No Freebies For Minnesota Docs At ASCO
18 CommentsBy Ed Silverman // June 2nd, 2008 // 6:50 am
At the Lilly booth, the docs were lining up 15 deep for a free taste of frozen yogurt, except docs from Minnesota. For the third year in a row, the drugmaker posted a sign saying there would be food or drink given to docs from the Land of 10,000 Lakes “in order to comply with Minnesota statutes,” Dow Jones writes. In fact, New York government employees were subject to the same treatment.
Across the aisle, Novartis was giving away soapstone bowls carved in Kenya as part of its support of a non-profit group that promotes economic growth in developing regions. But again, there was a sign, saying Minnesota docs, members of a Medicaid committee and state and federal employees “may be subjected to restrictions on acceptance of food, beverages or items,” the wire reports.
The restrictions reflect growing concern among some states that pharma marketing is unduly influencing prescribing habits and leading to higher health care costs. A Minnesota law prohibits drugmakers from giving gifts to docs with a combined value of more than $50 per year, but allows for compensation of docs for consulting and other services and has other exceptions, Dow Jones notes.
“We want to make sure we’re doing all the right things according to state regulations,” a Lilly spokeswoman told Dow Jones. She adds that it’s better for Lilly sales reps to keep track of items given to docs they call on, rather than try to track the giveaways at a large conference.
Were any Minnesota docs turned away? “Not to my knowledge,” she said, speculating that some may have stayed away on their own when they saw the sign. If they were turned away, Dow Jones points out, they could probably go elsewhere for free stuff - similar warning signs weren’t visible at all of the booths were drugmakers were handing out goodies.
Chris
A legitimate concern on the part of pharma companies, or an indirect call to action (warning)to physicians in other states?
Paul
This is the kind of nonsense that drives costs up. Rather than focusing on the big picture, States focus on the little things like the $2.00 cup of coffee or $0.50 pen or pad.
These actions do absolutely nothing but let the regulators in the States come across as acting in the public interest blah blah blah.
I have not been at ASCO, but can imagine that it is no different from other meetings where doctors line up 20 deep to grab small items and trinkets. As disgusting as this is, there is no way this influences what people do.
Bev
Why, Eli Lilly, aren’t you holier than thou
Think this “image boost” will let you take a bow?
Almost every state is sueing you now
For your horrible Zyprexa, your “block buster” - wow!
All the people with diabetes will be so impressed
while the families of the dead will remain ripped and stressed
In the end, all that matters is money not death
So just slip them a yoghurt, and take a deep breath
M Helm, MD
Paul, actually, there is fairly good evidence that all of those seemingly valueless trinkets and freebies DO influence prescribing practices. Trust me, if they did not work, the companies would not continue to provide them.
At a minimum, they provide an excuse for an interaction with a prescriber, and an opportunity to influence treatment. PhRMA “sales” is really about fostering a relationship. The relationship helps to promote one drug over another, often where there is no evidence of a significant difference between the “latest and greatest” new drug and any number of other (often less expensive but equally safe and effective) treatments.
The convention exhibit halls have been nausea-inducing to me for many years (including when I was on a PhRMA marketing team). Well-paid, presumably intellegent (at least academically accomplished) physicians and other professionals stand in line to get some irrelevant, unneeded freebie - just because it is free.
In the process, the prescribers listen to the pitch, and are engaged by the reps who are there (usually hand-selected) to create an opportunity to “sell” the products they represent. There is nothing wrong with this, but the complicity of the convention planners is but one example of the conflict of interest problem in medical education. Universally, educational meetings will set aside valuable daylight hours from the educational purposes of the convention so that there will be basically no excuse for failing to visit the exhibit hall. If you know the game, you can often pick up an invitation or two to a later “special reception” or presentation at which you can exchange more face-time for free food and/or drinks.
This is an understandable goal for the exhibitors, and they pay a lot for the privilege of being there. This does help lower the costs of the convention for the attendees, but it does not enhance the education that might occur. (I also always suspect that the linkage between “educational” conventions and the promotional opportunities for PhRMA may influence the content of the educational programming.) What is in it for the attendees? I don’t know.
