Drug companies voluntarily cut swag to doctors

To Lehman Brothers, Linens 'n Things and the blank VHS tape, add another U.S. institution that expired in 2008: drug-company trinkets.

Starting Thursday, the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster goodwill and, some would say, encourage doctors to prescribe more of the drugs.

No longer will Merck furnish doctors with purplish adhesive bandages advertising Gardasil, a vaccine against the human papillomavirus. Banished, too, are black T-shirts from Allergan adorned with rhinestones that spell B-O-T-O-X. So are pens advertising the Sepracor sleep drug Lunesta, in whose barrel floats the brand's mascot, a somnolent moth.

Some skeptics derided the voluntary ban as a superficial measure that does nothing to curb the far larger amounts drug companies spend each year on various other efforts to influence physicians. But proponents welcomed it as a step toward ending the barrage of drug brands and logos that surround and may subliminally influence doctors and patients.

"It's not just the pens; it's the paper on the exam table, the tongue depressor, the stethoscope tags, medical calipers that might be used to interpret an EKG, penlights," said Dr. Robert Goodman, an internal-medicine specialist at Montefiore Medical Center in New York.

In 1999, Goodman started No Free Lunch, a nonprofit group that encourages doctors to reject drug-company giveaways.

The new voluntary guidelines try to counter the impression that gifts to doctors are intended to unduly influence medicine. The code, drawn up by Pharmaceutical Research and Manufacturers of America, an industry group in Washington, D.C., bars drug companies from giving doctors branded pens, staplers, flash drives, paperweights, calculators and the like.

The guidelines also restate the group's 2002 code, which prohibited more expensive goods and services, such as tickets to professional-sports games and junkets to resorts. It also asks companies that pay for medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside-program coordinators.

Some critics said the code did not go far enough to address the influence of drug marketing on medicine. The guidelines, for example, permit drugmakers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations.

"Pens or no pens, their influence is not going to be diminished," said Dr. Larry Greenbaum, a rheumatologist in Greenwood, Ind. He has made a point of collecting ballpoint pens advertising formerly heavily promoted medications, such as the painkiller Vioxx, that were later withdrawn after reports of dangerous side effects.

Giveaways, detailing

Last year, besides giving away nearly $16 billion in free drug samples to doctors, pharmaceutical companies spent more than $6 billion on "detailing," an industry term for the sales activities of drug representatives, including office visits to doctors, mealtime presentations and branded pens and other handouts, according to IMS Health, a health-care information company.

The industry code also permits drugmakers to pay doctors as consultants "based on fair-market value," which critics said means companies can continue to pay individual doctors tens of thousands of dollars or more a year.

"Financial entanglements at all the levels have the potential to influence prescribing in a way that is not good," said Allan Coukell, director of policy for the Prescription Project, a nonprofit group in Boston.

40 sign on

About 40 drugmakers, including Eli Lily, Johnson & Johnson and Pfizer, signed on to the code. Representatives of several pharmaceutical makers said their companies intended to comply with the guidelines, but they declined to discuss past marketing programs involving branded gifts.

While some doctors applauded the gift ban, others seemed offended by the insinuation that a ballpoint pen could turn their heads. "It seems goofy to us; we like getting our pens," Dr. Susan Hurson, an obstetrician and gynecologist in Washington, said in a telephone interview.

Hurson said she paid no attention to the logos on the pens she carries around in her doctor's coat, adding, "It's hard for me to believe it influences what you prescribe."