Doctors take big perks
Doctors Take Big Perks from Pharmaceutical Giants
Just Say No
Source: CTV News Staff
Montego Bay, Jamaica is a tropical paradise and the perfect getaway. You can windsurf, golf or just relax on gorgeous white sand beaches along the Caribbean Sea and for some, the price is right.
For many of the Canadian doctors enjoying this particular trip, it's free and paid for by international drug giant, Boehringer Ingelheim.
Dozens of doctors, specialists and their spouses are staying at the luxurious and world-renowned vacation spot, the Half Moon Resort. There, the rooms start at more than $600 a night.
"It's upsetting, you know. It's very disappointing," says Canadian cardiologist, Dr. P.J. Devereaux.
He says drug companies are constantly offering doctors incentives to learn about their drugs.
"It is an enormous amount of money that the industry puts out in trying to actually offer promotions to physicians to hopefully influence their practice."
According to the invitations to Jamaica, obtained by W-FIVE, Boehringer Ingelheim offered to pay for the flights of doctors along with their spouses, accommodations and several meals. All the doctors had to do in return was to attend some seminars about arthritis drugs and the benefits of their product.
The president of the Canadian Medical Association, Dr. Henry Haddad, says it's wrong for doctors to accept gifts, because a gift implies obligation.
"Your dealings with the pharmaceutical industry must not come between you and your patient and we feel that accepting gifts, accepting trips, whatever order is wrong," says Dr. Haddad.
Some research has also shown that doctors are influenced by drug marketing techniques.
"There's good evidence to show that it influences physicians at the level of knowledge, at the level of their attitudes and at the level of practice," says Canadian researcher, Ashley Wazana.
Wazana published a study in the Journal of American Medical Association and concluded that with increased interaction with the pharmaceutical industry, doctors prescribed unnecessary drugs, drugs with more side effects and more expensive drugs.
THE COST OF DRUG MARKETING TO HEALTH CARE
The cost of drugs in Canada is soaring. Last year alone, drugs cost the health care system more than $15-billion. Only hospitals cost more than that amount. Some critics argue that a big part of what's driving up drug costs is the lavish marketing to doctors, such as the trip to Jamaica.
A return business class ticket on that flight to Jamaica costs $1,700. Three nights in the resort's least expensive rooms are another $1,900. The bill is $3,600 before you add in any meals, drinks or extras. Remember, that's for only one doctor.
Dr. Devereaux insists that every time a doctor accepts an invitation to a drug company event, it's taxpayers and patients who end up paying in the end.
"No one would go into Mrs. Jones' room and say, 'Mrs. Jones, would you mind paying for my lunch?' But in a way that's in fact what we are doing... It all comes back to higher drug costs. There's only one way to recuperate the money."
Drug company marketing is big business. Industry critics estimate it costs as much as a billion dollars a year in Canada, some of which is spent directly on doctors.
"It happens. It's ubiquitous, happening globally and it's happening all the time," says Dr. Devereaux.
W-FIVE wanted to speak with some of the doctors who attended the drug company event in Jamaica.
It's not known how many, if any of the doctors, decided to pay their own way. Few of the doctors returned W-FIVE's calls and among those who did, even fewer were willing to speak about the trip.
Finally one doctor was willing to be interviewed. Dr. Wally Pruzanski is a rheumatologist and lives in the upscale neighbourhood of Forest Hill in Toronto. The drug company paid for his trip to Jamaica.
Dr. Pruzanski says he's been on about five or six trips paid for by the drug companies and he went to Jamaica to get up-to-date information about a particular drug.
"You have to understand that when we leave Toronto, and when we accept this kind of invitation, we are losing part of our practice. So we are sacrificing part of our income, in order to educate ourselves."
He also says he in no way feels an obligation to the drug company.
Even CMA president Dr. Haddad says the offers can be pretty enticing, admitting that he once accepted a trip to Ireland from a drug company. It's a decision he now regrets.
"I tell you honestly, I felt bad. When I came home, I told my wife I shouldn't have done that... I didn't feel comfortable being wined and dined by the industry."
But what is there to stop doctors from taking drug company perks? Absolutely nothing.
Dr. Haddad says he's not aware of any doctor being sanctioned in any way for accepting gifts from a drug company.
