Influencing Doctors
How Pharmaceutical Companies Use Enticement to 'Educate' Physicians

By Brian Ross and David W. Scott

http://abcnews.go.com/sections/primetime/2020/primetime_020221_detailmen_feature.html

Feb. 21,2002 - It was doctors' night out last June at the
world-renowned Museum of Modern Art in New York City,
and the Saturday night party, put on by Pfizer Inc.,
was lavish.
The event was strictly private, closed to reporters,
as the pharmaceutical company entertained a very
select list of doctors and their guests. But
Primetime's undercover cameras saw the kind of
big-money splurge that some say drives up the cost of
prescription drugs and corrupts the practice of
medicine.
Further investigation into the $6 billion spent by
drug companies for what they say is a way to educate
doctors showed that tactics like lavish gifts and
trips are surprisingly common.

"It's embarrassing, it's extravagant and it's
unethical," said Dr. Arnold Relman, a Harvard Medical
School professor and the former editor of the New
England Journal of Medicine. "It makes the doctor feel
beholden . it suborns the judgment of the doctor."

But doctors seemed thrilled to have been invited for a
weekend in New York City with some seminars along the
way, with all expenses paid by Pfizer on behalf of one
of its drugs, Viagra.

One Small-Town Doctor: $10,000 in Goodies

Few doctors were willing to talk publicly about their
relationships with pharmaceutical companies, but one
upstate New York doctor was willing to come forward.

"It's very tempting and they just keep anteing it up.
And it's getting harder to say no," said Dr. Rudy
Mueller. "I feel in some ways it's kind of like
bribery."

Disgusted by how the free gifts and trips add to the
high price of medicine, and moved by the plight of
patients forced to skip needed medication, Mueller
agreed to provide Primetime with a rare glimpse of the
astounding number of drug company freebies he was
offered by various drug companies in a four-month
period.

He was presented with an estimated $10,000 worth,
including an all-expenses-paid trip to a resort in
Florida, dinner cruises, hockey game tickets, a ski
trip for the family, Omaha steaks, a day at a spa and
free computer equipment.

"It changes your prescribing behavior. You just sort
of get caught up in it," said Mueller, who said he was
offered a cash payment of $2,000 for putting four
patients on the latest drug for high cholesterol. The
company called this a clinical study; Mueller called
it a bounty.

"I've never been offered money before," he said. "I
don't remember that 10, 15 years ago."

Though Mueller normally declines the offers, he agreed
to attend a dinner, which Primetime secretly taped.
Not only were the doctors wined and dined, but each
was also offered a payment of $150 for just showing up
to listen to a pitch for a new asthma treatment for
children.

The company called it "an honorarium," but Mueller saw
it differently. "Again, it's bribery," he said. "This
is very effective marketing."

There's a wide range in value of the free gifts
offered to doctors - from lavish trips to free
Mother's Day flower bouquets for doctors willing to
hear a pitch about a new osteoporosis medicine.

In the latter example, when asked whether a floral
shop was the most effective place for a discussion on
pharmaceuticals, one of the representatives said, "I'm
sorry, we're not allowed to comment on anything."

Detail Men

The goodies are dispensed by an army of drug company
representatives known as detail men and women, of whom
there are 82,000 nationwide.

It's the job of the detail people to quietly befriend
doctors, keeping close track of which doctors take the
free gifts and then determining which drugs the
doctors later prescribe.

"I think it's sleaze," said Relman. "Anybody who's
been in that position knows that yes, those gifts,
$60, $100, $40, again and again, do influence your
attitude about that company . and will influence the
prescriptions that you write."

And the multibillion-dollar drug company blitz extends
throughout the profession, even at the yearly
gathering of one of the most prestigious medical
groups, the American College of Physicians. It was
like a carnival: Doctors could be seen taking free
massages, free food, free portraits, free Walkman
players, free basketballs, and from one company
pushing a new antacid drug, free fire extinguishers.

Many doctors say it's no different than any other
business or convention, and that it doesn't affect
their medical judgment. But that's not the view of the
new president of the American College of Physicians,
Dr. William Hall, who says anything beyond a pen or a
mug could have an impact.

"Whether we like it or not, it can cloud our clinical
judgment," he said. "Unequivocally, I would say that."

So why are some of the very practices Hall publicly
criticizes permitted at his group's supposedly
scholarly convention? "I think there it's a situation
where every physician is going to have to balance
what's right or wrong," said Hall.

"We are concerned about it.," he added, saying that at
some point the system may be changed.

But right now, Hall's group receives $2 million a year
from the drug companies to have their exhibition
booths at the convention, yet another example of how
the big drug companies spend billions to influence
doctors in this country.

"The basic mistake we're making with our health-care
system now is that we regard it as just another
business. And it's clearly not just another business.
Patients, sick patients and worried patients, are not
like ordinary consumers," said Relman. "Doctors ought
to be incorruptible . That's the doctor's sacred
obligation. They're being corrupted and undermined by
this kind of salesmanship."