As reported by The Hartford Courant, April 26, 2007.

Study: Most Doctors Take Freebies

Drug, Supply Companies Have Offered Everything from Pizza to Luxury Conferences

By William Hathaway

The next time your doctor prescribes something, consider this:

Nearly every physician in the United States, a total of 94 percent, has received something for free from a drug or medical supply company - usually meals and drug samples, according to a survey published in today's issue of the New England Journal of Medicine.

Slightly more than a third of doctors went further, taking more valuable freebies from drug companies - reimbursement for medical education fees or meeting expenses. One in four were paid outright for speaking fees, consulting, service on an advisory board or referring patients to clinical trials.

The survey - which puts hard numbers on a widely debated practice - did not, however, directly address the central question that still divides doctors: Do the drug company sales pitches influence how doctors treat patients?

"That is a difficult question," said Dr. Joseph Klimek, vice president of medical affairs at Hartford Hospital. "Some of these guys say, `I don't order antibiotics based on who bought me donuts this morning.'

"But in my travels I have seen physicians who are influenced by what drug companies make available."

There is plenty of evidence that drug company marketing practices do influence doctors - sometimes in ways that lead to less than optimal care for patients, said David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital and Partners Health System in Boston, one of the study's authors.

The survey of 3,167 physicians in late 2003 and early 2004 was prompted by excesses in marketing practices in the late 1990s, when pharmaceutical companies doubled their sales forces to try to make up for a lack of new blockbuster drugs, Blumenthal said.

Drug reps not only swarmed doctors' offices armed with free drug samples and pepperoni pizzas, but some doled out sports and theaters tickets, staged elaborate parties and sent doctors on all-expenses-paid trips to conferences at luxurious resorts.

"They were thinly disguised payments" to doctors by drug companies, Blumenthal said.

But until the survey was published today, nobody knew quite how common the practice was. Food in the workplace was the most common perk - with 83 percent of doctors reporting free chow.

Drug samples were second, with 78 percent getting free drugs.

The practices of accepting food and samples divides doctors. Some argue against accepting even a pen from a drug rep, while others say that free samples help poor patients and that lunch rewards hardworking staff.

"Ask 12 doctors and you will get 13 opinions," said Dr. Stephen O'Brien, a family practitioner in Enfield.

O'Brien said that doctors in his office generally do not meet with drug reps, but will accept samples, which they tend to hand out to poor patients. The office only rarely accept lunches from drug reps, he said.

The journal's survey broke down the survey by specialty. Family physicians such as O'Brien were twice as likely as cardiologists to meet with drug reps, but cardiologists were more than twice as likely to receive some sort of payment for consulting, speaking or other activities, the survey showed.

That makes sense because specialists are much more likely to prescribe intensive therapies, said Dr. William White, professor of medicine at the University of Connecticut Health Center and member of the Pat and Jim Calhoun Cardiology Center.

"Anywhere you write a lot of prescriptions, those are specialties I suspect are targeted" by drug companies, White said.

As the excesses of the late 1990s came to light, many hospitals began to adopt guidelines that limit what doctors can accept from drug companies, White and Klimek said.

At UConn, employees can not take gifts valued at more than $50 and must gain approval of superiors if taking speaking or consulting fees. Doctors must also show that that work is done on their free time, White said.

Hartford Hospital in 2003 adopted similar restrictions.

Drug companies in recent years have also adopted their own ethical guidelines limiting what sales reps can offer doctors. And more recently, many major drug companies have cut back on the sales forces that work with doctors. White suggested because there are fewer drug reps, there are fewer egregious abuses than there were 10 years ago.

"I have heard that anecdotally," Blumenthal said.

He noted however that at one point in the 1990s there was a drug rep for every five doctors in the United States.

"Even if that ratio is one in 10, that is still a lot of drug reps," he said.

Drug companies also seem to have made a decision that advertising drugs directly to consumers is more effective than lobbying doctors, he said.

Blumenthal notes drug company marketing practices can be a good thing - if they call attention to the benefits of aggressive treatments of conditions like high cholesterol or diabetes.