"The CMA is not a police. CMA has no role in enforcement. We can't sanction physicians."
ADDRESSING THE PROBLEM
In Houston, Texas, more than 1,000 medical students are attending an American Medical Students' Association conference.
This year, one of the main topics of discussion is the relationship of doctors with drug companies and the ethics of doctors accepting freebies.
"We want physicians to stop accepting gifts, all gifts regardless of size... Certainly some of the bigger ticket items, like the lunches and dinners and the weekends away and the trips to the golf course, golf outings, tennis outings and so forth like that," says Dr. Bob Goodman.
No free lunch has become a catchphrase for those who believe doctors should refuse drug company offers. The movement is due in large part to Dr. Goodman and his organization, called 'No Free Lunch.'
"Our motto is, 'Just say no to drug reps'."
As a specialist in internal medicine at Columbia Presbyterian Hospital in New York City and teacher, Dr. Goodman instructs medical residents how to best treat their patients.
Three years ago, Dr. Goodman decided to take a page from the drug companies' book. He created a line of his own paraphernalia with the brand name, 'No Free Lunch.'
"I created these mugs and pens and T-shirts as a sort of a bake sale to raise money to buy drugs for patients, that was the initial impetus. At the same time, I started the website and then the organization grew into something else."
What it grew into was a site for doctors to take a pledge vowing to abstain from drug company perks.
"I am committed to practicing medicine in the best interest of my patients and on the basis of the best available evidence, rather than on the basis of advertising or promotion. I therefore pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my practice, teaching, and/or research."
Dr. Goodman considers this almost an addendum to the Hippocratic Oath.
"They've sworn to Apollo to do what's best for the patient and this is one thing that will help them do what's best for the patient, rather than what's best for the industry."
Dr. Goodman feels that he's tapped into a receptive group of medical professionals.
"Students for example, who haven't been socialized yet and aren't busy accepting these gifts, can easily see that this kind of thing is wrong and are much easier to convince. And, in fact, I think students are really the answer to this problem."
But what about the drug companies? Well, there are rules about their dealings with doctors. The industry's code states that educational sessions must be the main focus of social events. Drug companies can't offer any free entertainment and trips like the one to Jamaica are strictly forbidden.
In recent years, drug companies have been sanctioned for paying for doctors to attend a number of different events, including everything from a night at the Winnipeg ballet, to an NHL game in Edmonton, an NBA game in Toronto, to free golf and free skiing.
During the course of its investigation, W-FIVE accumulated drug company invitations sent to doctors, such as invitations to fancy dinners at four-star restaurants, a trip to the Bahamas, a private box to an NBA game, and a dinner theatre in Mississauga, Ontario.
W-FIVE presented these invitations to the industry's self-regulating body, called Rx&D, to find out how appropriate they are. Lee Marks is in charge of reviewing complaints.
"The decisions on these kinds of situations are always those of the marketing practices review committee. I do not have the jurisdiction or the authority to rule on them." says Marks.
Boehringer Ingelheim, the company that sponsored the trip to Jamaica, declined W-FIVE's request for an interview, but did send a fax admitting they were wrong to offer the trip.
It states that Rx&D had contacted the company and the event in Jamaica had contravened the industry's code of marketing conduct. Boehringer Ingelheim states that they "accept the ruling" and have "taken steps to ensure that no such breaches occur in the future."
The penalty for the first breach is a fine of $1,000 and the infraction is cited in Rx&D's industry publication, Contact.
But in addition to the trip to Jamaica, W-FIVE has learned Boehringer Ingelheim was sanctioned two other times in the past 12 months for other unrelated matters.
The maximum penalty for repeat offenders is $15,000 and their infractions are published in Rx&D's publication.
"Much more importantly than the financial penalties are the reports of the misadventures of companies. That is the true penalty because no responsible company wants to see its name and details about inappropriate behaviour on the part of its personnel published in a national paper," says Marks.
However, the publication has a limited readership of only 3,000 people, mostly in the industry.
For repeat offenders, the board of directors does have the option to take whatever action they deem is necessary. However, the board has never expelled a company because of infractions to the code.
It is no doubt comforting news to companies, like industry giant Boehringer Ingelheim and to any doctors who want to take them up on their generous offers.
