Drugmakers hold too much influence over doctors' decisions, public says

How relationships with industry may influence physician decisions is not just a concern limited to Capitol Hill or medical ethics committees. A new poll found that 69% of patients say they believe drugmakers hold too much sway over doctors' prescribing.

Nearly half of the 1,154 adults surveyed nationwide said physicians' prescribing decisions are influenced by gifts from drugmakers, according to poll results released in August. A third of patients were so worried about pharmaceutical marketing that they felt they could not rely on their doctors' medication advice.

"Physicians should know that most patients now are concerned about the drug companies influencing them," said John Santa, MD, MPH, director of the Consumer Reports National Research Center, which conducted the poll in May. "When they're on the phone with a patient, when they have a patient in their office -- the patient may not say it -- but they are concerned ... and they're disturbed by it."

Especially troubling to patients are physicians who get paid to pitch drugs in ads, with 72% of respondents finding the practice distressing. Six in 10 patients are concerned about physicians being paid by drugmakers to speak at industry conferences, and nearly 60% objected to pharma-paid office lunches for physicians and their staff.

"This should be considered a wake-up call for physicians," said Adriane Fugh-Berman, MD, director of PharmedOut, a project founded with a $400,000 grant from the Warner-Lambert settlement over allegations of deceptive off-label marketing of Neurontin (gabapentin). The project aims to persuade physicians to steer clear of drugmaker-provided information about pharmaceuticals.

"Patients are watching," said Dr. Fugh-Berman, associate professor in the Dept. of Physiology and Biophysics at Georgetown University School of Medicine in Washington, D.C. "Patients notice the reps in your office and the pharmaceutical company swag."

Four in 10 patients said free drug samples are problematic, and one-third are concerned about drugmaker-branded pens or pads. Such "reminder items" were banned under a voluntary Pharmaceutical Research and Manufacturers of America code launched in January 2009. The code, adopted by 53 drugmakers, allows drug reps to provide "modest" in-office meals during informational sessions.

PhRMA defended drugmakers' efforts to communicate with physicians.

"Pharmaceutical marketing plays a critical role in improving patient care and fostering the appropriate use of medicines," said PhRMA spokeswoman Kate Michel. "Providing physicians with timely information about new treatment options and the risks and benefits of medicines clearly benefits patients and advances health care throughout the United States."

Answering patients' concerns

The poll results could spur more physicians to reconsider their interactions with the industry, said Ari Silver-Isenstadt, MD, whose five-physician Baltimore pediatric practice adopted a "no soliciting" policy for pharmaceutical sales representatives in January 2008.

"This will push the medical profession even more if patients are asking their physicians what kind of relationship they have with pharma," said Dr. Silver-Isenstadt, a member of the National Physicians Alliance, whose Unbranded Doctor Campaign urges physicians to refuse industry gifts and stop seeing drug reps.

"Doctors will need to have ready a convincing answer about how their prescribing decisions have not been affected by the billions of dollars spent on pharmaceutical company advertising and marketing techniques," he said. "They will need to be able to explain to patients that they are giving this brand-name prescription drug because it is really the best medicine, and not because they have any specific relationship with a drug rep."

More than three-quarters of physicians accepted drug samples, and 83% took free lunches from drugmakers, according to a survey of 1,651 doctors published in the April 26, 2007, New England Journal of Medicine. Nearly 30% of physicians were paid by industry firms for consulting, speaking, serving on an advisory board or enrolling patients in clinical trials.

The health system reform law enacted in March mandates that physicians who receive nearly any kind of payment of $10 or more from a drugmaker, device maker or other medical industry firm have the information listed on a publicly searchable website starting Sept. 30, 2013.

The American Medical Association's policy on gifts from industry says "modest meals" are OK, as are gifts worth less than $100 that benefit patients. It also says that "individual gifts of minimal value ... related to the physician's work," such as pens, are permissible. The AMA Council on Ethical and Judicial Affairs is re-examining the gifts policy.