Overall spending on pharmaceutical promotion increased more than 10 percent last year, to $13.9 billion from $12.4 billion in 1998. Experts estimate that the companies collectively spend $8,000 to $13,000 a year per physician. In recent years, as demands on doctors’ time have grown more intense, pharmaceutical marketers say they have been forced to become more creative.
“You have to have a hook,” said Cathleen Croke, vice president of marketing for Access Worldwide Communications Inc., which specializes in drug marketing. “If you offer them $250, that might get them. Or they are attracted to the prestige of being a consultant, that a company is asking for their opinion.”
The offer of dinner and a $250 consulting fee was sufficient to draw about a dozen South Florida physicians to Morton’s in West Palm Beach on Sept. 18. They gathered there, on a muggy Monday night, in a back room called the boardroom, where a slide show and a moderator from Boron, LePore & Associates Inc., the market research firm hosting the event, awaited their arrival.
Dr. Moskowitz, who has been in practice in West Palm Beach since 1978 and heads a group of 12 doctors, says he routinely receives – and rejects – such invitations.
The Morton’s dinner was not open to the public; had Dr. Moskowitz accepted, he would have been required to sign a confidentiality agreement. Instead, he told the companies he intended to take a reporter for The New York Times.
But when Dr. Moskowitz and the reporter showed up at Morton’s, the Boron LePore moderator, Alexander Credle, told them to leave. “This is a clinical experience meeting, a therapeutic discussion,” Mr. Credle said. “There is an expected degree of confidentiality.”
Dr. Moskowitz asked Mr. Credle why he was invited; Mr. Credle had no answer. But in an interview a few weeks after the dinner, John Czekanski, a senior vice president at Boron LePore, said the invitations were “based on databases targeting physicians” who prescribe cholesterol-lowering drugs or who might.
Boron LePore calls these dinner sessions “peer-to-peer meetings,” and in 1997, it acted as host at 10,400 of them. Typically, they feature presentations from medical experts, on the theory that doctors are receptive to the views of their peers. With new drugs coming onto the market all the time, physicians are hungry for information about them. Pharmaceutical companies say it is that desire for education, rather than a free meal or modest honorarium, that draws many doctors to the meetings.
But the dinners are creating unease among officials of the American Medical Association’s Council on Ethical and Judicial Affairs, which in 1990 published guidelines that limit what gifts doctors may accept. The guidelines, which have also been adopted by the Pharmaceutical Research and Manufacturers’ Association, the drug industry trade group, prohibit token consulting arrangements, but permit “modest meals” that serve “a genuine educational function.”
Compliance is voluntary, and Dr. Herbert Rakatansky, who is chairman of the A.M.A.'s ethics council, says doctors routinely ignore the rules. That is in part because they are murky, as the dinner at Morton’s reveals.
Whether the dinner was intended to educate doctors, or was part of a marketing campaign, or both, is not clear. In the $7.2 billion market for the cholesterol-lowering drugs known as statins, Baycol ranks last in sales, with just $106 million in sales last year. Bayer and SmithKline Beecham recently introduced a new dosage for the drug, and the companies said they used the Morton’s meeting to share new clinical data with doctors.
“As far as we’re concerned, it’s educational,” said Carmel Logan, a spokeswoman for SmithKline Beecham. But Tig Conger, the vice president of marketing for cardiovascular products at Bayer, said the company intended to teach a select group of doctors about Baycol, then use their feedback to hone its marketing message. And Allison Wey, a spokeswoman for Boron LePore, said the dinner was “part education and part marketing.”
While Dr. Rakatansky, of the A.M.A., could not comment specifically on the Baycol meeting, he had harsh words for these dinners in general.
“We think 99 percent of those are shams,” he said. “They are marketing devices and not true requests for information.”
As to whether the dinner fit the “modest meal” criteria, that, too, is unclear, because the guidelines offer no specifics. At Morton’s in West Palm Beach, the entrees range from $19.95 for chicken to $32.95 for filet mignon – a la carte. The sales manager, Lauren Carteris, said the restaurant frequently was the site of pharmaceutical meetings for Boron LePore.
“Doctors,” Ms. Carteris said, “will only go to an expensive restaurant.”
To heighten doctors’ awareness about the ethics of accepting gifts, the medical association is beginning an educational campaign. In addition, The Journal of the American Medical Association devoted the bulk of its Nov. 1 issue to conflict of interest in medicine, including an essay entitled “Financial Indigestion” that questioned the effects of pharmaceutical company gifts on doctors’ professional behavior.
But some prominent doctors say the medical association needs to address its own role, as a seller of information that helps drug marketers select which doctors to target.
“It potentiates this gift giving, and implicitly endorses it,” said Dr. David Blumenthal, a professor of health policy at Harvard Medical School who has used the A.M.A.'s data for his academic research.
(New York Times, 16 Nov. 200, p. A1)
