No Mug? Drug Makers Cut Out Goodies for Doctors

Dr. Jeffrey F. Caren, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, has collected more than 1,200 free pens from drug companies.

To Lehman Brothers, Linen ’n Things and the blank VHS tape, add another American institution that expired in 2008: drug company trinkets.

Starting Jan. 1, the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs.

No longer will Merck furnish doctors with purplish adhesive bandages advertising Gardasil, a vaccine against the human papillomavirus. Banished, too, are black T-shirts from Allergan adorned with rhinestones that spell out B-O-T-O-X. So are pens advertising the Sepracor sleep drug Lunesta, in whose barrel floats the brand’s mascot, a somnolent moth.

Some skeptics deride the voluntary ban as a superficial measure that does nothing to curb the far larger amounts drug companies spend each year on various other efforts to influence physicians. But proponents welcome it as a step toward ending the barrage of drug brands and logos that surround, and may subliminally influence, doctors and patients.

“It’s not just the pens — it’s the paper on the exam table, the tongue depressor, the stethoscope tags, medical calipers that might be used to interpret an EKG, penlights,” said Dr. Robert Goodman, a physician in internal medicine at Montefiore Medical Center in the Bronx.

In 1999, Dr. Goodman started No Free Lunch, a nonprofit group that encourages doctors to reject drug company giveaways. “Practically anything you can put a name on is branded in a doctor’s office, short of branding, like a Nascar driver, on the doctor’s white coat,” Dr. Goodman said.

The new voluntary industry guidelines try to counter the impression that gifts to doctors are intended to unduly influence medicine. The code, drawn up by Pharmaceutical Research and Manufacturers of America, an industry group in Washington, bars drug companies from giving doctors branded pens, staplers, flash drives, paperweights, calculators and the like.

The guidelines also reiterate the group’s 2002 code, which prohibited more expensive goods and services like tickets to professional sports games and junkets to resorts. And it asks companies that finance medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside program coordinators.

Diane Bieri, the executive vice president of Pharmaceutical Research and Manufacturers of America, said the updated guidelines were not an admission that gifts could influence doctors’ prescribing habits. Instead, she said, they were meant to emphasize the educational nature of the relationship between industry and doctors.

“We have never said and would never say that a pharmaceutical pen or notebook has influenced any prescription,” Ms. Bieri said.

But some critics said the code did not go far enough to address the influence of drug marketing on the practice of medicine. The guidelines, for example, still permit drug makers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations.

“Pens or no pens, their influence is not going to be diminished,” said Dr. Larry M. Greenbaum, a rheumatologist in Greenwood, Ind. He has made a point of collecting ballpoint pens advertising formerly heavily promoted medications, like the painkiller Vioxx, that were later withdrawn after reports of dangerous side effects.

Last year, besides giving away nearly $16 billion in free drug samples to doctors, pharmaceutical companies spent more than $6 billion on “detailing” — an industry term for the sales activities of drug representatives including office visits to doctors, meal-time presentations and branded pens and other handouts, according to IMS Health, a health care information company.

The industry code also permits drug makers to pay doctors as consultants “based on fair market value” — which critics say means that companies can continue to pay individual doctors tens of thousands of dollars or more a year.

“We have arrived at a point in the history of medicine in America where doctors have deep, deep financial ties with the drug makers and marketers,” said Allan Coukell, the director of policy for the Prescription Project, a nonprofit group in Boston working to promote evidence-based medicine. “Financial entanglements at all the levels have the potential to influence prescribing in a way that is not good.”

About 40 drug makers, including Eli Lilly & Company, Johnson & Johnson and Pfizer, have signed on to the code. Representatives of several pharmaceutical makers said their companies intended to comply with the guidelines, but they declined to discuss past marketing programs involving branded gifts.

The restrictions come as a blow to the makers and distributors of promotional products, an industry with an annual turnover of about $19 billion, according to Promotional Products Association International, a trade group. Such companies, accustomed to orders of up to a million pens a drug, stand to lose around $1 billion a year in sales as a result of the drug industry’s voluntary ban, the group said.

The sudden scarcity of free goodies, though, could enhance the cachet of collections that some doctors have assembled over the years as a mocking countermeasure to drug marketing. Dr. Nathan Anderson, a resident in internal medicine at a hospital in Texas, has posted photographs of the various items he has received on his blog, drugreptoys.blogspot.com.

Dr. Jeffrey F. Caren, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, has collected more than 1,200 pens and mounted them on a pillar in his office.

While some doctors applaud the gift ban, others seem offended by the insinuation that a ballpoint pen could turn their heads. “It seems goofy to us; we like getting our pens,” Dr. Susan B. Hurson, an obstetrician and gynecologist in Washington, said in a telephone interview.

Dr. Hurson said she paid no attention to the logos on the pens she carries around in her doctor’s coat.

Prompted by a reporter’s question, she pulled out a handful of pens from her pocket and read off the drugs advertised: Clindesse, a cream for vaginal infection; Halo, a system for detecting breast cancer, and Evamist, an estrogen spray. “It’s hard for me to believe it influences what you prescribe.”

But Dr. Phillip Freeman, a psychiatrist in Boston, said that physicians who contended that the giveaways were benign might be suffering from denial.

“The need to deny influence is damaging to the soul,” Dr. Freeman said. He suggested that doctors would feel less conflicted if they simply wore drug company patches on their white coats.

By NATASHA SINGER

http://www.nytimes.com