Treating the Symptoms
This move by pharmaceutical companies to stop handing out random trinkets to doctors seems like a pretty cynical move to me:
Starting Jan. 1, the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs.
No longer will Merck furnish doctors with purplish adhesive bandages advertising Gardasil, a vaccine against the human papillomavirus. Banished, too, are black T-shirts from Allergan adorned with rhinestones that spell out B-O-T-O-X. So are pens advertising the Sepracor sleep drug Lunesta, in whose barrel floats the brand’s mascot, a somnolent moth.
Doctors are well-paid professionals, none of them are going to seriously compromise patient care in exchange for a mug or a pen. But if you read Marcia Angell’s New York Review of Books article on the vast web of corruption between drug companies and medical professionals, you’ll see that mugs and pens have nothing to do with anything. We’re talking about serious cash. Things like a doctor who “failed to disclose approximately $500,000 he received from GlaxoSmithKline for giving dozens of talks promoting the company’s drugs.” Or this:
Senator Grassley found that Schatzberg controlled more than $6 million worth of stock in Corcept Therapeutics, a company he cofounded that is testing mifepristone—the abortion drug otherwise known as RU-486—as a treatment for psychotic depression. At the same time, Schatzberg was the principal investigator on a National Institute of Mental Health grant that included research on mifepristone for this use and he was coauthor of three papers on the subject.
This is big bucks, serious stuff. The branded mugs and such were, if anything, the achilles heel in the drug companies’ perversion of the process — patients could see the stuff, and the stuff has corporate logos on it. It’s a visual reminder that for all you know your doctor is prescribing courses of treatment that are in line with his financial interests rather than with your health interests. By adopting a new “no mugs” policy the companies are helping to re-obscure their financial relationships with doctors and at the same claim claiming to be cleaning up their act. It’s clever, but it’s not good.
46 Responses to “Treating the Symptoms”
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December 31st, 2008 at 4:17 pm
Well, $500,000 is mugs-and-ballpoints money for Big Pharma, so it’s probably just innocent confusion rather than cynicism.
December 31st, 2008 at 4:18 pm
My impression is that the trinkets served the purpose as sort of a “gateway” corruption. Of course doctor’s don’t prescribe more zoloft because of a pen. But the doctor then has breached a wall about accepting gifts, and has also now had an experience where he accepted a gift and it didn’t affect him. So, in a few go-rounds, when he’s accepting a weekend resort vacation, he’ll still think it isn’t affecting his behavior.
December 31st, 2008 at 4:21 pm
Actually, the cynicism should come from the fact that the companies are doing this to save money. they spend millions on these pens and trinkets, and if you’re right in that doctors are not persuaded by these cheap items, why not initiate a comprehensive ban on these products and save marketing money. but it does nothing for patients or the greater healthcare system.
December 31st, 2008 at 4:24 pm
I’m glad you made the connection to the NYRB article. I was thinking about it from the moment I picked up the Times article. My reaction differed only in seeing the cynicism as the media’s.
That is, it could be a good thing that the doctor’s office isn’t quite so branded and thus manipulating patient perception and, later, patient demands. And that’d be ok even if there are worse problems. But when the Times chooses this of the two stories to tell, it enables the paper to present the industry as cleaning up its act. And then I can’t help wondering if there are financial motives there, regarding advertising in the paper.
December 31st, 2008 at 4:42 pm
I wrote about this topic a few years ago while in law school (see http://writ.news.findlaw.com/student/20040113_kanabe.html). If you ask me, even small gifts (e.g., mugs and pens), when coupled with representative visits and the chatting that takes place during deliveries, can lead to subconscious effects on doctors’ prescribing habbits.
December 31st, 2008 at 4:42 pm
This is the least of the corrupting forces at work between big pharma and the medical industry. They’re killing people. They’re creating addictions and protracted withdrawals. They’re defining “mental disorders” and measures of health to push drugs for them. They’re lying in their studies, and in their marketing to doctors and to the public. They’re combining drugs and calling them “new” to keep the prices up. They’re pushing drugs that cause the problems they’re supposed to prevent…
AARRGH!
