No Mugs, but What About Those Fees?

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http://www.nytimes.com/2009/01/05/opinion/05mon1.html?_r=5 & emc=eta1January 5, 2009EDITORIALNo Mugs, but What About Those Fees?New pharmaceutical industry guidelines should stop most drug companies from distributing a wide range of trinkets and office supplies designed to keep their brand names before doctors as a subliminal inducement to prescribe high-priced drugs.The new code, which kicked in on New Year’s Day, bars the free distribution of everything from pens to coffee mugs and staplers by some 40 drug companies that have agreed to the restrictions. That may seem like small potatoes, but in the aggregate the promotional products probably cost about $1 billion a year, as Natasha Singer reported in The Times.The updated rules are the industry’s latest attempt to restore public confidence that doctors are prescribing medicines in the patient’s interest. The code still has too many loopholes.Although it prohibits company sales representatives from providing restaurant meals to health care professionals, it allows the sales teams to continue providing modest meals in professional offices while pitching their products. It allows companies to continue paying for so-called continuing medical education for physicians while correctly leaving the selection of content, speakers and study materials to conference organizers. There appear to be no loopholes in bans against providing free tickets to the theater, sporting events or resort junkets.None of the steps yet contemplated by industry or professional groups would completely sever the medical profession and many individual doctors from their far more disturbing financial ties to the drug industry.Over the years, prominent physicians have received hefty fees for conducting research, consulting or giving “educational” speeches touting the virtues of drugs to their colleagues. The new industry code would limit consultants’ fees to “fair market value,” but critics believe that still leaves far too much room to pay individual doctors handsomely.Two investigations now under way at prominent universities show how much more needs to be done to aerate undisclosed conflicts of interest.A prominent psychiatrist at Emory University is accused of taking large payments from a drug maker — and misleading his university about the amounts — while heading a government study of the company’s antidepressant drugs. Three psychiatrists at Harvard whose work fueled an explosion in the use of powerful antipsychotic drugs to treat children are accused of failing to report large payments from the drug makers, most of which they had not disclosed to their institutions.Congress needs to pass legislation that would force all drug and medical-device companies to report a wide range of payments to doctors through a national registry so that all conflicts are known. This is a reform that the industry itself now seems willing to accept. Better yet, the medical profession needs to wean itself almost entirely from its pervasive dependence on industry money. =====In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.