Imagine walking out of your doctor’s office just as a pharmaceutical sales rep is walking in. The rep shows up with lunch for your doctor and the staff and is also carrying brochures about the medication your doctor just prescribed for you. It would make you wonder, wouldn’t it? Am I about to start a treatment that my doctor thinks is best for me? Or is this the product of someone’s free lunch?
You’d be right to have that suspicion, and you’d have research to back you up.
Decades of studies make it clear that meetings between doctors and pharma reps lead to changes in the way physicians prescribe medications—notably, that doctors who receive even small gifts from pharma reps are more likely to prescribe certain medications than those who don’t. And a study just published last week shows that an increase in marketing of opioids is associated with more deadly opioid overdoses one year later.
This isn’t a patient access issue. There are specific guidelines for when these medications should be prescribed, and no one is being denied the medications they need when pharma sales people aren't delivering catered lunches to doctors' offices. Rather, this is evidence of over-prescribing, as well as prescribing the brand name when the generic would do, which drives up health care costs.
Philadelphia City Council is currently considering a bill that would ban gifts from pharmaceutical companies to doctors, and it’s critically important that this ban go into effect. When your health is on the line, you need to trust that your doctor has your best interest at heart and isn’t influenced – consciously or not – by profits, gifts, or other benefits, even those that may seem small on the surface.
This bill will do three things:
It will require pharma sales representatives to register with the Philadelphia Department of Public Health.
Reps will have to share their promotional materials with the department.
It will ban companies from giving gifts of any kind – large or small – to doctors.
The first two points are common sense requirements that will improve transparency. On the third point, as scientists, we only need to look at the evidence to see that passing this bill could have a measurable impact on public health. The new study found a connection between opioid prescriptions, overdose deaths, and pharma payments to doctors. The authors say policymakers should look to plans like the one proposed here in Philadelphia as part of the solution.
However, limiting this ban to opioid makers only would be short-sighted and dangerous. Overprescribing of medications for heart conditions, depression, and others represents its own patient safety issue as well as a financial burden on people who current evidence shows are already paying for medications they may not need.
Opponents of the bill claim it would be bad for business, leaving Philadelphia on the outside looking in as pharma industry opportunities pass the city by in favor of “friendlier” rules elsewhere. To that, we at Penn Medicine can point to our own experience. We banned pharmaceutical company gifts to our clinicians 12 years ago, but continued collaboration with industry has helped discoveries made in our laboratories and tested in our hospitals find their way to more patients each day. These partnerships have led to global scientific breakthroughs like immunotherapies for cancer that not only have real, life-saving benefits for patients, but also establish Philadelphia as the epicenter of the rapidly-growing cellular therapy industry – a so-called “Cellicon Valley.”
The relationships academia has with pharmaceutical companies are important, and open conversation between industry and physicians can lead to greater education on both sides and serve as an inspiration for new ideas. But those relationships must be carefully managed, and evidence shows that gifts – even something as small as a free lunch – influence the behavior of doctors and put patients in danger.
The city of Philadelphia has a chance to stand up and take action on behalf of people all across this region who want nothing more than to know they can trust their doctors when they need them the most. It’s important our leaders don’t lose sight of that opportunity.
Patrick J. Brennan, MD, is the Chief Medical Officer for the University of Pennsylvania Health System.