical companies are more likely to arrive at positive findings about a particular drug and to more frequently prescribe newer and more expensive drugs. A 2005 study published in the American Journal of Medicine found that residents who had consistent access to drug samples left by pharma reps were more likely to prescribe advertised, pricier medications than those without free samples. The underlying problem here is simple: doctors are not above the influence of money. Until more recently, very few have been able to resist the glittering temptation of pharma’s gold.

There has been a strong effort to curtail the more extravagant gifts to healthcare professionals, including golf games, sporting events, etc., through voluntary guidelines by Pharmaceutical Research and Manufacturers of America group and marketing disclosure laws that have been enacted in Minnesota, Vermont, and DC, to name a few. However, there are many clever ways to disguise unethical marketing practices. A primary example is the use of “Education” as an umbrella term to describe the primary purpose of marketing activities.  As Marcia Angell reported:

What guidelines and warnings have in common is an exemption for educational or research activities. If drug companies can plausibly construe their blandishments as having an educational or research purpose, they can get away with almost unlimited gifts to promote sales. Furthermore, it is largely left to them to decide what is education or research and what is marketing.

As patients and consumers we have more buying power than the pharmaceutical companies would have us believe. At the end of the day, we are the ones deciding to buy and take any prescription. As of January 6th, the New York Times reported that spending on prescription drugs actually slowed down in the year 2008. To be clear here, pharmaceutical spending did not decrease, but rather increased at a lower rate than previous years. The article cites that ending patents on several blockbuster drugs have made more generics available and could have contributed to the lower percentage of increase.

It is important that as patients we always question our doctors on whether or not a generic or older version of a prescribed medication is available. Although it may always seem that doctors have one foot out the door by the end of the visit, your health and economic investment into any treatment is worth another minute of their time.

So maybe you notice that your doctor actually has a regular old pen. But don’t forget to ask how often an attractive drug rep comes by and when was the last time they took them out to dinner? There are a number of doctors out there that have taken the more difficult but moral high ground on this matter. Check out the website No Free Lunch to find out what doctors in your area (if there are any) that have taken the pledge to not accept pharmaceutical industry influence.

On a side note, in searching for a gynecologist in the DC area that had registered for No Free Lunch I found ZERO results. Based on the bad rap given to psychiatrists I also searched within this field for the Washington area; the results were the same.

Lindsey Realmuto is an MPH candidate at George Washington University’s School of Public Health & Health Services and works as a Research Assistant in the School’s Department of Environmental and Occupational Health.

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