Take a look at this article that expands our discussion from last week into territory beyond samples.
Where should healthcare providers draw the line? Is it where we recognize that there may be a conflict of interest? Or is it where our patients perceive that we may have a conflict?
What do you think of the article's stance? Should all gifts, no matter how small, be denied to providers? Should this be an individual decision, or should it be an organizational or institutional policy?
In what situations should we be required to declare a potential conflict of interest, and to whom should we declare them?
28 comments:
I think that small gifts should be okay. When someone in the health field goes out of their way, above and beyond their job to help someone, at least in my case I would want to show them thanks by getting them a little something. It would be just a way of showing that I was thankful since actions are louder than words. Plus by showing that it did mean something to you for them to go above the role of the job they may be more willing to go the extra mile again.
I think drug representatives are beneficial. Educating doctors on new medications available is needed because there may be a better alternative for some patients. I do not think all gifts should be denied to providers. Small gifts or lunch are almost necessary to even have your voice heard. Providers are busy and an incentive for their time is needed. Doctor’s always have the choice of prescribing that medication or not. The doctor can take the information given to them and either decide to use the drug or decide that they will not use the drug. Furthermore, drug representatives provide samples and coupons for medications that many patients need. Sample medications and coupons help to reduce health care costs, where many patients may not be able to afford the medication they need without samples or coupons.
Holly Stallings, P1
Receiving gifts from an outside source(marketer, pharmaceutical company, supplier, etc.) should be condoned at all times. It is important to realize that these outsiders are trying to influence the healthcare provider no matter how big or how small the gift. Sometimes genuine relationships form and gifts may be exchanged on appropriate times such as birthdays and Christmas, but even if relationships exist, the healthcare provider and ousider should use common judgement not to excange gifts "for no apparent reason". Even if the gift be out of charity, it may be perceived from others as trying to influence a desicion..
I personally do not have a problem with samples. I think it's a good way to "test drive" a medication before purchasing it, especially if it's expensive. That brings up the downside to examples. I've seen patients bring prescriptions to the pharmacy only to find that the medicine the doctor prescribed, which they have been taking samples of for a month, is expensive. The majority of the time the patients do not not get the medication. This is a problem within itself. However, we, as pharmacists, are there to help the patient find a suitable medication for a decent price.
Ryan Tucker, P1
UC Davis Medical Center reviewed this article when it was published and developed a System wide Committee to address the concerns raised. Our conflict of vendor relations policies are consistent with this article. Some very good reading on the need for these type of policies can be found at
http://www.pharmedout.org/index.htm
http://www.nofreelunch.org/
http://www.nofreelunch.org/
I do not have a problem with drug reps going out of there way to make a sale or providing samples. Most of the time the drug reps have to do something extra just to get a few seconds of the doctors time. The reps should be able to do their job with freedom. When it comes down to who gets the medicine it should be up to the doctor to do the right thing by deciding what prescriptions are written for people, not dependent on what they want but what they need.
I disagree with the article on several levels. I do not believe that all gifts, no matter how small should be prohibited. These gifts allow relationships to be formed between the healthcare professional and drug/medical device companies that benefit the patient. No gifts would often result in no communication. Pharmaceutical samples should not be regulated either, as these allow for patients whose medication is expensive to still be able to receive that medication. With that said, I believe it is the individuals’ decision as to whether or not to accept these gifts. Healthcare providers have the final decision to draw the line if a conflict of interest arises and it should be declared where the healthcare professional sees fit.
Kyle Crisco, P1
Class of 2015
Mentors,
Do you often see an acute increase in the number of a certain brand name medication written by the same physician? Have you ever suggested to the physician or the patient that there are alternatives that are cheaper and might be more appropriate? When is it ok to do this? Are you crossing a line by questioning the physician, or are you keeping your patient's best interests in mind?
Kelly Campbell, P1
I feel like there are certain gifts that should be acceptable. A few pens are not going to make the doctor feel obligated to prescribe whatever that drug is. Also, I don't see a problem with the drug representative providing lunch. This is probably necessary in order to get the doctor to sit down long enough to listen to what they have to say. Although I understand that some reps would probably try and push their limits, all gifts should not be forbidden. Plus, if the doctor is worth anything he's going to prescribe the best medication for his patient regardless of what a drug representative just brought him for lunch.
