Tag Archives: conflict of interest

Newest Medical Combine: Delis and Hungry Docs

Over the last year or so, there has been a campaign to break the hold of the pharmaceutical companies on doctors. The aim is to get more transparency so as to show the true relations between the drug industry and doctors, which involves taking gift , getting exotic all-expense- paid vacations, signing their names to articles they didn’t write, and on and on. The ultimate goal is to expose and eventually stop these practices.

Among the most fervent of these efforts has been carried out by groups of medical students and doctors who try to stop drug companies from handing out free lunches to busy medical professionals, who are often in hospitals on their short breaks.

Now, the pharma-free lunch movement faces the wrath of the restauarant lobby, which in Massachusetts is said to face a serious loss of business due to the reduction in the numbers of lunches bought by Big Pharma for the docs. Restaurants in Massachusetts want the gift ban ended, according to BNET:

Statehouse Democrats say the ban, which prevents drug sales reps from delivering free sandwiches to doctors, has “severely impacted the profitability” of local businesses. Rep. Brian Dempsey told the Boston Business Journal:… “We’ve been hearing from device and biotech companies, the convention center and the restaurant industry, that this is causing additional problems during the worst recession in memory.

As BNET reports, a pumped up Jeff Norris from Twins Restaurant & Catering in Erie, Pennsylvania, tells EZ Restaurant Marketing, an outfit that counsels restauranteurs how to break into feeding docs:  

“I used to do 2 maybe 3 luncheons per week, and soon I was doing 2 or 3 luncheons PER DAY…Thru June 30th , 2004 I have done 4 TIMES the amount of business with drug reps than I did in ALL of 2003. My marketing is on cruise control. I have some offices REQUIRING drug reps to call me for their luncheons!”

In Los Angeles, for example, Dr. Lunch, an outfit that caters to docs,provides this testimonial from a Dr. Martin Levine: “My staff and I request their lunches repeatedly. We have always enjoyed the food and service provided by DR.LUNCH. The food is not only delicious, but always fresh. I highly recommend them for any event, whether it be your office or home. 

 BNET further reports:

Some doctors get so used to free lunches that they issue instruction sheets to sales reps, such as this delightfully specific one from a Baltimore doctor obtained by [the blog]Pharmalot: “(Please do not order wraps, several members of the office have not tolerated them well).”

And we’re not just talking sandwiches and chips. Free lunches can be elaborate. Angelo’s of Flemington, NJ, offers Tiger Shrimp sautéed in a pink cream vodka sauce with penne pasta.

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Drugsters in Academia: How Big Pharma “Educates” American Doctors

 The pharmaceutical industry has wormed its way into the hearts and minds of the medical professions in any number of ways—wining and dining doctors, sending them off to vacation in splendid spas, and even buying their names to put on industry-written articles promoting different drugs.

One little known facet of this drugster-doctor relationship is Big Pharma’s role in continuing medical education (CME) programs, which are important in keeping medical professionals informed and up to date on the fast developing profession. Of the $2 billion-odd spent on these programs every year, nearly half comes from the drug business, which not-so-subtly uses the education programs to push new drugs.

Last week a conference at Georgetown University called “Prescription for Conflict” pulled together experts from academia, government, and industry to discuss the question: Should industry fund continuing medical education? The main instigator here is a former colleague of mine named Adriane Fugh- Berman, a doctor and teacher at Georgetown University Medical School. Fugh-Berman long ago became the nemesis of Big Pharma with a stream of articles and talks questioning the different aspects of liaison between the drugsters and the medical profession. I worked with her helping to set up PharmedOut.org, a website that seeks to educate the public on these liaisons, in part through exposes, both written and on video.

The conference at Georgetown included few critics as candid as Fugh-Berman. Those gathered included polite academics with hedged criticism of industry funding, and regulators like Joshua Sharfstein, principal deputy commissioner at the FDA,  and Julie Taitsman, chief medical officer the Department of Health and Human Services, who presented a list of  the different laws protecting the public. By the time they finished, I was so frustrated with government bureaucrats that I was about ready to join the Tea Party (except that they, of course, would want to do even less to control the greedmeisters at Big Pharma).

One blunt critique came from Paul Thacker, an investigator for Senate Republican Charles Grassley, who has been the most visible Congressional muckraker on the doctor-drug company love-in. Thacker bluntly told the docs to get off their supercilious “who me?’’ attitude and come to grips with the scarcely believable conflicts of interest existing between the medical profession and the drug industry–conflicts that more often than not have been to the detriment of their patients.

The industry, as always, insists it isn’t doing anything bad–far from it. Big Pharma, its representatives would have you believe, is really performing a public service, trying to educate docs so they can do a better job. This conference, however, offered a different point of view, in the statement of an anonymous “pharmaceutical executive,’’ who admitted industry involvement in “CME has the potential for inappropriate promotional messaging and influence.’’ 

The anonymous exec went on to state:  “Typically,companies make CME investment decisions at annual budget meetings.  The Sales and Marketing divisions dominate deliberations.and distribution of CME cash.’’ In deciding what institutions are to get money, he continued, “large volume, influential institutions are not likely to be rejected…Friendly institutions, as defined by access and volume, are more likely to receive grants than those that favor another company’s products. Grants may also be made in support of programs including particular KOLs [key opiniong leaders] whose opinions resonate with the promotional plan…Similarly, those known for positions antithetical to the company’s promotional plan are less likely to be supported.’’

In conclusion, the exec said, “CME contributions are commercial decisions,’’ and, finally, “CME is not compatible with commercial intervention.’’ Too bad it takes a drug company whistleblower to make this statement of the obvious, rather than the medical organizations and government regulatory agencies who are supposed to be looking out for us.

Granny D on Campaign Finance Reform

Doris “Granny D” Haddock won national attention when she walked across the country in 1999-2000, at age 90, to support the McCain-Feingold campaign finance reform initiative. The lifelong liberal activist from New Hampshire also ran for the Senate in 2004, was arrested at the Capitol for reading the Declaration of Independence, and authored a memoir entitled Granny D: Never Too Old to Raise a Little Hell.

On Sunday, her 100th birthday, Granny D issued the following plan to counteract the Supreme Court ruling on corporate campaign contributions:

If your brother-in-law has a road paving company, it is clear that you, as an elected official, must not vote to give him a contract, as you have a conflict of interest. Do you have any less of an ethical conflict if you are voting for that contract not because he is a brother-in-law, but because he is a major donor to your campaign? Should you ethically vote on health issues if health companies fund a large chunk of your campaign? The success of your campaign, after all, determines your future career and financial condition. You have a conflict.

Let us say, through the enactment of new laws, that a politician can no longer take any action, or arrange any action by another official, if the action, in the opinion of that legislative body’s civil service ethics officer, would cause special gain to a major donor of that official’s campaign. The details of such a program will be daunting, but we need to figure them out and get them into law.

Remarkably, many better corporations have an ethical review process to prevent their executives from making political contributions to officials who decide issues critical to that corporation. Should corporations have a higher standard than the United States Congress? And many state governments have tighter standards, too. Should not Congress be the flagship of our ethical standards? Where is the leadership to make this happen this year?

This kind of reform should also be pushed in the 14 states where citizens have full power to place proposed statutes on the ballot and enact them into law. About 70% of voters would go for a ballot measure to “toughen our conflict of interest law,” I estimate. In the scramble that would follow, either free campaign advertising would be required as a condition of every community’s contract with cable providers (long overdue), or else there would be a mad dash for public campaign financing programs on the model of Maine, Arizona, and Connecticut. Maybe both things would happen, which would be good.