[e-drug] Massachusetts moves to curb drug vendors

[richardl@bu.edu]

E-drug: Massachusetts moves to curb drug vendors
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[This article appeared in today's (1 August 2002) Boston Globe. Copied as
fair use]

Mass. General moves to curb drug vendors
Concerns on influence spur hospital actions

By Liz Kowalczyk, Globe Staff, 8/1/2002

Massachusetts General Hospital executives, worried that pharmaceutical
company sales representatives have easy access to its hundreds of doctors
and residents, are adopting new policies to restrict vendors.

The hospital's move comes as concern grows nationally over the influence
drug firms wield over doctors.

Each day, dozens of drug and medical equipment company employees descend on
Mass. General's lobby  desk - stationed there to assist patients and
families - as ''physician locators'' and ''appointment makers'' so they can
get in to see doctors, hospital executives said.

New rules that went into effect this summer prohibit this practice and
require sellers to make appointments with doctors before coming to the
hospital. It also bars them from parking in Mass. General patient and
visitor garages. During a recent survey, parking attendants recorded 65
sellers parked in hospital garages.

''What we're trying to limit is vendors coming into the hospital
unannounced,'' said Dr. Jean Elrick, senior vice president for
administration. ''For doctors, it's a little like telemarketers calling you
during dinner.''

A separate, related policy applies specifically to pharmaceutical company
representatives and is expected to be approved by the hospital's medical
policy committee in September. These rules will bar vendors from promoting
drugs that are not on the Mass. General formulary - an approved list of
drugs that doctors can prescribe. Formularies allow hospitals to tightly
control medication costs and save hundreds of thousands of dollars.
Drug companies that want to promote or ''detail'' their drugs to groups of
Mass. General physicians will have to notify the hospital 48 hours in
advance, so the hospital can send its own pharmacists to ''counter-detail''
with objective information.

While the hospital has strengthened its policy, it's far from the strictest
in the country. Mass. General still will allow drug companies to sponsor
lunches for hundreds of residents - as long as the department head approves.
But the hospital's chief medical officer, Dr. Britain Nicholson, said the
meals will be discouraged. Many days, drug companies provide the meals that
residents, or doctors-in-training, eat during their noon conferences with
senior physicians, which Nicholson said saves residents time running to the
cafeteria.

''If evidence suggests that even these innocent lunches influence the
prescribing patterns of residents, then we would come back and look at a
stricter policy,'' he said.

Nicholson said the new policies will tighten the hospital's control over
sales representatives, who some physicians say have enjoyed nearly
unfettered access at an institution where more than 3,500 doctors,
residents, and clinical fellows work. ''We want it so they're just not
wandering floor to floor leaving information and handing out pens,'' he
said.

Federal and state prosecutors, concerned about rising drug prices,
increasingly are probing sales forces that improperly induce doctors to
prescribe their company's drugs. Some medical centers in Massachusetts and
across the country are adopting policies even stricter than Mass. General's.
Cambridge Hospital forbids companies from promoting drugs to doctors at the
hospital entirely, and does not allow them to buy meals for residents. ''We
take a harder line,'' said Dr. Rich Boehler, chief medical officer. ''When
reps detail large numbers of doctors, you see a spike in the use of that
product. The tactics do work, and we want to reduce the likelihood of people
being influenced.''

The policy at Johns Hopkins Hospital in Baltimore ''is being extensively
reviewed,'' a spokesman said. And in Seattle, Polyclinic, a large
multispecialty physicians group, is charging drug companies for access to
its physicians until the end of the year - when it will develop a formulary
and prohibit detailing altogether.

Jeff Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers
of America, said the organization does not keep statistics on whether more
hospitals are limiting access for drug company representatives, but has
heard scattered reports from around the country that they are.
Hospital detailing accounts for a small percentage of overall drug company
promotional spending - but it's a portion that has rose steadily until
falling slightly last year. Drug companies spent $702 million in 2001
pushing their drugs to physicians and pharmacists in hospitals, while
spending $19 billion total on promotion, mostly on free drug samples and
advertising directly to consumers.

It's unlikely hospital detailing will disappear, partly because academic
medical centers need drug companies as much as drug companies need them.
Mass. General and other academic medical centers receive millions of dollars
a year in research funding from pharmaceutical companies.
''Obviously there are places like Mass. General where these concerns have
surfaced,'' said Mary Anne Rhyne of GlaxoSmithKline. ''But if the medicines
you make can only be used in a hospital setting, like certain cancer drugs,
then there's no way around it. You have to detail in that setting.''

Liz Kowalczyk can be reached at kowalczyk@globe.com <mailto:
kowalczyk@globe.com>.


Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118 USA
Tel 617 414-1444 Fax 617 638-4476
E-mail richardl@bu.edu


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