December 31st, 2008 at 4:52 pm
If you ask me, even small gifts (e.g., mugs and pens), when coupled with representative visits and the chatting that takes place during deliveries, can lead to subconscious effects on doctors’ prescribing habits.
So can watching commercials. Or hearing other doctors talk about the drug. Or reading a pamphlet. Or seeing an advertisement for it in a journal. Should we ban all of those?
I look at the pharm companies’ “ban” as a form of mutual disarmament: like campaign yard signs, these are useless trinkets which don’t really matter but that everyone has to compete in as something akin to an arms race.
But man, those disorganized pen-losing students who are children of doctors are going to miss all of those free pen supplies.
December 31st, 2008 at 4:57 pm
If you ask me, even small gifts (e.g., mugs and pens), when coupled with representative visits and the chatting that takes place during deliveries, can lead to subconscious effects on doctors’ prescribing habbits.
To me this is the underlooked part. The representatives are sent in to work marketing magic on doctors that no commercials or trinkets ever could.
If you watch enough reality TV you begin to notice that all of the hot young female contestants fall into two categories: aspiring actresses and pharmaceutical representatives. I believe a pharma-sponsored prostitution scandal is inevitable…
December 31st, 2008 at 5:05 pm
Trickle-down effect: This will kill the tchotchke industry.
December 31st, 2008 at 5:06 pm
No cops on the white coat crime beat, or the Wall Street beat, or the insurance beat, or credit card beat, or . . .
December 31st, 2008 at 5:29 pm
Nothing encapsulates the Pharma’s decline more that three words: Restless Leg Syndrome.
If you have to invent diseases to make money, you have run out of ideas for curing the other fatal diseases.
December 31st, 2008 at 5:42 pm
There’s actually quite bit of empirical evidence that small trinkets like pens actually *DO* have an influence on the prescribing behaviour of physicians. See
http://No Free Lunch for details.
There’s a famous case of a sales rep who managed to increase the prescriptions of his drug by some outrageous amount (more than double, I think), simply by including a $5 coffee card with the pamphlet he was distributing. These trinkets are all the more effective precisely because doctors can’t possibly believe something as trivial as a pen could influence their behaviour. But they really do. The pens matter.
Matt is right, though, that this is a relatively minor issue when compared to the larger malfeasance of Big Pharma. For one thing, so long as Big Pharma sponsors clinical trials, the medical literature is going to be systematically biased, Angell argues that the only way to solve the problem is to not let Big Pharma sponsor any clinical trials, which is almost certainly true.
Matt’s wrong, though, that banning pens is a bad policy. It’s a good policy: the problem is that it is voluntary self-regulation. Big Pharma always manages to address criticisms by imposing voluntary policies, which means that effective legislation never gets passed. Banning pens should be part of a much larger package that is imposed on the industry, rather than a single policy voluntarily adopted.
December 31st, 2008 at 5:44 pm
I have an M.D. friend who gives all kinds of “talks,” “workshops,” and so forth, at very nice venues. Sometimes overseas venues. And the honorarium is just a token, you understand…
One pharma company engaged her as a “consultant” to evaluate some video programming they were putting together. The videos came on a Digital Video Recorder, and, gosh darn it, the pharma rep never bothered to come pick it back up.
Ugly, ugly business–and the pill-rollers know exactly what they’re paying for.
December 31st, 2008 at 6:16 pm
This is silly, and a pain in my ass. I’m not a doctor, but I work with them, and I get my pens from them. And now they want me to drag my ass down to Target for a fucking pen? You’ve got to be kidding me. It’s bad enough for me, but doctors don’t even know how to buy pens. Fortunately, they have assistants to handle that crap.
And the there’s this:
“none of them are going to seriously compromise patient care in exchange for a mug or a pen.”
No they won’t, but that free trip to Hawaii might make a difference. Look, I’m in the medical device field. When we have conferences, they aren’t in Newark. The conferences are certainly legitimate, but they always coincide with a nice family vacation in a place you’d want to be. And we pay all expenses. And that really won’t change because there is a legitimate need for the conferences. And if we don’t pay doctors to go, they won’t go. But, please, don’t make us go to Newark.
