Drug makers gift disclosures: the ethics issue

Drug company Eli Lilly has said that it will start disclosing the amounts of money over $500 that it pays to physicians – and other firms are likely to follow suit one jump ahead of a US Congress that is planning to mandate such transparency.

Research has shown that payments to doctors can influence behaviour. As Dr. Arthur L. Caplan (pictured left), director of the University of Pennsylvania’s Center for Bioethics, puts it: “[Disclosure] is a good thing because we have a great deal of evidence that gift-giving can influence behaviour in terms of prescriptions, publishing positive findings but suppressing negative findings, and generating enthusiasm for new drugs.” He cites the extreme example of Emory University ‘s Dr Charles Nemeroff, a psychiatrist who, according to Health Care Renewal, raked in hundreds of thousands of dollars as a paid speaker on behalf of drug marketers, and denied these earnings while running a government-funded project meant to evaluate some of the products of his commercial sponsors.

Dr. Caplan believes that “the ethical handwriting is on the wall.” In an interview with HOC , he said that even small gifts can sway doctors, and he cites articles in the Journal of the American Medical Association and the New England Journal of Medicine underscoring that. His own article “All gifts great and small”, which appeared in the American Journal of Bioethics (3, 2003:39–46), gives further weight to that contention – and policy makers, he says, are starting to pay attention. Caplan believes that Congress will enact disclosure legislation shortly after the new president is sworn in on 20 January.

So what can pharmaceutical companies do if legislation shuts the door on how they can forge useful relationships with the medical profession? Dr Caplan believes there are four ways:

• Rethink the traditional approaches of sponsoring dinners and trips, and focus on building useful websites for physicians; perhaps something similar to the SERMO approach (see HOC December 2007) – a social networking initiative involving physicians whose real life clinical experiences can be made available to pharma.
• Hold conferences and peer-reviewed public meetings for healthcare associations.
• Maintain registries of research, which would be a useful service for both physicians and patients.
• Think ahead to putting medical information on YouTube, etc, and make sophisticated information advertisments for doctors – turn DTC into DTDoc

Is $500 a suitable threshold for disclosure? Dr Caplan believes it is; he also thinks that device manufacturers should be included in any disclosure mandates.

With legislators and even medical associations such as the AMA and the Association of American Medical Colleges looking for a zero tolerance approach to drug company handouts to physicians, the industry would be well advised to develop a Plan B if it wants to influence physicians and stay within ethical boundaries.

Otherwise, recipients of drug company gifts might decide to do what one Minnesota hospital chain did. They swept them all up in 20 shopping carts and shipped them off to the West African nation of Cameroon.