14 September 2005
If you’ve ever received a free sample of a prescription drug from your doctor, chances are you were happy to get it. It saved you money and the time of going to a pharmacy, at least for the short-term.
But did you ever wonder why your doctor had a free sample to give you in the first place? Was it truly the best option available?
That free prescription drug sample is just the tip of the iceberg. Drug companies spend $12 billion to $18 billion each year marketing directly to physicians and residents. And they start even before students even enter medical school.
What’s influencing your doctor’s decision on which drug to prescribe?
“This contact with drug companies begins in the weeks and months after students graduate from college. By the third year of medical school, they are being saturated with this,” said Dr. Frederick S. Sierles, a professor of medicine at Rosalind Franklin University of Medicine and Science, in North Chicago, Ill, who conducted a study on the topic.
The study, published in the Journal of the American Medical Association, found that by the third year of medical school, students get, on average, one gift or attend one activity sponsored by a drug company each week. It also found, via a survey sent out to 1,143 third-year medical students at eight medical schools, that:
93.2 percent of the students were asked or required by a physician to attend at least one lunch sponsored by a drug company.
68.8 percent of the students did not think the gifts would influence their practices.
57.7 percent believed the gifts would not affect colleagues’ practices.
Students tended to feel that their peers were more likely to be influenced than they were.
80.3 percent of the students believed they were entitled to gifts.
“Basically, we have medical students exposed to marketing. We know the marketing is biased in favor of the products. We know the students don’t think they are being influenced. So they’re being set up to be influenced
without knowing it, and to prescribe in a way that is going to be bad for their patients,” Sierles said.
Not Just Free Lunches
Every year, pharmaceutical representatives make 60 million visits to doctors to inform them about their products.
And, says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of “The Truth About Drug Companies: How They Deceive Us and What to Do About It,” the top U.S. drug makers spend 2.5 times as much on marketing and administration as they do on research.
So just how do these drug representatives work their magic to “teach” doctors about the newest and most expensive drugs on the market? They visit hospitals and private practices, bringing with them bagels and cream cheese, pens, pads of paper and other trinkets emblazoned with
their company’s logo. They sponsor extravagant lunches and take doctors on all-expenses paid trips to luxury resorts.
Said one former drug rep, “[Gifts] buy you time with a doc, time that might change his mind. Money is the big resource. The pads and pens are great for access, but the dinners and what costs money -- CDs, handheld computers, everything given in the name of research -- this is what’s thrown at docs to get them to change their minds.”
But if a free dinner or pad of paper wouldn’t change your mind, maybe a check -- a five- or six-figure one -- would.
Free lunches, trips, and other gifts may be influencing which drug you’re prescribed.
According to the New York Times, drug maker Schering-Plough sent six liver-disease specialists checks for $10,000, along with a letter explaining the check was for consulting services that were explained on the attached “Schedule A.” As it turns out, “Schedule A” was nothing more than a blank sheet of paper with “Schedule A” printed at the top.
Another doctor also received a $10,000 check from the company, this one as payment for a consulting agreement that required only that the doctor commit to prescribing the company’s drugs. Other doctors have reported receiving six-figure checks from other companies under similar circumstances.
The Gifts Work
The drug companies wouldn’t be spending money on free lunches, computers and trips if it didn’t pay off in the end.
In one study, the prescribing habits of two groups of 10 doctors were tracked before and after they went on a free luxury vacation from separate drug companies (and attended several hours of drug seminars each day).
Doctors in the first group, whose trip was sponsored by the makers of an intravenous antibiotic, prescribed 81 units of the drug before the trip -- and 272 units afterward.
The trip for the second group of doctors was sponsored by the makers of an intravenous heart medication. Before the trip, doctors prescribed an average of 34 units. After the trip, it rose to 87 units.
What is perhaps most disturbing is that none of the doctors believed they were influenced. “Maybe I was indirectly influenced by important scientific information that I might not otherwise have heard, but nothing else would influence me,” said one.
Clearly, though, doctors are being influenced, often without their even realizing it.
“They [doctors and residents] are more likely to prescribe the marketed products than prescribe what they should be prescribing. That’s a big danger,” said Sierles.
Going back to that free sample from your doctor, it’s typically the newest, most expensive drugs that the drug reps give out. But, once your free sample runs out, guess who will foot the bill for those pills, that may be two to three times more expensive than an older or generic (but just as effective) drug? You.
So in the long run, those free samples aren’t really free.
“We think that big pharma has gotten intricately involved in every aspect of medical education and clinical practice,” said Leana Wen, president of the American Medical Student Association and a medical student at
Washington University in St. Louis. “Medical schools really have a duty to educate students about the proper ways to interact with drug companies.”
Until that happens, though, it’s up to you to protect yourself. The best way to do this? Rather than just accepting whatever prescription your doctor gives you (free sample or otherwise), talk to him or her about all the options available, why this brand is better than others, and whether there’s a less expensive alternative on the market.
And, says Dr. Angell:
“Doctors are too willing to provide drugs for very minor conditions. Those drugs are too often the very most expensive, heavily advertised, me-too drugs. I think that patients have to get a little savvier about that. Instead of just grabbing that sample and thinking they’ve gotten something for free, they ought to think about what it means. Nearly every drug has side effects. I do think that we are an overmedicated society.”
Journal of the American Medical Association September 2005; 294:1034-1042
Forbes September 6, 2005
As Doctors Write Prescriptions, Drug Companies Write Checks
The Truth About Drug Companies
Prescribing Under the Influence