[ Medical School Resources | Appendices | ]
When the patent expired on the heart drug Inderal, Ayerst, the manufacturer, developed a promotional package to ward off the expected drop in sales as the generic product cornered the market. Doctors who wrote 50 prescriptions could claim a free round-trip ticket to anywhere in the continental United States.[846] One commentator writes, "The fact that Ayerst started this program shows an enormous amount of contempt for the ethics of American doctors."[847]
In 1990, the Senate Labor and Human Resources committee held hearings about pharmaceutical company marketing practices. They found instances such as, "Offering a physician $100 to simply read a company's literature that encourages the prescribing of a highly toxic drug for a use that was not approved by the Food and Drug Administration."[848]
The committee revealed that a common quid pro quo for a drug sales pitch to a physician is a good dinner and a $100 "honorarium" for listening.[849] I am told drug companies have a new tactic of paying marketing firms to pay doctors to "help them" with their advertising. But in the wash it seems the same here's-your-$100-check for listening to the benefits of our latest. Quoting from JAMA, "Something is wrong with a system that allows large amounts of money to induce physicians to use a certain healthcare product, while many who may need that very product cannot afford it."[850]
It has been reported that medical journals get half of their income from drug company advertising, and the medical press which doesn't have subscriptions relies totally on the pharmaceutical industry.[852]
From the New England Journal of Medicine:
The party line, of course, is that the advertising provides education. If you were buying a used car, would you get your information from Sam, a friendly used-car salesman? If, on Monday, someone in San Francisco comes up with a new treatment that clearly reduces the mortality or morbidity from some disease, people in Boston will know about it by Tuesday....[853]
Indeed I can see no role whatsoever for drug advertising.... I cannot see that it is appropriate for a drug company to get us to prescribe a drug we would not otherwise prescribe.
When marketing claims conflict with the available scientific evidence, researchers are accorded the opportunity to study the impact these ads have. According to Harvard Associate Professor Jerry Avron:
Although the vast majority of practitioners perceives themselves as paying little attention to drug advertisements and detail men as compared with papers in the scientific literature, their belief about the effectiveness of the drugs revealed quite the opposite pattern of influence in large segments of the sample.[854]
From New Physician:
Let us consider the AMA and its journal as an example of the situation. The AMA receives roughly 50% of its revenue from the pharmaceutical industry. One manifestation of the association's drug industry affiliation is the medical text/drug-ad contradictions that appear in the journal. That is, a drug condemned in a published article or even in an editorial will be enthusiastically promoted in full-page, four-color ads that aim to please the MD from his crotch to his frontal lobe.[855]
Dr. Dale Console, former medical director for drug giant ER Squibb, testified to a Senate sub-committee, "It seems impossible to convince my medical brethren that drug company executives and detail men are either shrewd salesmen or shrewd business-men, never philanthropists. They make investments, not gifts."[856] Quoting from JAMA, "No profit minded company would give gifts out of disinterested generosity."[857]
The New England Journal:
People who think the drug companies are throwing money at doctors... without expecting a thing are simply fooling themselves.... Can any physician really believe that patients would be happy to know that their doctors were taking bribes, no matter what the size?.... I believe physicians can buy books and attend meeting without fear of landing in the poorhouse.[858]
"So where does this money come from?" one commentator asks. "It does not come from the tooth fairy.... Obviously it comes out of the pockets of the patients.... Accepting these bribes therefore boils down to cheating patients."[859] Not surprisingly, surveys show that patients find drug company gifts considerably less appropriate and more influential than physicians do.
From JAMA:
Physicians ought to ask themselves whether or not they would tell their patients, 'I'm going off to Aspen for a week, and by the way, you're paying for it.' If they aren't willing to say it, that to me is a good sign their conscience is concerned about the activity. Patients should be paying for their medical care, not for physician's vacations.[860]
From "All Expenses Paid, Doctor," an article in the Lancet:
Thus, we see on one hand, physicians, making very nice incomes accepting all sorts of largess from pharmaceutical companies, including free trips, free educational courses, various handouts and gifts, and on the other hand many patients struggling to afford essential medications which frequently cost over $100 a month a piece.[861]
Senator David Pryor:
All we receive in return for the extravagant tax credits and tax breaks, monopolistic patent protection and general federal government research subsidies that we give the drug industry is the highest medication prices in the industrial world.
More on the Medical Industrial Complex in Appendix 72b.
[845] "Enlightenment on the Road to Death." The Lancet 343(1994):1109-1110.
[846] New York Times Magazine 5 November 1989:88.
[847] Franklin, Karen. "The Pharmaceutical Tango." New Physician 39(1989):24-28.
[848] Randall, T. "Kennedy Hearings Say No More Free Lunch - Or Much Else - From Drug Firms." Journal of the American Medical Association 265(1991):440-441.
[849] Greenberg, DS. "All Expenses Paid, Doctor." The Lancet 336(1990):1568-1569.
[850] Randall, T. "Kennedy Hearings Say No More Free Lunch - Or Much Else - From Drug Firms." Journal of the American Medical Association 265(1991):440-441.
[851] Waud, DR. "Pharmaceutical Promotions." New England Journal of Medicine 327(1992):351-353.
[852] Barnhart, R. New Physician 1971(March):165-171.
[853] Waud, DR. "Pharmaceutical Promotions." New England Journal of Medicine 327(1992):351-353.
[854] Randall, T. "Kennedy Hearings Say No More Free Lunch - Or Much Else - From Drug Firms." Journal of the American Medical Association 265(1991):440-441.
[855] Barnhart, R. New Physician 1971(March):165-171.
[856] Ibid.
[857] Randall, T. "Kennedy Hearings Say No More Free Lunch - Or Much Else - From Drug Firms." Journal of the American Medical Association 265(1991):440-441.
[858] Waud, DR. "Pharmaceutical Promotions." New England Journal of Medicine 327(1992):351-353.
[859] Ibid.
[860] Randall, T. "Kennedy Hearings Say No More Free Lunch - Or Much Else - From Drug Firms." Journal of the American Medical Association 265(1991):440-441.
[861] Greenberg, DS. "All Expenses Paid, Doctor." The Lancet 336(1990):1568-1569.