December 31st, 2008 at 6:19 pm
I’m a psychologist; until recently, I practiced at a large multidisciplinary group practice. Lots of psychiatrists, so lots of drug reps (and yes, for the most part they were young and attractive, both sexes). The branded pens, notepads, mugs, stress-balls, and on and on, clogged the place; one friend there began collecting them to someday sell them on eBay as collectibles; not sure of the market for that, but more power to her.
It was the pharma-sponsored lunches that got to me: elaborate, often expensive spreads (and always grossly unhealthy fare, no less) for MDs, PhDs, MSWs, office staff – basically, anyone with an appetite who happened to be in the building; this happened more days of the week than not. The kicker was the rep’s medication-specific spiel for the first 20 minutes of the lunch, followed by a (usually non-starter) Q&A period.
Reminded me of my granddad’s tales of living in NYC during the Great Depression: he told me that at most soup kitchens, you were required to sit through a sermon to be able to get to the chow. Like his experience, I doubt that many of my colleagues were proselytized by Olive Garden veal parmesan and tedious neurotransmission mini-lectures, but still – pretty egregious shit.
I bowed out early on. I’d like to say because I’m unduly ethical. Truth is, I put on 15 pounds in two months, and just had to stop.
December 31st, 2008 at 6:24 pm
“And we pay all expenses.”
Let’s make that clear. How many of you have ever seen a $30,000 restaurant bill? I have. I had a friend who took a doctor from India to lunch. The doctor insisted on going to China Wok at the mall. When he turned the expense report in, the accountants questioned the bill. It was so small, they thought it was off by a decimal point.
December 31st, 2008 at 6:42 pm
For a long time, I thought it was silly that big scientific supply companies gave away trinkets and muffins and stuff, but it’s so pervasive that it must work for them.
“Well, I wanted the thermal cycler that works faster, but Thermo gave me these cool pens.”
December 31st, 2008 at 6:49 pm
Another example:
Psych seems more troublesome than most here, not least because of drug creep: last year’s hospital anti-psychotics are this year’s mild depression pills or kids’ ADD pills. (My suspicion is that tchotchke branding helps “normalise” drugs as they move into the DTC-advertising space: if you can put “Abilify” on a pen, it must be safe, right?)
Reps also know that the long-lunch goodie-bag thing is one of the few breaks at an otherwise deadly-dull conference. Those packed lunches are also bought by Medz’R'Us.
December 31st, 2008 at 7:01 pm
I’m a psychologist; until recently, I practiced at a large multidisciplinary group practice.
I’ve been told by psychologists that they can detect whether a psychiatrist works full-time at a facility the moment they arrive. If there’s nobody prescribing, the stationery is standard-issue.
one friend there began collecting them to someday sell them on eBay as collectibles; not sure of the market for that, but more power to her.
Oh, there’s a market, albeit at the dollar-a-dozen level. Metal is better than plastic (unless it’s plastic with LEDs in the barrel), and chunky plastic is better than skinny plastic. I just looked at the pen cup, and the pick of the bunch are the illuminated Seroquel pen and the metallic Geodon one. (The tackiest: the Botox pen with the rotating ad spiel in the barrel.)
December 31st, 2008 at 7:50 pm
pseudonymous in nc: I’ll pass the info on to my friend. She’s held onto some pretty elaborate branded crap; might be her answer to the looming Greater, Bigger Depression. Me, I was errant and gave away my battery-powered, self-stirring Xanax coffee travel cup (I’m not kidding).
More seriously, I’m now in New Mexico, one of a few states in which psychologists can receive further training and, you guessed it, prescribe psychotropics. I have mixed feelings about it, to say the least; one certainty, though – the reps, trinket-less or otherwise, have discovered the market.
December 31st, 2008 at 8:23 pm
In fact, along with the “no pens” rule the pharma companies are also voluntarily disclosing financial ties with doctors (like Lilly, others have followed). They’re trying to get out ahead of Grassley’s pending bill
before it passes but in both cases they’re doing the right thing.
