THE RIGHT THING
Just Saying No to Gifts From Drug Makers
JEFFREY L. SEGLIN
Dr. Rusty West, a physician at the Nocona Medical Clinic in Nocona,
Tex., the free golf balls, dinners and sports tickets he had
received over the years from drug companies were a "small price to
pay" for access to him and the other doctors in his practice. But
the trade group representing the pharmaceutical industry is now
discouraging such gifts through a voluntary code of ethics that took
effect in July.
Though many other doctors seem to feel the same way as Dr. West,
such guidelines from the Pharmaceutical Research and Manufacturers
of America should come as no surprise. Offering gifts unrelated to a
physician's practice a common way to gain access to a physician
was explicitly discouraged in 1991 by ethics guidelines of the
American Medical Association, to which roughly 30 percent of
physicians belong. The Texas Medical Association, to which Dr. West
belongs, also denounces such gifts. (Dr. West says that he has not
been offered any perks lately, but that he had no ethical qualms
about accepting them before.)
"It's pretty hard to see how a round of golf entails a benefit to
patients," said Dr. Alan R. Nelson, a former president of the A.M.A.,
who this year headed a group charged with educating its members
about the ethics of accepting drug-company gifts.
The pharmaceutical group's code is viewed by some people in the
industry as a leveler, helping to ensure that companies compete for
a physician's attention based solely on the merits of their
products. The guidelines, among other things, prohibit any gifts,
even of modest value, that are not for the primary benefit of
patients: anatomical models for examination rooms are O.K.; World
Series tickets for a doctor's family are not.
Few pharmaceutical companies admit to engaging in the behavior
that the guidelines reject.
"Quite frankly, complying with the PhRMA code is not going to
require any changes on our part," said Bradley T. Sheares, president
of the US Human Health division of
Merck & Company.
But Scott Willoughby, assistant general counsel for the
pharmaceutical group, said the industry was facing a growing
perception problem. "Our C.E.O.'s kept getting beat up in the paper
over our marketing practices and wanted us to find a way to put a
code together to keep bad press from happening," he said. "If people
thought we were doing a bad thing, we wanted to change that
Perhaps not enough, however. It is up to each pharmaceutical
company to establish mechanisms to punish representatives who break
Some consumer groups find the self-imposed call for better
behavior disingenuous. "Here is an industry that has created, funded
and built its livelihood around these conflicts," said Ronald F.
Pollack, executive director of Families USA in Washington. "To
expect effective policing of these practices when they're the
creator of these problems is a stretch of credibility."
Some government officials feel that way, too. In June, Vermont
became the first state in the country to enact a law requiring all
pharmaceutical companies to report gifts for physicians if the gifts
are worth more than $25.
"We think most physicians will not take anything over $25 if they
know their names are going to be on the Web associated with these
pharmaceutical companies," said Gov. Howard Dean of Vermont, who
once was a practicing physician himself.
Doctors, meanwhile, seem to be wrestling with their own ethics
code. Earlier this year, the Polyclinic, which runs three health
care clinics in Seattle, started charging the pharmaceutical
representatives $30 to drop off samples. Howard Springer, the
practice's associate administrator, said that this did not violate
the A.M.A.'s policy prohibiting physicians from accepting cash
payments, because "we're not guaranteeing them access to the
But Dr. Leonard J. Morse, chairman of the A.M.A.'s Council on
Ethical and Judicial Affairs, disagreed. "It's inappropriate to the
A.M.A. code," he said. "Such payments should not be accepted." It's
a moot point for now. Polyclinic, which once had 15 to 20 visits a
day from pharmaceutical representatives, now has none after imposing
the fee, Mr. Springer said.
For drug companies, the challenge goes beyond merely promulgating
a new code of behavior. The public will be watching for attempts to
skirt the spirit of the guidelines. Doctors should refresh their
memories about their own code and refuse the gifts they should have
been refusing all along.
If they fail to comply, state governments may have to step in.
Laws like Vermont's will go a long way toward policing the ethical
behavior of the companies and the physicians if they cannot police