Comments on MedPageToday Article on Freebies for Docs

From MedPage Today readers:

richard w. moczygemba, m.d. - Sep 16, 2010 The ethical issues that caused the relative ban on small freebies involved thousands of dollars in bogus honoraria, junkets to resorts, and other sorts of unethical "under the table" activities by pharmaceutical companies. The ban on free pens, mugs, etc. is a smokescreen and essentially meaningless.

I do not believe my prescribing was ever influenced by having a product's pen in my hand or drinking coffee from a mug labeled with the name of a medication. I don't miss the pens and mugs. I think the move was window dressing on an ethical dilemma, and was actually done to save money.

Dr Babcock DO - Sep 17, 2010 Unfortunately the people who read only the headline will see the freebies can still be gotten, but will miss the disclaimer that the targeted donors from past congresses are complying, and that it is not pharma providing the goodies.

Like Dr. Moczygemba, I have not been influenced to prescribe merely by looking at the label on my mug or the brand name on the side of my pen. My biggest beef (pun to follow) with the new regulations is that in the diligence to document all the free lunches provided to physicians, that each meal is accounted for, the very people who could benefit from an occasional free lunch, that is the office staff, lowest on the salary hierarchy and without prescription-writing powers, are denied a seat at the banquet.

David Lubin, MD - Sep 17, 2010 Insurance company decisions dominate my practice with prior authorizations and formularies determining what I can prescribe. Patients are losing jobs and insurance coverage. The cost of meds to treat diabetes and other major illnesses are becoming unaffordable to those without insurance or in the "donut hole."

Patients are facing bankruptcy with exorbitant bills after they're gone to the emergency room. Healthcare reform is still not resolved for everyone as promised. And what's the big dilemma Big Pharma has to deal with? Doctors receiving pads and pens!

todd lupold, PA-C - Sep 17, 2010 I agree with Dr Moczygemba. To think a cheap pen will influence my prescribing preferences is insulting to the average medical practitioner who uses evidence-based medicine to prescribe the appropriate drug therapy. The only thing lunches get our local drug reps is access to us...the lunches are used to provide lunch to our employees and the providers then talk with the reps.

Many times the discussion involves all aspects of the product that the rep is pushing and is usually changed to include the best treatment for the disease process involved. The drug reps provide valuable info about their drug and we listen but to suggest that i prescribe a certain drug simply because of a meal or pen is insulting.

The interactions with the drug reps are what influence prescribing practices and it is through information exchange that causes the change. If information is presented that has evidence behind it and there's no generic available then the prescribing preference changes.

At least several times per week the discussion of a particular drug often turns to one of intellectual confrontation with the drug rep as we candidly discuss their data and the proper treatment of disease. This will only get worse as we give the government more control over health care. Wasting money on political witch hunts when the government is writing laws that stifle competition in medicine and benefit the health insurance industry and unions to the detriment of the citizens of the US.

The government is a blunt instrument so when they try to legislate an ethical problem that only affects a few it ends up hurting us all even though we had nothing to do with the problem to begin with. If someone is abusing his license for money and commits unethical acts then punish that person, not everyone.

markomd - Sep 17, 2010 I agree with richard w. moczygemba, m.d. that the move has to this point been window dressing on an ethical dilemma, BUT the principle is sound. Gifts are bribes. Small gifts are small bribes. Large gifts are large bribes. I do not accept bribes. Period!

varian keller - Sep 17, 2010 Most companies would prefer to keep the money that goes to the relatively inefficient and expensive promotional give-aways and entertainment. As this can't be risked unilaterally, laws that limit them for all such as the one in Massachusetts have the potential to improve profits for these "greedy" corporations. Unfortunately, the monies that were returned to the local community via entertainment and local services will now also stay with the pharmaceutical and medical device companies. As empirical evidence that promotional activities have a significant negative impact on health is lacking one might reason that something else is driving the passage of these anti-free enterprise laws.

PYeargin - Sep 17, 2010 I'm torn on this; I laughed when I read what "freebies" this headline referred to. I agree with Dr. M that the pens and mugs are not even close to the biggest problems. However, I would submit that it's hard to say how you personally are subliminally influenced by seeing, for example, the name of a drug, whether or not it registers consciously, 50 to 100 times a day.

By far, most doctors believe that they are not influenced by this kind (or any kind) of advertising, but the drug and other medical companies apparently feel differently. The studies so far would suggest that prescribers are influenced more than they think. It seems that humans are a bit more emotionally complex than most of us know.

todd lupold, PA-C - Sep 17, 2010 PYeargin, What studies are you referring to?? Let's see the evidence and not make decisions based on hearsay or by being influenced by someone with an agenda. I'm confident that i do that every day by evaluating the evidence and challenging the data provided....are you afraid that your integrity will be sold for a $.49 pen?? If that's the case you have a lot of self-reflecting to do. Keep in mind that your thought process of "prescribers are influenced more than they think" is short sighted at best. You're forgetting that influence could be a good thing rather than just a bad thing all the time....by your statements you are suggesting that influence is the same as replacing free choice. I fundamentally disagree with this assessment.

You have the right and responsibility to make the proper choices for your patients in your prescribing and if you allow a "subliminal message" to control your free thought process then i would really question your ability to provide high quality medical care to patients. I'll bet you're the kind of prescriber that writes antibiotics for your patient's viral URI because they asked for it.

I have patients repeatedly ask me for antibiotics for viral URIs many times per week but i don't allow this to influence my prescribing. This whole exchange is such a non-issue i can't even believe educated people are having this discussion!! If a prescriber violates ethical and legal standards then punish them and stop this punishing everyone for the potential or theoretical crime.

Ann Fonfa, advocate - Sep 26, 2010 Hello all, I have to agree with PYeargin. I just went to PubMed.gov (I am sure all of you are familiar with it). A SEARCH using 'ethics', 'influence of gifts by pharmaceutical companies' yielded 19 studies. Not a huge amount but indicative of the nature of the problem. AND if advertising did not work, it surely wouldn't have grown into a giant industry. Exposure to an idea or concept is the same. When you see the company name, the product name, when your trusted resource is someone who is SELLING you, you must be aware. I speak as an advocate - advocacy organizations often receive funds from the pharmaceutical industry - and studies have shown they can be influenced as well. My organization www.annieappleseedproject.org provides information about natural therapies, lifestyle issues, complementary and alternative treatments that rarely get attention in the mainstream medical community. We are not offered pharma funding but we have to be careful too about the influence of our supporters. That's real life for all of us.

Joy Simha, Consumer Advocate - Sep 27, 2010 Where do you draw the line? At the Medical Meetings I have been to it's not just pens and pads given away, but phone chargers, fancy coffee drinks, Burt's Bees travel kit and fleece blankets. A bribe is a bribe and it's much cleaner if you don't take it.

Pradeep Kumar - Oct 05, 2010 Where do you draw the line? Is it a pen, pad or $ 1500- $5000 for industry sponsored speech. It's personal choice of every physician. Big Pharmas are not sole evil, they do a wonderful job for society at large. what I see the companies are more interested in making new products either isomer of original compound or bromide or meslyate or by-product of same original compound with different patent name. We physicians are scientists and should diligently make the difference, before handing another prescription to our patient. One simple principle, would I take generic of same medication, if I have to pay-self, will be good judgment call and guideline.



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