Ethics Catches Up to the Golden Age of Medicine

DANIEL S. GREENBERG

November 26, 1991|By DANIEL S. GREENBERG

WASHINGTON. — Washington -- The medical profession is trying to shake off the seamy tradition of doctors accepting gifts and holiday travel from pharmaceutical firms that want them to prescribe their pills.

The move, praiseworthy and long overdue, is notable, not least for the list of dealings that are now shunned and that were formerly tolerated.

One step ahead of fulminating congressmen, the ascent to the )) ethical high road has been led by the American Medical Association, closely followed by the Pharmaceutical Manufacturers Association. The latter group, Washington lobby for the seducers, has pledged adherence to an AMA manifesto, ''Guidelines on Gifts to Physicians from Industry,'' which the AMA put into effect last month.

To assist physicians in following the rules, the AMA has published a series of questions and answers about the beneficences that they may and may not accept from pharmaceutical firms.

NTC The list invites wonder about the world of modern medicine. For example:

''Q. May CME [Continuing Medical Education] conferences be held in exotic places, such as the Bahamas, Europe or South America?

''A. They can be held anywhere as long as attendees pay their own travel.''

''Q. May a company rent an expensive entertainment complex during a medical conference and invite attendees?

''A. No. The guidelines permit only 'modest' hospitality. This would include inexpensive boat rides, barbecues, local performers. In general, such events should be open to all registrants.''

''Q. In cases when a physician may accept free travel, lodging or meals, does this also apply to the spouse?

''A. Only when the extra subsidy is 'modest.' For example, a modest meal is permissible, and the hotel room may not cost much more for a second person, but a second airplane ticket would be unacceptable.''

''Q. May companies send their top prescribers or referrers [of the company's products] on a cruise?

''A. No. For the reasons stated above.''

''Q. May industry hold a sweepstakes for physicians in which a few are selected for a trip to a specified destination to a medical meeting of their choice?

''A. No. The use of sweepstakes or raffle to deliver a gift does not affect the permissibility of that gift.''

Heavy and imaginative spending on gifts for doctors is a well-established practice in the pharmaceutical industry, with the tab in 1988 totaling $165 million, according to a survey conducted for hearings last December by the Senate Labor and Human Resources Committee.

Among the practices revealed were ''frequent prescriber'' points for physicians favoring a particular drug -- with the number of prescriptions translated into airline mileage.

The going rate for a doctor's willingness to hear a drug pitch was reported to be $100 cash and a good dinner.

A former promotion executive for a major pharmaceutical firm told about a company-sponsored ''night at the opera for psychiatrists attending a meeting in New York. Singers performed a recital of the great neurotic episodes from opera. The program described each condition, advertised our drug and conferred credits for medical education on the doctors who attended this marvelous gala.''

And then there was the doctor who testified that he responded coolly to a pharmaceutical salesman who urged him to make more use of one of his company's drugs. Not long after, the doctor agreed to ''cover'' for a partner bound for a Caribbean vacation.

The partner and wife returned, telling of a fine hotel, excellent food and snorkeling -- all at the expense of the salesman's company. The doctor who testified said that his holidaying colleague had also been cool to the drug, but upon returning from the islands he made it his ''drug of choice in all his patients.''

The guidelines adopted by the AMA and endorsed by the Pharmaceutical Manufacturers Association are advisory rather than mandatory. It's too early to tell whether they will bring an end to the golden age of medicine.

Daniel S. Greenberg publishes the newsletter Science & Government Report.

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