Incidentally, Matt, it seems to me that going to nice medical device conferences (to use the example from the comments above) isn’t significantly different than going on “fact-finding” junkets provided by the Committee to Promote Switzerland, both in the intent of the provider and the recipient. Of course I’m sure you paid for that one out of pocket, right…?
December 31st, 2008 at 9:47 pm
Yes, I too fail to see the difference between a multibillion dollar drug company trying to influence doctors to prescribe untested antipsychotics with severe side effects to 4 year olds, or foist excessively priced medical equipment to Medicare patients and a chamber of commerce trying to curry favor with bloggers who have readerships in the thousands.
January 1st, 2009 at 12:35 am
William Tell: You are so right. After all journalists would never be so swayed by some special attention — say, maybe “embedding” them in military units — that they would write favorable stories in support of a war in which hundreds of thousands of people would be killed. No, that would never happen.
I don’t accept dinners, lunch time sandwiches, or tchotchkes (in primary care I don’t get offered anything bigger than dinner programs with “CME”). I mostly write with the pens that have our group’s own advertising logo. I have more vendors’ advertising swag in the house from my pre-medicine engineering career and my husband’s non-medical career. OTOH, my husband thinks nothing of going out to dinner with a vendor. It really is something that gets done in every other field.
January 1st, 2009 at 8:26 am
If you think that a pen and a mug will not make a difference, you don’t know doctors.
Also, these things make a big difference with the doctors staff.
January 1st, 2009 at 9:45 am
Man, that’s disappointing.
I liked those pens.
January 1st, 2009 at 10:03 am
Can’t wait til they take away the really high-end prostitutes and the “safe houses”. Now those are two things the Docs will miss.
January 1st, 2009 at 10:43 am
I can guess what is coming next: a ban on samples. Giving doctors free samples of drugs can only corrupt the process, right? Of course, my doctor’s practice uses the samples for patients who can’t afford to buy the drugs they need (and in some cases can’t afford the copayments even if they have some sort of plan). Cutting off samples will really help there I am sure.
Cranky
January 1st, 2009 at 1:14 pm
“Doctors are well-paid professionals, none of them are going to seriously compromise patient care in exchange for a mug or a pen.”
If you really believe that, You need to educate yourself on the topiic. Try reading “Kluge” by Gary Marcus. It is a short book and pretty easy reading, but it might change your view a little.
January 1st, 2009 at 2:11 pm
“Doctors are well-paid professionals, none of them are going to seriously compromise patient care in exchange for a mug or a pen.”
In my experience, doctors can be bought cheap, regardless of whether they are well-paid professionals. I’ve seen lines 20-30 docs long at the booths at conferences giving out the best tchotchkes. I’ve worked in medical settings for the past 25 years and learned early on that the way to get the docs to your meetings is to serve pizza. As described above, drug reps have learned this lesson as well. The best explanation I’ve heard of the phenomenon is that during their residencies doctors-in-training are worked so long and hard that they have to grab food when and where it’s available or they starve, and that mindset never subsides.
January 1st, 2009 at 2:57 pm
I’m a hospital pharmacist. The pens and catering buy face time for the drug reps to pitch their company talking points. I’ll be curious what the reps will do without it because frankly, they are not good sources of information. They are clever with the colorful bar graphs, and very fluent with “the literature,” which amounts to catchy acronyms touting the one positive study out of thirty that the company saw fit to publish.
Candidly, if they weren’t feeding me I wouldn’t give them the time of day because they have nothing I couldn’t download from the company web site.
January 1st, 2009 at 3:04 pm
Does anyone recall the old-fashioned black and chrome trimmed ballpoints with “Skilcraft – U.S. Government” stamped on them? Are these still made?
January 1st, 2009 at 4:14 pm
In my experience, doctors can be bought cheap, regardless of whether they are well-paid professionals
There’s a difference between being cheap and being bought on the cheap. Lots of doctors I know aren’t the sort who can be bought for any price– their ego is too big. They are, however, extremely conscious of how their office supply and meal expenses cut into their bottom line and are perfectly willing to defray those costs by loading up on free pens, memo pads, and pizza.
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