However, like it or not, these activities and the seemingly inconsequential gifts do influence people. Last I checked prescribers are people too. Disbelieving that the extent of the influence is one of the funny tricks we play on ourselves. There’s lots of social science research on this - some of it has dealt specifically with treatment decision-making among physcians. I think “Pharmed-Out” and the “No Free Lunch” AMSA materials have more background on that.
Are the state laws misguided? That’s not my call, but given the amount of money most states and the federal government spend on health care, it is irrational to argue that the governments have no interest in avoiding any inefficient resource allocation.
I don’t believe that the companies put the notices out to actually discourage or turn away any Minnesota (or New York, etc.) physician who wanted the free frozen yogurt. More likely this is just a political point as Chris suggested, or a PR stunt someone hoped would be noticed. Another possibility is an oddly legalistic attempt to absolve the company of any obligation to report the activity to any states that would require it. Whatever the reason, it got them in the news and they got to state their side of the story.
Paul
M Helm,
Thanks for your comments.
I keep hearing that same comment, “if they didn’t work, companies would not continue to provide them”.
Of course the low value trinkets work. They work as reminders, they work to help with access, they work to help patients (yes, many of those trinkets are for patient support).
Where the argument breaks down is when people claim that those minor items are enough, all by themselves, and in some magical ways, to cause a doctor to treat a patient in a way that they otherwise would not have done it. That a $0.50 pad is enough to put a patient at risk. Come on, give doctors some credit. That is not how they make decisions!
When you see an ad on TV for a car, do you immediately go sell your car and run off to buy that one? Of course not. And that is not even dealing with health, and you don’t have a formulary limiting what you can and cannot do.
pg
“At a minimum, they provide an excuse for an interaction with a prescriber, and an opportunity to influence treatment. PhRMA “sales” is really about fostering a relationship. The relationship helps to promote one drug over another, often where there is no evidence of a significant difference between the “latest and greatest” new drug and any number of other (often less expensive but equally safe and effective) treatments.”
Good point :)
Paul
This discussion can happen in the presence or in the absence of a pen. So doesn’t make sense to regulate the presence of the pen.
pg
But, the freebies “provide an excuse for an interaction with a prescriber, and an opportunity to influence treatment”. Hence the discussions that result?
pg
ie:
“Aw, thanks for the pen/yogurt”
“You’re welcome. Have you attended our freebielunches before and, hey, did you hear about our new drug Krapotoxia?”
“No, never heard of it”
“Its great, here’s some scientifically unsound information we paid a key opinion leader to write for us and a few more to ignore the data write publications showing it has been proven to be beneficial to millions for everything worldwide”.
These kinds of tactics have worked since the immaculate conception of big pharma, junkie Sigmund Freud and the selling of cocaine. See http://scienceblogs.com/neurophilosophy/2008/05/sigmund_freud_cocaine_big_pahrma.php
lol
Anonymous
Physicians have habits like everyone else. Understandably clinical experience with a particular med drives those habits. Trinkets are not the impetus to drive prescribing behavior, but merely a reminder of the habit, or a reminder that another product exist that may be a better option for their next patient in the category under consideration.
The above is fairly simplistic, several factors come into play relating to risk/benefit. But I know many doctors that would prefer to stick with what they have gained experience with, and believe to have predictable results, rather than try something different regardless of what data suggest in terms of getting patients to goal with less risk of AE, their limited clinical experience with an unknown drug(to them)does not allow them to venture out.
This is not entirely difficult to understand, the patients care is their responsibility; undoubtedly they have been “burned” so to speak in the past. But that doesn’t mean an agent aside from their favorite in a particular class of drugs wouldn’t be an appropriate or even better alternative. If a trinket reminds them, after they have been presented with compelling data. Just how egregious is that?
pg
Apologies to the long deceased guy from the 19th Century, I meant the psych EXPERT cocaine junkie Sigmund Freud who gave birth to so many “scientific” theories leading to disasterous treatments, drug deaths and masses of money for drugmakers all round… but never mind that for now.
