Docs & Pharma Mkting w/less Contact

Curbed Contact Makes New Docs Wary 0f Drug Sales Pressure

Study finds they're less susceptible to marketing pitches later

By Adam Marcus HealthScoutNews Reporter

TUESDAY, Oct. 23 (HealthScoutNews) -- Keeping drug marketers away from doctors in training makes them more skeptical of pharmaceutical industry marketing later, a new study says.

The findings are based on a survey of doctors in Canada, some of whom trained at a McMaster University Medical Centre in Ontario that in the 1990s imposed strict no-contact rules between drug company representatives and certain residents studying there.

The researchers say the policy gives young doctors the sense that regular and close contact with drug companies is unhealthy.

"By banning drug reps, it sends a message to your residents that these aren't people you should be spending your time with," says study co-author Dr. Allan Detsky, chief of physicians at Toronto's Mount Sinai Hospital. The findings appear in the Oct. 24/31 issue of The Journal of the American Medical Association.

On the other hand, the study didn't address whether it's better for patients if doctors are skeptical about drug company pitches, says Detsky, who also is an economist. "How much of their marketing is not helpful, how much is really helpful, it has never been studied," Detsky says. "It may be that what they do in McMaster is prevent doctors from getting information that really helps their patients. I don't know that."

Whatever the case, one thing is certain: Pharmaceutical firms are waging an all-out information war for the eyes and ears -- and ultimately the prescription pads -- of physicians.

The industry spent more than $13 billion last year marketing their wares to doctors in America, according to IMS Health, a research firm in Plymouth Meeting, Pa. That includes nearly $8 billion in free samples, free lunches, company-sponsored junkets and promotional materials, including pens, caps and tote bags.

At least one group of Ohio doctors has exploited the eagerness of drug company reps to get a hearing by charging them for the privilege -- $65 for a 10 minute interview.

Earlier this year, the American Medical Association (AMA), whose flagship journal published the latest study, announced stepped-up efforts to educate its members about the ethical perils of accepting gifts from the pharmaceutical industry.

Dr. Herbert Rakatansky, a gastroenterologist at Brown Medical School in Providence, R.I., and past chair of the AMA's council on ethical and judicial affairs, says gift taking is "getting out of hand" after falling off in the early 1990s.

Rakatansky says drug reps "have a motive, and there's nothing wrong with their motive. But our motive is different."

Wary of the growing influence of drug reps on campus, the department of medicine at McMaster implemented a policy in 1992 to reduce contact between the reps and internal medicine trainees in residency there. The new rules banned drug reps from educational events, ended firm-sponsored free feeds and rejected pharmaceutical industry funding linked to specific diseases.

To learn if the 1992 policy altered the opinions of McMaster-trained doctors about drug company information, Detsky and his colleagues surveyed 57 former McMaster residents who attended the program both before and after the policy went into effect, as well as 242 trainees from the University of Toronto, which doesn't have such restrictions.

Nearly 90 percent of doctors in each group who responded said drug reps had visited their office in the last year, so the McMaster policy didn't seem to influence the amount of contact between the industry and physicians.

However, internists trained under the restrictive policy tended to have somewhat fewer contacts than the other doctors. And those trained after the policy began were much less likely than the others to say the information they received from the drug reps was helpful in guiding their treatment choices.

"There was a difference, and the difference was not small," says Detsky.

The McMaster policy did not prohibit contact between drug reps and all doctors in training, Detsky says. And the study found that doctors who had the most contact with drug reps were much more likely than those with the least contact to say the information they got from drug company reps was useful.

Detsky says he's amazed that doctors continue to insist that they're above the influence of marketing. "It's unbelievable to me the extent that they can deny that they can be biased in some way," he says.

Dr. Ron Wright, a University of Arizona psychiatrist who has studied the effects of marketing on physicians, says two well-known psychological forces help explain the influence drug company reps have in the doctor's office.

Although the so-called "buy-off" problem is the most hotly debated in medicine, Wright says another factor, which he calls "cognitive accessibility," is at play. Given a choice of which medication to prescribe, says Wright, "You think of the one that's the most in your face." So, he says all those sticky notes and calendars that shout a brand serve as a constant, soft voice whispering a name that's bound to be the first to appear on a doctor's prescription pad.

The second force is somewhat more subtle and involves a concept called cognitive dissonance, Wright says. In essence, cognitive dissonance theory argues that people will be more willing to believe a lie when they're paid less, not more, to listen to it.

If a drug company offers doctors an all-expenses paid trip to Hawaii, "I'm on my guard about that," Wright says. But if the "bribe" is instead small favors, "I'm not on my guard, but I am positively inclined toward" the company's representatives and their products. "They tend to give you things that are extremely useful that you really are going to want to keep around. And every time you see that you see that drug name."

As a result, Wright says, "Small gifts may in fact be more dangerous than large gifts, and all of the regulations go in the other direction." Wright says he doesn't accept drug company marketing paraphernalia to avoid biased prescription choices for his patients.

He says advertising drugs to doctors is different from selling televisions to the masses. "In normal advertising you make decisions and suffer the consequences. But with [drug marketing] I decide what you're going to get, your insurance company or you are the one that pays for it, and you take it."

The Pharmaceutical Research and Manufacturers of America, a drug industry group, did not respond to a request to comment on the study.

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