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Just say no to drug reps

Just say no to drug reps. The Physician-Pharmaceutical Industry Relationship. Are you drug company dependent?. If you answered yes to 2 or more of the above, you may be drug company dependent. Levels of Interactions:. Clinicians gifts promotional information

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Just say no to drug reps

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  1. Just say no to drug reps

  2. The Physician-Pharmaceutical Industry Relationship

  3. Are you drug company dependent? If you answered yes to 2 or more of the above, you may be drug company dependent.

  4. Levels of Interactions: • Clinicians • gifts • promotional information • Researchers • Professional societies; medical journals • Continuing medical education (CME)

  5. Case It is a busy day in the office, but you have agreed to speak for a minute to a pharmaceutical representative who has stopped by to drop off some samples of a new quinolone antibiotic, called Ubiquinone. Knowing your interest in golf, he has brought you golf balls emblazoned with the letter “U,” and also invites you to a round of golf at the country club this weekend. Would you accept the golf balls? Would you accept the invitation? (From: “Really difficult Problems in Medical Ethics”)

  6. Is it appropriate for a medical student to accept any of the following gifts from a pharmaceutical company? • small gifts (e.g. pens, writing pads, golf ball) • a free meal (e.g. lunch at a departmental journal club meeting or at a restaurant) • a textbook (worth R200) • a stethoscope (worth R500) • pharmaceutical samples (drug samples) • tickets to a Bafana Bafana game (worth R150) • sponsorship for travel and attendance at a conference (worth R3000) • free shares in the company (worth R1000)

  7. Consider the following: • Is there any potential for harm for the medical student? • What are the implications of accepting a gift from a pharmaceutical company? • Is there anthing wrong with getting “something for nothing”? • Why may pharmaceutical companies offer such freebies? • Should medical students response to the pharmaceutical industry regarding gifts differ from that of their seniors (qualified doctors)? • Would it be fair to prohibit all industry presence in medical schools and training hospitals and general practices where students are placed?

  8. Attitudes and Practices

  9. Are gifts from pharmaceutical companies ethically problematic? A survey of physicians • Survey of 42 residents and 52 faculty at a university-based IM training program. • 21 item questionnaire. 4 point Likert scale. • 0 = “not problematic” • 3 = “very problematic” • 90% response rate (105/117 residents). • 93% of residents, 73% faculty responded. Arch Intern Med. 2003;163:2213-2218

  10. Are gifts from pharmaceutical companies ethically problematic? A survey of physicians P=.08 P=.04 P=.05 P=.88 P=.10 P=.34 Arch Intern Med. 2003;163:2213-2218

  11. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions • Survey of 117 1st and 2nd year residents at a university-based IM training program. • Attitudes towards 9 types of promotion assessed. • 90% response rate (105/117 residents). Am J Med 2001;110:551

  12. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions Am J Med 2001;110:551

  13. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotionsPractices Among Residents Who Consider Promotion Appropriate Am J Med 2001;110:551

  14. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotionsPractices Among Respondents Who Consider Activity Inappropriate Am J Med 2001;110:551

  15. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotionsPerceived influence of pharmaceutical reps on Prescribing Practices “You” “Other Physicians” P<.0001 Am J Med 2001;110:551

  16. Pharmaceutical branding of Resident Physicians • Survey of 181 primary care residents; 164 (91%) responded. • First asked to complete survey, then asked to empty pockets of white coats. • 98% had eaten drug company-sponsored meal within the past year. • 97% of residents were carrying at least one item with pharmaceutical insignia. JAMA 2001;286:1024

  17. Pharmaceutical Branding of Resident Physicians JAMA 2001;286:1024

  18. Pharmaceutical Branding of Resident Physicians JAMA 2001;286:1024

  19. Patient Attitudes

  20. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts Survey of physicians and patients at 2 tertiary care medical centers (1 military, 1 civilian). 196 patients and 268 physicians completed survey. 54% of patients were aware that pharmaceutical industry gave gifts to physicians. Does your own doctor accept gifts? 27% yes, 20% no, 53% unsure. J Gen Int Med 1998;13:151

  21. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts J Gen Int Med 1998;13:151 P<.004 for all except mug, p=.24)

  22. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts J Gen Int Med 1998;13:151 P<0.0001 for all except trip, p=0.0017

