As of Thursday, you’re going to see a lot less of something the next time you visit your doctor: pens, Post-It notes, clipboards, flash drives, and other items branded with a pharmaceutical product’s logos. Watchdog groups have long claimed that these items should be banned because they influence doctors’ prescribing habits. Is a cheaper generic drug just as good for you as a branded version? You might get prescribed the expensive brand anyway, argue such groups, because the doctor just got a desk clock splashed with the logo and colors of the expensive drug.
Although Congress has not yet placed an outright ban on these gifts, PhRMA (Pharmaceutical Research and Manufacturers of America), an industry group based in Washington, has agreed to a moratorium on them beginning this year. PhRMA claims that the move is not an admission that gifts influence prescribing behavior, but rather a chance for pharmaceutical companies to focus on their educational relationship with doctors.
PhRMA’s decision worries me, and it’s not just because I work for a pharmaceutical advertising agency. Why? Because as much as this moratorium is much-vaunted as being “voluntary,” it really isn’t. Pharmaceutical manufacturers do not want to stop giving out pens and notebooks. PhRMA is creating “voluntary” restrictions so as to avoid
voluntary regulation from Congress that would create harsher bans: for example, some industry critics would prefer if drug reps were not allowed to see doctors at all, much less drop off a box of free pens on their way out. In their dream world, doctors would get all of their information from supposedly unbiased sources, meaning anywhere but the pharmaceutical industry.
People who assume that the drug industry is out to get you, and that any contact between pharmaceutical companies and the doctor is bad, are making a plethora of bad assumptions: First, that the doctor is too stupid to evaluate information for himself. Is he really going to prescribe one painkiller over another just because he has a shiny new pen — or because he listened to a sales rep whose presentation was all style and no substance? Are we really going to accuse people who have been through at least four years of postgraduate education, plus rigorous training once they’re out of medical school, of being as gullible as that? I have yet to visit a doctor who prescribed me a branded drug willy-nilly. The experience I’ve had with my gynecologist is, I suspect, far more typical: When he talked to me about various birth control pill options, he told me that Seasonale (which was, at the time, not available as a generic) would not be any better or worse for me than taking a generic Pill and skipping the placebos, but that my insurance might make co-pays for the latter option tricky because I’d be taking the generic on a non-FDA-approved schedule. My doctor gave me all the information. He didn’t leave anything out because the Seasonale rep left him a gift.
Second, that pharmaceutical companies lie about their products. A company that commits fraud is not going to stay in business for long, and even one that overhypes the benefits of its products to a degree short of fraud can’t fool the consumer forever. The path to long-term success lies in mutual trade to mutual advantage — not fleecing consumers for as long as a company can get away with it.
Third, that third-party sources are automatically “better” sources of information. Who would know more about a drug than the manufacturer of the drug itself? Doctors should be able to weigh information from as many sources as they choose when making treatment decisions.
And fourth, that gifts automatically lead to prescriptions. You’ve probably noticed on a trip to your doctor’s office that he doesn’t have just one kind of branded pen or notebook — he has them in every color of the rainbow, from every pharmaceutical company. Even if your doctor
easily influenced by these gifts, the fact that he’s getting them from a number of different companies who are competing with each other would mean that he’s going to have to go back to making up his own mind.
PhRMA is making a bad assumption, too, or at least they’re hoping that their assumption — “If we voluntarily cut back on tchotchkes, we won’t have to stop doing the other things we like to do, like have our reps make presentations to doctors” — is true. But the moratorium hasn’t shut up the watchdog groups at all — they’d still like nothing better than to muzzle pharmaceutical companies completely. Just make your drugs and keep quiet! And if they can sway enough politicians, PhRMA and the companies it represents may find themselves facing the very regulations they’re trying to avoid.
It would be better if PhRMA were to stand up and make a principled defense of pharmaceutical companies’ right to free speech. Pharmaceutical companies have the right to offer gifts, and doctors have the right to refuse such gifts. Patients, too, have the right to pay attention and quit seeing a doctor whom they think is unduly influenced by pharmaceutical company gifts. What’s not a right? Watchdog groups don’t have the right to use the government to restrict voluntary associations between pharmaceutical companies and doctors.

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