Inside Medicine: Restrict drug company 'bribes' of doctors

03/21/2013 12:00 AM

03/21/2013 12:21 AM

For generations, the pharmaceutical industry has had a cozy and often intimate relationship with doctors and organized medicine. There was a "you scratch my back and I'll scratch yours" mentality that led doctors to feel entitled and deserving of drug company bribes.

Of course, doctors regularly denied that they were influenced by a free gift, a free meal at a high-end restaurant or a little bitty trip to Hawaii or Vail. They felt they were above such influence. Yet doctors accept these "gifts" because it is human nature to want free stuff.

But the companies know that once they get a doctor to accept a gift – even a small one – this creates a social feeling of reciprocity such that the doctor feels a need to change prescribing behaviors to justify the gift.

It is now crystal clear, based on sound studies, that the billions and billions of dollars that pharmaceutical companies spend bribing doctors absolutely does alter their prescribing practices.

Actually, all we really needed to do was ask ourselves why pharmaceutical companies spend billions of dollars bribing doctors if they didn't have absolute proof that it worked to sell more drugs.

New rules have come along and there is greater attention to "report cards" that report on public websites the name of doctors who receive gifts. These reports have had some impact, but more was needed. So some medical schools and hospitals passed conflict-of-interest rules that forbid free drug samples, drug company sponsorship of free meals in the hospital, contact with drug sales people, and bribes to hospital doctors. Do these policies make a difference?

Researchers at the University of Pennsylvania just completed a clever study showing that these policies make a large difference. The study was done with doctors training in the field of psychiatry, one of the specialties with the most conflicts of interest.

The researchers wanted to explore whether new rules affecting these doctors would change their prescribing behaviors. They compared doctors who trained in hospitals that enacted strict rules with doctors who trained in hospitals that had lax or no rules. They specifically looked at two antidepressant drugs that were being very heavily marketed to doctors.

What the researchers found was that doctors who trained under the most restrictive rules limiting their exposure to pharmaceutical propaganda were far less likely to prescribe expensive drugs that were heavily marketed when compared with doctors at other hospitals who had no such rules.

Of course, no hospital policy can completely cut off drug company propaganda. Advertisements and subtle promotional messages are still everywhere in medical journals, on medical websites and at medical conferences. But it seems that keeping drug salespeople away from doctors and prohibiting free samples makes a big difference to the public's health.

With this new evidence, it is unclear why many hospitals and medical centers still don't have these conflict-of-interest rules. It is time for all hospitals and medical schools to enact and strictly enforce such tough rules.

Placing the names of those doctors who still receive gifts on public websites is one step, and so is holding hospitals accountable for their doctor's behaviors, but even more important is holding drug companies responsible for offering the bribes that increase drug costs and decrease quality of care.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at

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