  23. Professional Guidelines

  24. American Medical AssociationCouncil on Ethical & Judicial Affairs • “Any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value.” • “Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or personal expenses of the physicians who are attending the conferences and meetings . . .” • “No gifts should be accepted if there are strings attached.” JAMA 1991;261:501

  25. American College of PhysiciansGuidelines on Physician-Industry Relations • The acceptance of individual gifts, hospitality, trips, and subsidies of all types from industry by an individual physician is strongly discouraged. • The acceptance of even small gifts can affect clinical judgment and heighten the perception (as well as the reality) of a conflict of interest.. • The dictates of professionalism require the physician to decline any industry gift or service that might be perceived to bias their judgment, regardless of whether a bias actually materializes. • Ideally, physicians should not accept any promotional gifts or amenities, whatever their value or utility, if they have the ability to cloud professional judgment and compromise patient care. Annals of Internal Medicine 2002;136:396-402.

  26. American College of PhysiciansGuidelines on Physician-Industry Relations Acceptable industry gifts: • Inexpensive gifts for office use (pens and calendars). • Low cost gifts of an educational or patient-care nature (such as textbooks). • Modest refreshment. Annals of Internal Medicine 2002;136:396-402.

  27. PhRMA Codeon interactions with healthcare professionals • Items primarily for the benefit of patients may be offered to healthcare professionals if they are not of substantial value ($100 or less). • Items of minimal value may be offered if they are primarily associated with a healthcare professional’s practice. • Items intended for the personal benefit of healthcare professionals (CDs, tickets to a sporting event) should not be offered. www.PhRMA.org, April 2002

  28. PhRMA Code FAQs Question: Under the Code, may golf balls and sports bags be provided if they bear a company or product name? Answer: No. www.PhRMA.org, April 2002

  29. PhRMA Code FAQs Question: Under the Code, may healthcare professionals be provided with gasoline for their cars if they are provided with product information at the same time? Answer: No. www.PhRMA.org, April 2002

  30. PhRMA Code FAQs Question: Under the Code, may items such as stethoscopes be offered to healthcare professionals? Answer: Yes www.PhRMA.org, April 2002

  31. “That stuff doesn’t influence me at all. I don’t even know what drug is on my pen. I just go for the food.”--Fill in your name here?

  32. Pharmaceutical industry Spending on Promotion

  33. Promotional spending on prescription drugs, l996-2002 Source: NIHCM, 2001

  34. Promotional spending on prescription drugs, 2002 Total spending: $21 billion Source: IMS Health

  35. Direct to consumer advertising on prescription drugs, l996-2000 Source: NIHCM, 2001

  36. Direct to consumer advertising spending in the U.S., 2000 Source: NIHCM, 2001

  37. Comparison of median revenue dedicated to R&D, profits, and marketing/administration, Fortune 500 drug companies, 2000 (n=11) Source: Public Citizen, 2001

  38. Main task of drug company employees, 2000 Source: PhRMA Industry Profile 2000; percentages calculated by Sager and Socolar

  39. Drug company jobs in marketing and research, 1995-2000 # Jobs Source: PhRMA Industry Profile 2000; percentages calculated by Sager and Socolar

  40. Profitability of drug industry, l993-2000 2.8% • Source: Public Citizen update of Stephen W. Schondelmeyer calculation, Competition and Pricing Issues in the Pharmaceutical Market, PRIME Institute, University of Minnesota based on data found in Fortune magazine, 1958 to 1999; Fortune magazine, April 2000, Fortune 500 (www.fortune.com).

  41. Fortune 500 drug company profitability compared to all other Fortune 500 companies, 2000 Source: Public Citizen, 2001

  42. Sources of increased drug expenditures, 2000-2001 37% 39% 24% Total increase: $22.5 billion Source: NIHCM, 2002

  43. “Gifts are just a form of promotion or advertising, and advertising is a part of our society, like it or not.”

  44. Gifts: • Cost money (like other advertising). • Influence behavior (like other advertising). • Create obligation, need to reciprocate (unlikeadvertising). Conflict of interest • Create sense of entitlement (unlike advertising). • Erode professional values; demean profession (probably unlike advertising).

  45. Conflict of interest Set of conditions in which judgement concerning a primary interest tends to be unduly influenced by a secondary interest. NEJM 1993;329:573-6

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