Barbarians at the garage gate

Can you feel it? Can you sense the electricity in the air? That’s the exciting buzz of change on the way. Because come next Monday, everything will be different.

As of next Monday, July 1, 2002, pharmaceutical companies and their salespeople will have new guidelines to follow concerning their relationships with physicians. These guidelines are clear and detailed. But above all, they arevoluntary.

First the facts

Last April, the Executive Committee of the Pharmaceutical Research and Manufacturers of America (PhRMA) unanimously adopted a new marketing code that will, to use its phrase, “govern the pharmaceutical industry’s relationships with physicians.” This is in response to a rising tide of criticism about drug company perks offered to doctors. The perks can range from the low rent, such as filling up a doctor’s car with gas, to far more luxurious all-expense paid junkets to conferences.

PhRMA would have us believe that these new rules of the road will rein in the sometimes wild excesses drug salesmen use to win over doctors and healthcare professionals. But PhRMA is not a governing body. It’s a trade organization. And one of its primary functions is to polish the public image of its industry and its membership that includes giant drug companies such as Bristol-Myers Squibb, Pfizer, Novartis, Merck, etc.

So, does the new code have teeth? In a word: no.

First of all, let me repeat: it’s voluntary. They’re asking salespeople to show restraint even if their competition does not. A long shot proposition at best.

Second: for more than a decade the AMA has had very similar guidelines in place. In fact, they revised them last summer and then kicked off a high-profile campaign to get the word out to doctors and pharmaceutical reps. If those guidelines didn’t have any effect, who is really going to pay any attention to this new “code”?

And third: fortunately for the sales reps, these clear and detailed guidelines are full of hazy language and loopholes. For instance, throughout the document you’ll find phrases like “reasonably necessary,” and “appropriate use,” and “reasonable compensation” – all providing plenty of “reasonable and appropriate” wiggle room when it comes to interpretation. And the code still allows the irresistible “consultant” loophole – that is: drug companies can hire doctors as “consultants” and send them to conferences, all expenses paid.

Can’t we all just get along?

Okay, I’ll try to play nice for a minute.

The PhRMA code is not a set of binding regulations. It’s a set of guidelines. And that’s a good thing. In general, we work with our peers to find a consensus of values and boundaries. Then, if everyone isn’t on the same page, well at least we have a page that we can point to and say, “there, that’s our ideal,” and we hope everyone will strive to meet the standards of that ideal.

But down in the trenches it’s a different story. The salesman is motivated to sell in a marketplace where the competition is fierce. So it would seem that if anyone is going to enforce this code it would have to be the only ones who are present at the point of contact with the pharmaceutical reps: the doctors. If the doctors “just say no,” then the problem vanishes. But so far, there haven’t been a lot of “no’s.” (Want proof? Remember when I told you that the New England Journal of Medicine announced it had to change it’s editorial policy because there weren’t enough doctor/authors who were not receiving compensation from the pharmaceutical companies?)

Who’s the loser? You and me, of course. The ones, for instance, who pay a premium price for a patent medicine when the doctor could just as easily write a generic prescription; the ones who pay more than we need to because a doctor over-prescribes a medication; or the patients who could be effectively treated with an inexpensive supplement but are prescribed a drug instead.

Back to the garden

I’m reminded of a story I once heard about a boy who saw his father put a small padlock on a garden shed. He said, “Dad, that little padlock wouldn’t keep anyone out.” And his father said, “I know. It’s just there to keep the honest honest.”

At best, that’s what the PhRMA code is: a flimsy padlock.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“PhRMA Code on Interactions with Healthcare Professionals” Pharmaceutical Research and Manufacturers of America
“PhRMA Adopts New Marketing Code” Press release, Pharmaceutical Research and Manufacturers of America
“Drug Industry Adopts Guidelines on Giveaways to Doctors” The Washington Post
“Drug-marketing Perks Curbed” The Washington Times