Bess Urie, P1
All gifts - no matter how small - develop a realtionship between the prescriber and sales representative. The prescriber develops a sense of "owing" to the representative. Patients drug costs increase as the prescriber writes for the most recent medication they were "detailed." Is this drug the best drug for me as a patient or is it because of the relationship between the prescriber and the rep? Could generic "X" work just as well and cost the patient less?
Ms. Campbell,before we implemented vendor relation guidelines, I could tell you which companies representative was in the clinc just be the prior authorizations the clinic would be asking for.
Another good resourse on the difference or lack of differences between the different products is the Oregon Drug Effectiveness Reviwe Project
http://www.ohsu.edu/xd/research/centers-institutes/evidence-based-policy-center/derp/index.cfm/
I don't feel like the drug reps influence the doctors decision in choosing a medication for a patient. Many times the free samples provide the doctors with an easier outlet than giving the patient a prescription. Most doctor's are set in their ways, if they feel that a particular medicine works better than they stick to that. However, drug reps do give doctors a little more education on certain medications, such as testosterone: now they are available in a few different dosage forms, and education the doctors on them and providing them with discount cards saves the patient money.
I'm torn. On the one hand, I know first hand the benefits of the coupons or samples that reps provide. Samples are a good way for a patient to test drive a medication before they pay a $50 copay for a drug that doesn't work. On the other hand, as the paper says, even small gifts or samples can unconsciously effect a physician's prescribing patterns. Overall, I think small gifts should be permissible. Possibly some sort of monetary cap could be put into place.
In my opinion, any kind of gift regardless of the size should be denied by health care professionals. most of the time these companies are giving out gifts to providers only for one reason, which is to influence the decision of the provider in terms of selling their products. I think, there should be strict rules to avoid these situations.
I do not think that pharmaceutical reps should be banned from giving reasonable gifts, but it should be regulated. They are in business to make money and I feel it is a nice gesture. I believe that the reps are a necessary part of the healthcare system because they educate doctors on the new medications that become available. However, they should not be allowed to give the doctors extravagant gifts along with presenting their product. Ultimately, I believe that doctors should prescribe medicine in a way that is going to be most beneficial to the patient, not the pharmaceutical companies.
conflict of intersest is very possible in terms of marketing strategies deployed by some drug representatives. Such strategies as we talked about can include gifts and an array of other things such as buying linch and so on, just so that the physicians are convinced to actually inocorporate the new medications into list of the regular drugs they prescribe. yes, some phyisicians, regardless of all these persuations will still stick to what they know however, there will always be those physicians who will definitely compromise and this may be rather, to the detriment of the patients' health. There should be some type of regulation so that such physicians will not cross the line.
Thanks
Jennifer Adjei P1
I believe that it is ok for the drug representatives to have this relationship with doctors where they can provide reasonable gifts such as pens or paper pads to promote a drug. Also, I agree with samples as a beneficial way to help patients as a test run for medications. In the end, doctors will be know if a medication will treat an illness or not regardless of what gift or prize they received to try to promote it, so if a certain drug is prescribed and samples are available, I view that as a cost alleviating way to help our patients and also to make sure he or she will not have any uncommon side effects before they go out and pay for a full months worth that they might not be able to use.
I disagree with the article on a few levels. I don't think that all small gifts should be thrown out. Drug representatives need gifts to basically even talk to a physician about their medication and if that is what they have to do then so be it. If we get rid of small gifts then it would be extremely hard for drug representatives to educate people on their product. I know that most people think that the drug might cost more than usual or does just as good of a job as a generic but it might also be a drug that shows improvements in a treatment or has less severe side effects. These are important things that physicians should know about when prescribing medications that could be beneficial to the patient. With that said, it should be the healthcare providers responsibility to truly base their decision on a prescription for a specific drug on the patients health and costs benefits and not because of the gifts they receive from an outside source.
Nathan Batchelder, P1
Gifts given from drug companies disregarding how small can always seem to present a conflict of interest. Physicians normally have their own comfort level on the drugs in which they prescribe. Even a little initiative can be too far. If it goes as far as patients noticing this conflict there is not a doubt there should be a limit on giving gifts. Which can been seen in some cases.
Andrew Helms
There needs to be a balance between profits and patient well being when it comes to drug development and sales. The ultimate goal should be patient well being, since we are all in the healthcare field and this is our primary job. However the pharmaceutical companies still need to make a profit. If they did not, they would shut down, for not a lot of people in this country will work for free. That being said, gifting is a way for them to ensure that their newly developed drug sees it's way into the marketplace. Whether this is because doctors feel an obligation to prescribe it, or just because it is on their minds. Regardless of the reason these gifts help it find its way into use by doctors who can then make judgement as to its efficacy. In doing this the pharmaceutical companies still make their money(if their drug works and continues to be prescribed), and patients get the care and medication they need.
