Unethical drug marketing practices abound

A number of doctors reacted to the series of columns on prohibitive prescription drug prices in this country. They called my attention on what they describe as excessive and unethical marketing practices of the drug companies as a major factor for high drug prices. Some of these doctors told me they are scandalized that in many cases, their fellow doctors allow themselves to be practically bribed to prescribe particular drugs.

Of course I am familiar with these practices. I have read about them in the Internet and because I come from a family of doctors, I have some first hand knowledge too. The reason I didn’t mention this as a possible reason why drug prices here are so high is simply because I considered it an open secret in the medical profession. It’s a given. I feel uneasy to even suggest that some doctors are no different from greedy politicians and yes, corrupt journalists. It is after all, the noble profession.

But now that doctors themselves mentioned it, yes it is true that there are doctors who have compromised themselves by allowing drug companies to give them favors. I am told that the inducements for a lucky few now include fully paid vacations with the family. Worse, doctors’ offices have also become part of the drug companies’ marketing network.

Take the case of the Norvasc discount card that is being distributed in doctors’ offices. Of course it is normally the secretary or receptionist that dispenses it but she does so with the knowledge and approval of the doctor. Given that Norvasc’s sales in the Philippines in 2005 hit P1.185 billion and have been growing annually at 34.5 percent, there is plenty to share with doctors who agree to be part of Pfizer’s marketing network.

But is that ethical? Why should a doctor have anything to do with a particular brand of drug? I doubt if he is doing the drug company a favor for free. The situation certainly looks unethical and smacks of commercialism. But then again, because it has achieved the dubious distinction of being an accepted practice in the local medical community, no one gives it a second thought. For Norvasc, a straight discount at the drugstore level is more proper and ethical, something expected of Pfizer, the world’s largest drug company.

The fact is, worldwide, drug companies are spending lavishly on doctors. But a backlash has started. I note that this is a cause of concern in responsible sectors of the medical community in the United States. And for good reasons… It raises drug prices, for one. It also corrupts the doctor. It is entirely possible that contrary to claims of the big drug companies, the reason prices here are so high is not so much because of research expenses but because of drug marketing practices.

In 2002, after giving up hope that doctors would police themselves, the American state of Vermont enacted legislation that requires drug companies to file annual reports with the state that disclose the value, nature and purpose of any gift, payment or subsidy worth over $25. The law applies to marketing activities to any physician, hospital, nursing home, pharmacist, or health plan administrator. Maine, Minnesota, West Virginia and the District of Columbia have adopted similar measures.

A group of influential doctors and academic leaders in the United States, concerned about the ethical implications of gift giving to doctors, have also called for a ban on all pharmaceutical gifts to doctors at academic medical centers. They are calling for reforms intended to resurrect and maintain the integrity of medicine and medical professionals. Amen to that!

"Gifts require reciprocity. Docs say they can’t be bought but each time you get a gift, ultimately it does affect what you prescribe," said David J. Rothman, president of the Institute of Medicine as a Profession at Columbia University, New York, and co-chairman of the committee that wrote the recommendations.

"We want to make certain that it’s scientific knowledge and patients’ best interest, not reciprocity, conscious or unconscious, that underlies doctors’ prescribing," he commented to MedicineNet.com. Several studies show that the free lunches – plus small gifts like pens and sticky notepads, along with drug samples – can lead doctors to prescribe the more expensive brand names when cheaper generic drugs would be as effective.

David Magnus, co-director of the Stanford University Center for Biomedical Ethics, said, "There’s huge amount of empirical evidence that lower gift amounts have an influence dollar-for-dollar, disproportionately even greater than large gifts. You probably get a lot more bang for your buck with small gifts. If it’s unethical at high dollar amounts to buy influence and it has the same impact at lower amounts, it seems inescapable to conclude that you can’t have it at any dollar amount."

According to MedicineNet.com, the study stated "gift-giving and other support is a significant part of the pharmaceutical industry and much of it is focused on physicians. About 90 percent of the $21 billion marketing budget of the pharmaceutical industry continues to be directed at doctors, the study stated."

"We know more about drug-company marketing practices," Rothman told MedicineNet.com. "Drug companies are more and more powerful, more and more energetic in terms of their marketing. Now we have the data that these gifts matter, these company practices matter."

The working group spent two years looking at industry marketing practices and papers detailing the effects of marketing on physician decision-making. I suspect that if we did the same study here, we will get the same results. Prescription drug marketing practices jack up prices of drugs to patients and compromise the professional and ethical integrity of doctors.

Plainly, reforms are called for. But believe me, nothing is going to happen. The relationship is just too cozy for doctors and drug companies to break it up.

BSP independence

I just read the column of William Pesek of Bloomberg mourning the death of Paeng Buenaventura. I am glad to note that as I did in my column last Wednesday, he also cited Paeng’s independence from politicians as one of Paeng’s outstanding legacies at the BSP.

Buenaventura became Central Bank Governor in July 1999, Pesek recalled, amid the fallout from the 1997-1998 Asian financial crisis. "Buenaventura’s real accomplishment was being what one of Asia’s more fragile and geopolitically important economies needed most: an adult in the room … Buenaventura did what he could to be the glue holding together Asia’s 14th-biggest economy."

Pesek observed that the first lesson Paeng taught is simply "central bankers must be independent. In a region where central banks tend to help governments pump up growth with ultra-low interest rates, Buenaventura proved to be a maverick… A truly autonomous monetary authority that doesn’t need to run for reelection or settle political scores draws favorable attention to any economy. In Asia, more attention to controlling monetary policy and less to manipulating currencies at the behest of governments might attract more foreign capital."

Another important lesson from Paeng, according to Pesek, is, "don’t buy into the government’s hype. It was always refreshing to chat with Buenaventura after a few days of making the rounds with government officials. When you would ask him about all the ooh-rah-rah’s coming from politicians, he would roll his eyes before setting you straight. Monetary officials in Asia too often seem to view themselves more as economic cheerleaders than managers. Buenaventura knew the best way to impress investors was to keep his head down, do a transparent and steady job. Markets eventually will notice."

Then of course, Paeng worked hard "to improve transparency in an economy notorious for its absence at all levels–government, central bank and commercial banks." What can I say? It’s all true. Too bad Paeng’s gone for good. But future BSP leaders can learn from his lessons and build on the legacy of independence, competence and transparency that Paeng left behind.

Strawberries

This one is from Dr. Ernie E. Precisely why my late father, a parasitologist and infectious disease specialist, wouldn’t let us eat fresh strawberries or fresh green vegetables, for that matter.

A farmer was driving along the road with a load of fertilizer. A little boy, playing in front of his house, saw him and called, "What’ve you got in your truck, mister?"

"Manure," the farmer replied.

"What are you going to do with it?" asked the little boy.

"Put it on strawberries," answered the farmer.

"You ought to live with us," the little boy advised him. "We put sugar on ours."

Boo Chanco’s e-mail address is [email protected]