http://www.nytimes.com/2002/01/18/business/18DRUG.html

January 18, 2002

Merck Is Said to Limit Perks in Marketing to Physicians

By MELODY PETERSEN

sales representative for Merck (news/quote) says she and her associates have been told by their superiors that they should no longer treat doctors to free Broadway plays, weekend trips and other gifts that could be viewed as inappropriate.

That would be a departure from what is common practice in the industry. Many drug companies woo doctors by paying their way on lavish weekend retreats and expensive evenings out, even though such practices may violate ethics guidelines that the industry and the American Medical Association agreed to in 1990.

Greg Reaves, a spokesman for Merck, said the company could not talk about its sales tactics for competitive reasons. Mr. Reaves said he was not privy to what the sales representative, who spoke only on the condition that she would not be identified, might have been told by a manager.

He did not deny, however, that such a conversation could have occurred. "I'm not going to say it didn't happen," he said.

The employee said many sales representatives had complained that they would be put at a disadvantage with companies that still give lavish perks to doctors. Her managers responded that there was a risk that the company could lose sales, the employee said, but that they believed that other pharmaceutical companies would soon join Merck.

She added that she and many of her colleagues had become convinced that it was "the right thing to do."

George Hradecky, editor of Pharmaceutical Representative, an online magazine, said that he had been told by drug sales representatives that other companies may also be scaling back their marketing.

"There is a general trend," he said. "A lot of doctors are turned off by it."

One common practice is to pay doctors to attend meetings at expensive hotels and restaurants where they listen to information about products.

Many of those events fall into a gray area of the A.M.A.'s published ethics guidelines. The guidelines state that "token consulting" arrangements between a doctor and a drug company cannot be used to justify expensive gifts. But token consulting is not defined, leaving it unclear whether, for example, it is appropriate to pay doctors to attend a dinner at an elegant restaurant, where they listen to a presentation and then are asked for their opinions.

Eli Lilly, for instance, invited a group of doctors to dinner at Maloney & Porcelli in Manhattan on Jan. 8. According to the invitation, the doctors were paid $500 each. At the dinner, which the company called a regional consultant meeting, a physician presented clinical information on a new drug Lilly is developing. After the presentation, the doctors were asked for their opinions.

In another case, Forest Laboratories (news/quote) held what it called an advisory board meeting in Manhattan last Friday night. The meeting, the invitation said, was to give doctors "marketing data" on Celexa, an antidepressant, update doctors on the latest clinical trials and get their advice on treating depression.

The doctors were given a free night at the Plaza Hotel, where a standard room costs more than $300. Forest paid the doctors $500 each and gave them three meals.

Forest and Lilly said yesterday that the events did not violate the medical association's guidelines because the doctors were paid for working as consultants. Both companies say they carefully follow the guidelines.

Dr. Timothy Franson, Lilly's vice president for clinical research and regulatory affairs, said the Jan. 8 dinner was not token consulting. The meeting was four hours, he said, and the doctors were asked for their impressions of the clinical data and about how they make decisions on treatment and medicines.

Dr. Franson said that $500 for four hours of a doctor's time is not unreasonable.

Kenneth E. Goodman, president and chief operating officer of Forest, said the event at the Plaza was not aimed at persuading doctors to prescribe Celexa. "These doctors were sitting there for four hours providing their advice," he said. "Our company very carefully adheres to the A.M.A. guidelines."

The amount that drug companies spend to court doctors has been rising steadily for several years. The companies spent almost $2 billion on events for physicians in the first 11 months of last year, compared with $1 billion for all of 1997, according to the consulting firm Scott-Levin.

The A.M.A. began a campaign this summer to educate doctors on its ethics guidelines. About $700,000 of the campaign, which is expected to cost more than $1 million, was paid for by drug companies, including Lilly, Merck and Pfizer (news/quote), according to the A.M.A.

On Wednesday evening, representatives of the A.M.A. and the major drug companies met in Washington to discuss several issues, including gifts to physicians.

Dr. Andrew M. Thomas, an internist at the Ohio State University Medical Center and an A.M.A. member who is helping coordinate the education campaign, said that before it began, many drug companies were clearly violating the guidelines.

"The number of events that were clearly overstepping the line seems to have now decreased," he said.

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