Giving Up on Small Gifts

The Pharmaceutical Research and Manufacturers Association this morning will unveil a voluntary code asking member companies to give up the practice of showering drug logo-bearing small gifts like mugs, pens and mousepads on physicians. Both the New York Times and Wall Street Journal report that the code won't limit the consulting and speakers fees earned by so-called key opinion leaders who encourage other doctors to use particular pharmaceuticals.

Critics, while welcoming the move, will continue to push for the Physician Payments Sunshine Act, which requires disclosure of such gifts, according to the story. It seems to me that PhRMA's endorsement of a ban, while voluntary, should embolden the bill's sponsors to include that more far-reaching step, at least on small gifts.

But even if the chotzkes disappear from physician offices (as I write this, I'm staring at the Vioxx-labeled reflex hammer that a physician-friend gave me as a present a few years ago), this PhRMA guideline doesn't get at the most significant ways that drug companies (and medical device and biotechnology companies, who aren't covered by this voluntary guideline) influence medical practice.

Doctors in community practice take their cues for the most part from their professional societies, from the leading journals in their fields, from their annual continuing medical education classes, and, most importantly, from what will be reimbursed. With that thought in mind, here's a starter list of items that ought to be banned:

* Clinical practice guidelines that are written by physicians who double-dip on industry's payroll;

* Clinical practice guidelines that are underwritten by professional societies that accept cash from firms with a stake in the outcome;

* Continuing medical education classes that are underwritten by the drug and medical device industries (Pfizer recently announced it would stop underwriting CME at for-profit CME providers, a start);

* Medical journals allowing industry-funded physicians to write reviews and conduct meta-analyses that outline the "state of the science" in their medical fields; and

* Reimbursement guidelines that rely on compendia that are written by clinicians with financial ties to firms whose products they are evaluating.