[india-drug] E-drug: Massachusetts moves to curb drug vendors

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E-drug: Massachusetts moves to curb drug vendors
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[This article appeared in 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.''


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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