Op-ed: Pads, pens, prescriptions

The following op-ed was published on February 26, 2009 in the USA Today.

Have you ever noticed the pens, coffee mugs and prescription pads at your doctor’s office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.

The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of their medications. This cozy relationship has raised increasing concerns and criticism that these marketing tactics are unduly influencing physicians’ decisions on the drugs they prescribe.

The Pharmaceutical Research and Manufacturers of America, the industry’s trade group, recently acknowledged that branded trinkets “are not based on informing (physicians) about medical and scientific issues.” It instituted a voluntary ban on drug companies giving gifts to doctors.

But these trinkets are the least of the problem. There are other tactics that should be addressed:

Medication sampling. Representatives from drug companies often leave samples of brand-name medications for doctors to dispense. Because only heavily promoted “” and often the most expensive “” drugs are sampled in most cases, patients must pay for refills at prices significantly higher than a generic drug of similar efficacy.

A study published last year in Medical Care, the journal of the American Public Health Association, showed that out-of-pocket costs for prescription drugs increased 47% for patients who received free medications to try, when compared with those who were not offered such samples.

Medication sampling accounts for $16 billion a year, or half the pharmaceutical industry’s marketing budget. Numerous studies have shown that physicians who had access to samples tended to give more expensive medications, which is a concern when prescription drugs cost $227.5 billion annually, or 10% of all health care spending in the USA.

Limited drug evaluation. Research shows that many doctors rely more on the pharmaceutical industry’s own information about a medication than on checking independent sources for evaluations of the drug.

For example, a report by BlueCross BlueShield found that more than half the doctors in a group of “high-prescribing” physicians used information from drug companies as their primary source on new medications, compared with 26% who used medical journals.

Doctors should seek information on new drugs from reputable medical journals or independently published pharmaceutical newsletters. Also, programs where representatives recommend cheaper, but equally effective, generic drugs to doctors need to be better funded and promoted. Research shows that every dollar spent on unbiased information yields $2 in drug savings.

Industry funding. Courses doctors must take to maintain board certification are funded in large part by the drug industry, and that subsidy comes at a price.

Robert Centor, professor at the University of Alabama School of Medicine and member of the American College of Physicians’ Board of Regents, says that by allowing industry funding, doctors tend to receive educational lectures “targeting diseases that require expensive treatments,” and that this “will increase awareness and indirectly increase the use of (the funders’) drug.”

Doctors must be more pro-active in seeking unbiased sources of information, and physician education needs to be divorced from drugmaker funding.

As the practice of free medication sampling continues unabated, the effect of banning branded trinkets appears to be minimal. That means the pharmaceutical industry — for the time being — will continue to help direct your doctor’s prescribing pen.