December 27, 2007
Doctor Combats Pull of Drug Reps
He's in the lead of a drive to curtail effects of industry freebies.
By Kris Hundley
James P. Orlowski may not be the only doctor in the Tampa Bay area who has given pharmaceutical
sales reps the boot.
But he's the only one listed in the online directory of No Free Lunch
an organization opposed to accepting freebies from the pharmaceutical industry.
That means Orlowski, chief of pediatrics at Tampa's University Community Hospital, rejects all drug company goodies, from free pens to expensive dinners. By doing so, he's rebuffing a well-oiled marketing machine that spends about $7.2-billion a year wooing doctors and another $18-billion on sample drugs.
Pharmaceutical salespeople, known as drug detailers, generally soft-pedal their spiel, casting themselves as trusted resources for both research and free medicines. But when they talk to doctors, well-trained reps know exactly how much of their product the doctors have prescribed in the past. The reps' goal is simple: increase it.
Orlowski said that when he was a struggling medical student at Case Western Reserve 33 years ago, no one discussed the ethics of accepting drug company gifts, and freebies like medical instruments and textbooks were hard to resist.
"Then I saw research that showed these gifts have tremendous influence on prescribing practices, though physicians always deny it," Orlowski said. "There's no way I was going to let a drug company gift influence my decisionmaking."
Orlowski refuses to see drug reps and has refused to let the American Medical Association sell personal information that makes it possible for pharmaceutical companies to track his prescribing habits.
What's more, Orlowski, 60, has used his position to influence University Community Hospital's policy regarding pharmaceutical reps. Where they once wandered freely through its halls, dispensing doughnuts and free lunches, drug reps are now restricted to certain areas of the hospital and are not allowed to approach students, doctors or nurses or host lunches.
Orlowski also tries to instill a wariness of pharmaceutical reps in the medical students who rotate through his department. A recent survey of all U.S. medical schools by the American Medical Student Association found that only five institutions completely restrict drug reps' access to their campuses and hospitals.
The University of South Florida's College of Medicine, which reportedly is in the process of drafting a policy regarding student interaction with drug reps, received a "C" from the group.
Orlowski, who mentors students from USF as well as Nova Southeastern College of Medicine in Fort Lauderdale, said he often finds pharmaceutical companies' pens in students' pockets.
"I ask them if their interactions with drug reps are in the best interests of patients or if they help them in the practice of medicine," he said. "I believe the answer is no."
Though Orlowski was an early opponent of pharmaceutical marketing, there is a growing sensitivity to the issue among doctors in private practice, hospitals and medical schools.
Research has repeatedly shown that even inexpensive giveaways like coffee mugs create a sense of obligation and influence prescribing habits. According to a study that appeared earlier this year in the journal of the American College of Obstetrics and Gynecology, "Even small gifts produce in their recipients a disproportionately powerful willingness to reciprocate in some manner."
While free samples might seem to help patients initially, they also result in doctors prescribing expensive brands over generics which may be just as effective. And "research" on new products provided by drug reps is often biased and incomplete. "Free information is worth about that," said Orlowski, who relies on the independent publication Medical Letter for drug research.
Rob Restuccia, executive director of the Prescription Project in Boston, said the billions spent on drug marketing to doctors undermine professionalism, increase cost and undermine care.
"From all angles, it's an important issue that is symptomatic of a lot of problems in the health care system overall," he said. "And it's essentially gone unregulated."
The intensity of the industry's marketing blitz was tracked recently by a member of the National Physicians Alliance, a 10,000-member group that supports a ban on all gifts.
Over a six-week period, the doctor, an internist in Minnesota, turned down 12 free breakfasts, 18 lunches, 16 branded pens, a branded eyeglasses cleaner, two branded pen lanyards, branded pill holders, Post-it Notes, notepads, a pocket Physicians Desk Reference, correction paper strips, a coffee mug, a poster, a highlighter, a diagnostic manual, a giant clip-refrigerator magnet, a ruler, a water-oil globe, a History of Viagra book and a Viagra soap dispenser.
About a dozen states, including Minnesota and Vermont, require drug companies to disclose gifts to doctors. Earlier this year, Sens. Chuck Grassley, R-Iowa, and Herb Kohl, D-Wis., introduced a bill that would make such reporting mandatory nationwide. Florida has no law or pending legislation to require drug companies to report physician gifts.
"Normally I don't like seeing the government get involved," Orlowski said. "But this type of public exposure is likely to influence doctors."