Tactics worked for the makers of Lithium
http://www.bonkersinstitute.org/medshow/7up.html
and years later they did even better for the makers of thorazine, a true miracle of (pseudo) science - a cure for just about ANYTHING from “peptic ulcers” through “vomiting” in children to a cure for “schizophrenia” for the ancestors of one of the current drug dealers: http://www.bonkersinstitute.org/medshow/thorazine.html
How can anyone take Big Pharma seriously once they’ve done a bit of research?
lol
M Helm, MD
Paul,
I’ve been on three sides of the debate about freebies and PhRMA sales - specifically, manufacturer, prescriber, and (managed care pharmacy) payor. You may be right that the pens and pads aren’t that important or influential. Maybe it is silly to outlaw these. On the other hand, I think you may give MDs a little more credit than we deserve as a group about the complexity of our prescribing decisions. They are called “habits,” after all.
Personally, I think it would make more sense to bar samples dispensed in the office. There is some very good evidence (and a lot of empiric experience if you stand near the sample closet) which supports that sample availabity skews prescribing practices. Sample use is associated with higher costs and use of newer products which may or may not offer long-term outcomes/benefits relative to older products not avaialable as samples (for an example think Zetia versus simvastatin). There are patient safety/drug interaction issues also. Doctors do not always know all of the medications patients take, not to mention all of the interactions we should worry about. However, as soon as anyone talks about barring samples, just wait for the gnashing of teeth and rending of garments. So politically, maybe limiting pads, pens, lunches and cupcakes are the only thing states can do.
As for TV ads, for PhRMA they really exist to induce the patient to come in an request the advertised brands. Most MDs are accomodating and are reluctant to deny a patient request. Most also are too overscheduled to sit down and thoroughly discuss the merits and demerits of all available treatments. The drug treatment part of such a conversation would assume the MD has enough information to do that. Given the limited emphasis on pharmacology in medical education and the limited amount we know (or think we do) about all of the effects of the medications we use, that would be a real stretch for many clinicians.
The conversations do happen without the prescence of the pen. So where is the harm in states deciding it should not be part of the exchange. Even a gift of minimal value creates a social obligation. I would say skip the gift.
One last comment about formularies… Like diets we all one whether we plan to or not. Virtually all physicians limit themselves to even fewer medications than they could prescribe. This is not just due to their specialization. Complaints about formularies arise when there is disagreement about the important considerations or factors for inclusion/exclusion. Physicians don’t like to have their autonomy limited, but we have to live under the golden rule in healthcare. This also applies to give-aways.
The golden rule goes like this: He who has the gold makes the rules.
M Helm, MD
pg, I actually did LOL at your sales dialog. Very funny and wierdly true to life.
Allan
Minnesota law bans gifts over $50 to docs, but it neither bans nor requires disclosure of cups of frozen yoghurt or other small stuff.
Eli Lilly is playing politics.
HorusCat
Allan,
Actually, from what I understand, Minnesota limits the TOTAL spend in a year for a doctor to $50. So a rep has to keep track of what she spends for coffee, a cup of yogurt or whatever.
That being said, I can’t convince my MN counterparts to give me their budgets to spend!
Paul
Indeed Allan HorusCat s correct. Companies have to track every single dollar for every single thing and ensure they don’t go one dollar over $50 by the end of the year.
The costs in systems, time, analysts, etc. to track all this are enormous…guess who pays in the end?
M Helm, MD
Paul,
You can’t seriously believe that a bit more accounting work significantly increases the cost structure for PhRMA. I was not on the accounting side of things, but it seems that every sample delivered has to be tracked. How is tracking expenditures different or more/less burdensome than sample tracking. I would imagine that the information infrastructure was already in place. This all assumes that PhRMA companies actually created systems to ensure compliance with the state regulations. I’m not in a state that has limits, but I’d bet that there are still reps in MN calling on physicians just like they did prior to the requirements.
Remember all the very well paid PhRMA reps and their company cars? More believable would be the burden placed on the profitability of the companies by the rising costs of providing a car, gas and salary/bonus to thousands of reps who gets 8 to 12 three minute interactions with prescribers per day in the field. Guess who pays for all of that in the end?
It is absurd to complain about the burden on PhRMA for tracking expenditures per MD. If it were that big of a deal, PhRMA companies would have abandoned their sales operations in MN. The regs - whether they will have their intended effect or not - are unlikely to have a negative financial impact for PhRMA. You neglected to consider that without the limits, the per MD expenditures would have been likely to be more than $50 per MD per year. At least on some level, the limits level the playing field, and could conceivably reduce PhRMA costs (and therefore increase profitability).
Paul
Not a huge burden, but one more…on top of many that keep piling up.
What a waste of time and money.