Pharma Gift-Giving: Influence, Relationships, & Zero-Sum Games

Drug company reps giving physicians goodies to try to convince them to prescribe — oops, I mean, educate them about — their branded drugs is hardly a new story. But it’s one that bears repeating. No one buys the companies’ rhetoric about education; and physicians who categorically deny that they’re not influenced are delusional. Whatever else they may be, drug companies aren’t stupid. And there’s empirical evidence that marketing does work on physicians — if not on every physician, every time, then at least on average.

Here’s a particularly good, detailed account, from the St. Petersburg Times: To move more prescription drugs, sales reps sling swag

The transformation of a Jacksonville psychiatrist from a skeptic on Seroquel into a super-prescriber was marked by months of gentle pestering, generous $1,500 speaking engagements and giveaways of everything from a plastic brain to gourmet chocolates.

A neurologist in Tampa joked with Seroquel sales reps that she doled out so much of the powerful antipsychotic drug for migraines that they probably thought she was psychiatrist. She was rewarded with free trips to Scotland and Spain. “I want to go too ! =)” her Seroquel rep wrote.

Wooo hoooo!


I must say I find these stories depressing, though I can’t say I find them surprising. Companies want to sell drugs. So they reward sales reps for convincing docs to prescribe more. And the reps stroke and coddle the docs into prescribing. And the patient? Well, in most cases the patient is just happy someone is taking care of them, and they haven’t got a clue whether the doc is prescribing what’s very best for them or not. (That’s because many pharmaceuticals are what economists call “credence goods,” goods that the consumer can’t effectively evaluate even after consuming them.)

Now, one thing the Times mostly leaves out is that a few things have changed, at least on paper, since the events recounted in the story. Most significantly, the Pharmaceutical Research and Manufacturers of America (PhRMA) has revised its code of conduct to forbid its members from buying physicians meals at restaurants and giving out non-educational gifts bearing their logos. Here’s the story as reported by USA Today: New pharma ethics rules eliminate gifts and meals. And here’s PhRMA’s press release: PhRMA Revised Marketing Code Reinforces Commitment To Responsible Interactions With Healthcare Professionals.

The change in policy was effective in January (2009). I have no idea whether it’s been effective. But there are two things I’m pretty sure of.

First: as one insider quoted in the Times story points out, the problem isn’t about the value of the gifts. The problem is the personal relationship forged between the drug rep and the physician. When physicians get defensive and object, “Hey, I can’t be bought for the price of a free lunch and a coffee cup bearing a corporate logo!” they are absolutely right. It’s not the freebies, per se. It’s the pat on the back, the chumminess, the “hey, how did your daughter’s violin recital go?” (See also this blog entry by Nancy Walton: Personal relationships, conflict of interest and ethics.)

Second: Like most people, I find it easy to be skeptical about the kind of self-regulation represented by PhRMA’s changes in its code. There is, after all, still one helluva lot of money to be made here, and that means lots of incentive for gaming the rules. But on the upside, notice that the industry, collectively, really does have reason to want this to work. After all, lavishing goodies on doctors to get them to prescribe your drug is a game the companies can’t all win. It’s like athletes taking steroids. If everyone does it, no one has any advantage, but all pay the costs. So they’d be better off as a group if they could stop. (In more technical terms, it’s a zero-sum game.) That doesn’t make playing by the rules easy, because each company may be tempted to bend the rules, just in case the competition is doing so. And then there’s still the issue of convincing docs not just to prescribe your company’s drug, but to prescribe more of it — and that, unfortunately, is a game that all the companies can win at. So, the situation is strategically comlex. But it’s worth noting that there’s at least some reason for drug companies genuinely to support and end to the gifts and free lunches.

2 comments so far

  1. John Mack on

    Not all drug companies have signed on to PhRMA’s guidelines. I guess you can call it a near-zero sum game!

  2. plasticsyntax on

    Another unethical thing these companies do is < HREF="" REL="nofollow">encourage doctors to prescribe many of their drugs for off-label uses<>. Of course, that veers off from the merely unethical to the blatantly illegal, but it’s still pretty sad.

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