Freebies, farewell: New PhRMA guidelines restrict gifts, permit educational items

March 1, 2009

National report - Dermatologists won't miss the free pencils, notepads and posh dinners that new Pharmaceutical Research and Manufacturers of America (PhRMA) guidelines prohibit companies from providing, say physicians contacted by Dermatology Times.

Key Points

National report - Dermatologists won't miss the free pens, notepads and posh dinners that new Pharmaceutical Research and Manufacturers of America (PhRMA) guidelines prohibit companies from providing, say physicians contacted by Dermatology Times.

And although some worry that these guidelines might crimp funding for medical education, at least one manufacturer's representative says this is unlikely.

Effective in January, PhRMA updated its voluntary Code on Interactions with Health Care Professionals to address everything from sales representatives' interactions with physicians to manufacturers' relationships with physician advisers, clinical investigators and medical societies.

PhRMA's 31-page code permits sales reps to supply "occasional" in-office meals of modest value, but it nixes providing prescribers with off-site meals and entertainment, or distributing logo-bearing incidentals such as pens.

However, educational items such as anatomical models and patient brochures are permitted, logos and all, says Ann Kaplan, PhRMA vice president and general counsel.

Giveaways detract

"There wasn't anything unlawful or unethical about what companies were doing," Ms. Kaplan says. But freebies detracted from the educational nature of physician-pharmaceutical company interactions, she says.

"I'm not quite sure" what the function of these giveaways was," Ms. Kaplan says. "But I don't believe they influenced prescribing behavior."

Dermatologists agree, to a point.

"I'll be writing with a drug-company pen and won't even know whose name is on it," says William Philip Werschler, M.D., president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Freebies: How will new rules impact medical education?

Freebies: How will new rules impact medical education?

However, David S. Balle, M.D., a Grosse Pointe, Mich., dermatologist in private practice, says that with more extravagant items such as travel, "that probably influences (doctors) on some subconscious level. And the more extravagant the gift, probably the greater the tie or feeling of obligation to do what the pharmaceutical representative wants."

In fact, some ethics researchers contend that any gift creates such an obligation, and that arbitrary dollar limits don't work (Katz D, Caplan AL, Merz JF. Am J Bioeth. 2003 Summer;3(3):39-46).

Free keychains don't sway doctors, but drug-company stipends and consulting fees do, adds Wendy Lewis, president, Wendy Lewis & Co., Global Aesthetic Consultancy.

"In many cases, doctors make more money lecturing than they do in clinical practice," she says. "And it would be hard to say with a straight face that there hasn't been some undue influence exercised in terms of podium presentations and favorable reviews for products and devices."