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By Susan Okie
The American Medical Association is mounting a $1 million campaign to educate
doctors about its ethics guidelines against accepting gifts from
drug companies -- with most of the funding for the effort coming from drug
companies.
"Nine large pharmaceutical companies
are contributing a total of about $675,000 to help pay for the
campaign, which is aimed at medical students, physicians-in-training and
drug company sales representatives as well as practicing doctors,”
said Alan R. Nelson, a former AMA president and special adviser to the American
College of Physicians.
The ethics guidelines allow doctors to attend company-sponsored conferences
and to receive textbooks or drug samples that will directly benefit their
patients, but advise them against accepting individual gifts of more than
minimal value.
Some observers criticized the AMA move. "They're certainly not exactly
going to encourage doctors to adhere to [the guidelines] when they're setting
this kind of example," said Sidney M. Wolfe, director of Public Citizen's
Health Research Group, a consumer organization.
"The campaign is not going to have any credibility."
The guidelines were formulated in 1990 by the AMA's Council on Ethical
and Judicial Affairs and were last updated in 1998. They were issued in
response to public concern over marketing practices in which drug companies
often treated doctors to expensive gifts, lavish dinners, trips or cash
payments.
Publication of the guidelines helped curb such practices in the early 1990s,
but more recently, studies and media reports have suggested that gift-giving
to doctors by drug companies has increased, according to the AMA. At the
same time, surveys indicate many doctors are unaware that the ethics guidelines
exist.
Spending by the pharmaceutical industry for marketing has increased dramatically
in recent years. Last year, drug companies spent about $15.7 billion on
marketing, compared with about $9 billion in 1996, according to IMS Health,
which collects data for the industry. Last year's figure includes about
$4 billion spent by companies to promote drugs to doctors in their offices,
compared with about $2.5 billion in 1996.
Prescription drug costs have become the fastest-growing
fraction of the nation's health care spending, with newer, more
expensive brand-name drugs fueling much of the increase. Many observers
believe that aggressive marketing of new drugs to doctors and patients is
partly responsible.
“Drug companies' gifts to doctors
typically include such items as pens, notebooks, coffee cups, desk accessories
and tote bags emblazoned with the name of a company or a drug,” said
Lisa A. Bero, a researcher at the Institute for Health Policy Studies at
the University of California at San Francisco.
In addition, company sales representatives often provide free drug samples
for doctors to hand out to patients and frequently fund educational conferences
on new drugs or pay for refreshments at such meetings. “In some cases,”
Bero said, “the companies pay travel costs for doctors to attend conferences.”
The AMA guidelines state that doctors should not accept gifts if there
are strings attached -- for instance, if the gift is an incentive
or a reward for prescribing a company's
drug. But Bero said research suggests that company gifts influence doctors'
attitudes and behavior.
"Even the smallest gifts make doctors feel
more favorable towards a company," Bero said. "Acceptance of
gifts is also associated with formulary decisions favoring new drugs from
the company that gave the gift."
Companies contributing to the education campaign are AstraZeneca International,
Bayer Corp., Eli Lilly and Co., Glaxo SmithKline, Merck and Co., Pfizer
Inc., Pharmacia Corp., Procter and Gamble Pharmaceuticals and Wyeth-Ayerst
Laboratories. Nelson said most companies contributed about $50,000 each,
but some gave almost $100,000.
The AMA contributed $50,000 plus the time of various staffers, he said.
The campaign was created by a working group that also included representatives
from about a dozen other large medical organizations.
The money helped to pay for educational kits to be used to teach doctors,
medical students and drug company sales representatives about the guidelines,
as well as a new AMA Web site on the topic, Nelson added.
Washington Post August 30, 2001; Page A03
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