B.C. Health Minister won't prevent gifts going to doctors

B.C. health minister George Abbott says he trusts doctors to police themselves and has ruled out taking action on controversial gifts and benefits from drug companies. Critics say these perks influence which drugs doctors prescribe and are fuelling PharmaCare’s skyrocketing drug-subsidy spending.

In an interview with the Georgia Straight, Abbott said it’s up to the medical community’s professional colleges to regulate gifts from drug companies. “We expect people to behave in responsible ways. I’ve no doubt there should be a line in respect of those kinds of gifts and benefits,” he said.

But defining that line is “in the purview of the colleges”, he said. Abbott also ruled out banning hospital doctors and residents from getting free pharma-sponsored meals at weekly and monthly staff meetings—a frequent practice at some hospitals.

“It’s not something that’s been brought to my attention,” he said. “I’m sure there is a line of responsibility on that. The [professional] colleges would define that line.”

Pharmaceutical lobbying of doctors, known as “detailing”, has come under growing scrutiny in B.C. and beyond. Two-thirds of doctors in the province say drug reps visit them at least monthly, according to a 2006 survey by the B.C. Medical Association. Forty-two percent of general practitioners are visited several times a week.

Studies say doctors who accept gifts like meals, trips, or free drug samples from drug reps are likelier to prescribe that company’s product instead of cheaper alternatives or treatments better suited to patients. Doctors in some cases are influenced to prescribe drugs for so-called “off label” uses that lack regulatory approval.

In one study, doctors cited pharma reps as their main influence when choosing which drug to prescribe. Some U.S. states have sharply restricted the gifts. But in Canada, the lobbying of doctors is subject to virtually no government regulation and is seen as a major reason behind soaring prescription-drug costs in B.C., where spending by the province’s PharmaCare drug-subsidy program has shot up 173 percent since 1996.

Abbott refused to criticize the interactions with doctors. He stood by his vow to scrap or overhaul the Therapeutics Initiative, a B.C.-funded program to independently evaluate drugs. The controversial move, expected to be announced this fall, was recommended by a provincial task force that included pharma lobbyists.

He denied that lobbyists “skewed” the task force and said he merely wants the program to be more “inclusive” and “transparent”—code words the program’s defenders say mean forcing it to include pharma-linked doctors in its evaluations.

Asked if a doctor with links to a pharma company should be barred from evaluating that company’s drug, Abbott said, “It’s difficult to say”¦I don’t know. You’d have to look at the details.”

Canadian Medical Association president Robert Ouellet also sees no need for action on how doctors interact with drug reps. “I don’t think there is much influence [on prescribing]. I’m not sure doctors will change their mind each time they see a rep,” Ouellet said, claiming that drug companies have changed their marketing in recent years and now give doctors fewer freebies.

Critics say doctors have shown they can’t police themselves. “Self-regulation is, by and large, a joke,” said Joel Lexchin, a Toronto doctor and professor of health policy and management at York University. “The codes are weak and not enforced by any active monitoring.”

Rx&D, the Canadian lobby group for brand-name drug companies, didn’t respond to a request for a phone interview, sending only an e-mail saying the group’s code of conduct “explicitly forbids our member companies to provide gifts or inducements of any kind to health-care professionals in order to promote their products and includes serious penalties up to and including expulsion for violators”.

But the B.C. Medical Association has depicted the Rx&D’s code as largely ineffectual. “Adherence to the [Rx&D] code is voluntary, and penalties are minimal,” it said in a 2007 report.

Alan Cassels, a University of Victoria researcher who studies drug-company marketing, told the Straight that doctors “say they’re being invited all the time [to pharma-sponsored trips and events]”.

The CMA helps promote some of those events. Its Web site has a page of education courses for doctors that includes a link for “2008 CME Cruises” as well as two courses sponsored by drug companies and nine others offered by MDcme.ca, a consortium of medical schools that includes pharmaceutical companies as sponsors.