I don't like the idea that drug representatives try to "win over" doctors. Not only do they just try to win them over, but they must also succeed as drug companies still see representatives as economically favorable for them. When doctors allow themselves to be schmoozed, it conflicts with their professionalism and the objective advice that the public expects of them. No matter the gift's size, there is expected reciprocity on the doctor's part that can interfere with optimal patient care. Therefore, gifts should be eliminated.
Kim Tooker
P1
The idea of any sort of gifts can actually be consider a conflict of interest. One has to consider the conflicts of interest that are present for all healthcare professionals not just the benefits that doctors receive since that have all kinds of appreciate weeks (i.e. nurses appreciation week) which are usually sponsored by some of sort of major corporation.
After reading the article, I do not believe that all gifts should be prohibited. However, when drug reps are giving out long trips to Hawaii and expensive presents, it is obvious they are trying to influence the doctor and not just trying to stimulate a relationship with the physician. I think that small gifts such as lunch or something inexpensive are necessary to get a good running communication between the doctor and the drug reps. It is important for drug reps to get their drug samples into the physician office so that doctors can test out these new drugs so they are not blindly prescribing them. However, I have heard some people say that patients begin to rely on free samples then all of the sudden realize that they cannot afford them once they are forced to pay for the prescription.
J Crump -P1
I think that gifts from the drug reps, within reason, are the only way most people will listen to them. They are doing a job and trying to sell something, which in the long run supports the industry and the research that drives it. Anyone that has ever had to listen to a rep knows that the drug is usually presented as the greatest in its class and the hyperbole continues in the presentation of the statistics. I don’t care how many pens or counting trays a rep gives out, I don’t think a rational medical professional is going to be swayed by a sales pitch over legitimate research regardless of cheap freebies. Large gifts of course present a possible issue, and what constitutes the point a small gift becomes an inappropriate gift has to be defined somewhere. I could see legislation defining "appropriate gifts" as being reasonable.
Jonathan Graham P1
I think that drug representatives are a good way to get new drug information to physicians. These drugs could actually be a better fit for some patients than their current medications. If a drug is not appropriate for a patient, then a doctor should have no problem not feeling obligated to prescribe said drug. Some small gifts such as lunches provide an opportunity for a physician to hear about innovative medications that could be a good fit for their patients. This is an issue that is largely under the control of the physicians rather than the drug representatives.
I think that Small gifts such as pens, sticky notes, trays etc are not a big deal. They can be useful and still convey the message a sales person is trying to get across. Large extravagant gifts are not ok though. I fail to see how it is cost effective for the drug company especially in the long term but also because it is a conflict of interest if a company flies you to Jamaica for a conference or buys your staff or you dinner at a nice restaurant. At that point, it stops becoming a gift and starts to become a “political” bribe type of thing. Patients can suffer if doctors are only willing to prescribe drugs because of what they get verses what the patient needs. The same can be said when pharmacists recommend a drug to a physician. However, Drug reps trying to push new drugs are not bad. A new drug might be much better than an old dug and if we impose too many restrictions on drug reps then it will be harder to determine if new drugs are effective.
I believe that it is important for the drug reps to give out small gifts, but as many others this industry is supported by how much money is made by selling pharmaceuticals. Therefore it is important for doctors to support the drugs that do the most good and prescribe them so that companies can then put money into more research to help further pharm research. These gifts will probably not sway doctors unless the doctor believes that the drug is good...or at least I hope doctors think like this.
John K
I feel that the ultimate responsibility in this matter comes down to the actual physicians. Unless laws are enacted, no one is going to be able to stop pharmaceutical reps from doing their job, so it is up to the actual physicians to make sure that they consider every possible medication for their patients while taking affordability into consideration.
Pharmacists have the obligation to serve the community with the fullest of pharmaceutical knowledge in order to serve their patients one hundred percent. Any kind of conflict of interest, whether it is an employee issue, a drug rep issue, or a patient issue, should be quickly resolved and should not affect the work of the pharmacists and the environment of the pharmacy. Conflicts of interest are easy to come across while in the position of being a pharmacist. It is important to know the rules and regulations, how to spot conflicts of interest, and how to resolve them in a quickly and in an efficient manner.
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