Can I Buy You Dinner? Pharmaceutical Companies Increasingly Use Doctors’ Talks as Sales Pitches

mPharmaceutical companies have significantly escalated the frequency with which they are paying physicians to promote their products to fellow doctors, according to a new report in the Wall Street Journal. A July 15th article by Scott Hensley and Barbara Martinez, documented that doctors delivered considerably more drug talks to other doctors last year than did the companies’ own sales representatives. The article shows that, based on data from the market research company Verispan, in 2004 “237,000 meetings and talks sponsored by pharmaceutical companies featured doctors as speakers, compared with 134,000 meetings led by company sales representatives.” In 1998, both doctors and sales representatives delivered only 60,000 talks.

The WSJ noted that this form of marketing has replaced earlier forms that contravened    the drug industry’s own 2002 “Code on Interactions with Healthcare Professionals.” Formerly, according to WSJ, pharmaceutical sales representatives would sweeten their sales pitch by “taking [doctors] on free golf outings or filling up their cars with a tank of gas,” practices that the code advises against. Pharmaceutical companies held conferences in vacation spots, paid  physicians to attend and only required a nominal “consultation” of them. Now, consultation and speaker training must be “bona fide,” according to the voluntary guidelines. These more ostentatious inducements of the 1990s are replaced by today’s more subtle practice of paying physicians to trade on the rapport and trust between them and their colleagues. 

The new form of marketing has proven both highly effective and highly profitable to the industry. Physicians turn out to be far more capable than pharmaceutical sales representatives in selling drugs to fellow physicians, internal documents from Merck show. According to a Merck slide show dated 2001 obtained by the WSJ, doctors who attended lectures given by their physician colleagues prescribed an additional $623.55 worth of Vioxx, which has since been removed from the market, during a 12 month period compared with doctors who did not attend a lecture. Those who attended smaller discussions led by doctors paid by Merck wrote $717.53 worth of additional Vioxx prescriptions, whereas those who attended a lecture given by a pharmaceutical sales representative prescribed $165.87 worth of additional Vioxx. Merck found that its return on investment for the physician-given talks was an impressive $3.66 for each one dollar invested compared to a more modest $1.96 per dollar spent for a talk given by a pharmaceutical sales representative, according to the WSJ.

The WSJ noted that the speaking engagements are frequently “small meetings, often over lunch or dinner” and describes the example of Dr. Lawrence Newman’s dinner discussion with a dozen fellow physicians. Dr. Newman is a professor of clinical neurology at Albert Einstein College of Medicine in New York City, and his talk was sponsored by the pharmaceutical company GlaxoSmithKline, the makers of the migraine drug Imitrex. According to the WSJ, Dr. Newman recommended that migraine treatment “should be bread and butter from primary care doctors,” and advised the attendees that a complaint of a sinus infection may actually be a migraine headache, which is treatable with migraine drugs. Glaxo’s sponsorship of the event included paying for dinner, paying Dr. Newman a speaking fee, providing some of Dr. Newman’s slides for his talk, and providing the attendees with Imitrex note-pads.

Other physicians who similarly sold their services to the pharmaceutical industry were featured as well in the WSJ article. In 2002, Dr. Subir Roy, a gynecologist on the faculty at University of Southern California contracted with Wyeth and was paid $61,250 in speaker’s fees and $11,117 in expenses for 53 speaking engagements, for an average of $1365 per engagement. According to the WSJ, an internal Merck document shows that Dr. David Pitts, an internist in New Mexico, spoke 134 times for Merck in 1999 to promote Merck’s cholesterol-lowering drug Zocor. Based on Dr. Pitts’ characterization of his popularity as a speaker and Merck documents describing lecturing fees, the WSJ estimated that Dr. Pitts was likely paid between $1500 and 2000 per talk for a total of $200,000 or more for the year.

The pharmaceutical industry has hit upon an extraordinarily profitable new form of marketing, in which indentured but respected physicians play a starring role. Doctor-salespeople bank on their reputation to push the company drug, and their trusting colleagues respond predictably by writing more scripts. Successful as a marketing technique, the dinner-infomercials inappropriately distort physician prescribing practices and therefore harm public health and increase the cost of our system.

In its July 19th issue, the Wall Street Journal reported on responses to the article they had run on the 15th. Doctors from around the country expressed disapproval of the practice of physician-delivered drug talks, the article pointed out.    Doctors expressed concern over the drug industry’s stark focus on profit at the cost of corrupting prescribing practices and driving up drug prices.

Dr. William Bernstein, a recently retired neurologist of Coos Bay, Ore., called the physician drug talks "a scandal in so many dimensions." The fact "that physicians take money from the big pharmas to speak and that they actually need to be trained to speak about something they're supposedly expert in" is bad enough. What is worse, said Dr. Bernstein, is that "their colleagues actually listen to them rather than, shudder, read and absorb the peer-reviewed literature.”

Bill Hemeter, an ophthalmologist in New Orleans, explained the cynical arrangement and its effect on drug costs for all consumers. "We all sit listening attentively to the propagandist du jour, and in return, get a free meal…They send out all these attractive young reps to wine and dine us and lay a guilt trip on us if we don't reciprocate. The real scandal is that the drug companies get away with charging so much so they can fund this largesse."

Robert Israel, M.D., a professor of obstetrics and gynecology at the University of Southern California maintains that "travel funds, honoraria for minimal consultant visits, lunch for students/residents/faculty, elegant dinners associated with product demonstrations, and guest lecturers with favorable views of donors' products are all suspect. They threaten our integrity and our ability to put patients first in our medical decisions."

While these responses prove that many in the medical community have a conscience and will speak out about this abusive form of   “education”, the pharmaceutical industry will continue to buy off those doctors who are willing to trade on their reputation to push pills for the industry. The criticism of their fellow doctors can do a certain amount to make the drug industry’s inducements to would-be physician-spokespeople less attractive, but the industry itself must be held accountable for paying off physicians and the recipient physicians have to answer as to why they are so bribable.