Wisconsin Medical Society Discourages Gifts From Drug Firms

The Wisconsin Medical Society’s board has come out against doctors accepting gifts, speaking fees and other payments from pharmaceutical and medical device companies.

The new policy ranges from the ubiquitous pens and pads found throughout doctors’ offices to the controversial practice of paying doctors to give talks about a company’s products.

It also includes the free lunches and other food that pharmaceutical sales representatives bring for doctors and their staffs on sales calls.

The Wisconsin Medical Society’s policy goes beyond the guidelines of the American Medical Society and most state medical societies.

“We have chosen to take a firm stand,” said Steven Bergin, president of the Wisconsin Medical Society. “This makes a statement.”

The Wisconsin Medical Society has about 12,000 members, or roughly two-thirds of the state’s doctors.

Pharmaceutical and medical device companies spend an estimated $19 billion a year on gifts, grants and other payments to doctors. The policy comes at a time when the ties between the companies and the doctors who prescribe or use their products is drawing increased scrutiny and criticism.

Several states have passed laws that limit gifts and other payments or that require pharmaceutical companies to disclose them. Minnesota, for example, bars pharmaceutical companies from giving doctors food or other gifts worth more than $50 a year.

U.S. Sens. Herb Kohl (D-Wis.) and Chuck Grassley (R-Iowa) also have introduced a bill that would require companies to report gifts and payments and establish a national online database disclosing the information for each doctor.

Arthur Derse, a professor of bioethics and emergency medicine at the Medical College of Wisconsin, described the Wisconsin Medical Society’s new policy as courageous. “They are out in front of the majority of their members on this,” Derse said.

A survey published in the New England Journal of Medicine last year found that 83% of doctors received food and beverages from pharmaceutical sales representatives.

Some health care systems already have policies prohibiting their employed physicians from accepting gifts from pharmaceutical and medical device companies.

Studies have shown that the practice of giving doctors pens, coffee mugs and other small gifts makes doctors more likely to prescribe certain drugs. “They don’t know they are being influenced,” Derse said, “and the drug companies know they are.”

Studies also have shown that accepting even a small gift creates an obligation to return the favor.

“There is an obligation – either conscious or unconscious – to return that gift,” said Michael Oldani, a former drug representative and now a medical anthropologist and assistant professor at the University of Wisconsin-Whitewater. “The entire informal economics of the pharmaceutical industry is based on gift exchange.”

The Pharmaceutical Research and Manufacturers of America, or PhRMA, said in a statement that it does not believe small items and modest meals influence doctors, and that the Wisconsin Medical Society’s new policy is not needed given the trade group’s new voluntary guidelines that prohibit the giving of non-educational items.

PhRMA’s new guidelines also reaffirm that interactions between company representatives and health care professionals should be focused on providing scientific and educational information and supporting medical research and education.

But pharmaceutical and medical device companies have ties to doctors that go beyond lunches for the staff and small items.

Many companies pay doctors to give talks about their products to other doctors, typically after an expensive meal in a fine restaurant.

The Medical Society of Wisconsin’s policy states that doctors should not participate in speaking bureaus for pharmaceutical companies. It also recommends that:

• Doctors not accept payments from pharmaceutical and medical device companies for participating in online courses for continuing medical education.

• Drug samples should be limited and, when possible, should be replaced by a system of vouchers.

• Doctors who have a commercial relationship with pharmaceutical companies should not serve on formulary committees that recommend which drugs doctors should use.

Doctors can still consult and do research for pharmaceutical companies under the policy.

SOURCE: Journal Sentinel Online