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Drug Firms Cut back on freebies for doctors Print E-mail
Aug 14, 2007
Drug firms cut back on freebies for doctors
By Salma Khalik , Straits Times

 

WITHOUT fanfare, an association of drug companies here has put the brakes on a longstanding industry practice of entertaining their best customers - doctors.

Gone are treats to meals and drinks at top-notch restaurants, and overseas conference trips with costly extras like golf, cruises and tours.

Instead, the Singapore Association of Pharmaceutical Industries (Sapi) introduced a code of conduct last year spelling out the limits on entertaining doctors.

It decided it is all right for a drug company representative to treat a doctor to 'inexpensive' food and drinks, provided this is not worth more than $20 a time.

A gift for a festive occasion is fine, if it is worth $50 tops.

A doctor can be given medical items like thermometers, but the value cannot exceed $100 each time. And gifts of medical books cannot be worth more than $500 a year.

What is not allowed: picking up the tab for golf games and skiing trips, cruises, theatre tickets or nightclubbing.

Those who breach the code can be fined up to $10,000 and may also have to pay administrative charges of up to $10,000. But Sapi will act only if an official complaint is made.

Sapi president Michael Khor, who is country manager for Pfizer, explained: 'Industry relationships with the health-care professional must support and be consistent with the professional responsibilities health-care professionals have towards their patients.'

In other words, doctors should not let freebies - or the lack thereof - affect their decisions on medicine to prescribe.

Sapi felt it had to act last year because people generally take their doctor's advice when it comes to prescriptions.

Drug companies here spend about $60 million a year - roughly 9 per cent of sales - on promoting their products.

As they are not allowed to advertise directly to consumers, they spend the money on educating doctors and providing free samples which are not meant for sale.

The Singapore Medical Council's ethical code states clearly that a doctor 'shall not ask for gifts, hospitality or other inducements that may affect or be seen to affect his judgment in making decisions about patients' treatment'.

When the drug companies put on a conference here or overseas, they need doctors to attend, listen to the experts and, possibly, be convinced that the drugs being showcased are worth prescribing.

It is a business, and the drug companies do throw in incentives to encourage doctors to leave their clinics and attend.

But industry players say some doctors have been known to drop big hints that they expect invitations to expensive restaurants, karaoke lounges and nightclubs.

'Why do you think most drug reps are sweet young things?' joked an industry player.

Overseas conferences are a favourite among doctors.

Sapi rules allow the drug companies to spend up to 25 per cent of the total cost of the trip on entertaining doctors. This could be a significant amount if the doctors fly business class - and some have apparently made it plain they expect no less.

These trips usually come with extras like tours, entertainment, food, shopping and sight-seeing.

The hospitality is frequently extended to accompanying spouses, though recently, most drug companies expect partners to pay their own way, except for hotel rooms.

What has changed with the Sapi code is that doctors have begun paying their way for some of the extras.

When a drug company invited doctors to South Africa last year, for example, it organised a side trip that included a safari - but the doctors who took the tour shared the cost.

Sapi's rules, in force since March last year, are said to have gone down well with most doctors, including some who thought the wining and dining unnecessary.

Dr Daphne Khoo, head of endocrinology at Singapore General Hospital, recalled how she recently told a drug company which sponsored her trip to a diabetes conference in the United States that she did not need the 'extensive' list of social activities planned for her.

The sponsor told her some doctors insisted on seeing the social programme before deciding whether to go.

She said: 'I can understand why a private specialist may want to see what's provided before they accept such invitations. They sustain a loss when they close their clinics to attend such conferences.

'But I feel strongly that public sector doctors should not accept anything beyond the level Sapi allows. We are paid while we are away. Our organisations expect us to spend that time acquiring knowledge or networking.'

The word is that the drug companies have tended to woo specialist doctors and high-end general practitioners the hardest, as they are more likely to prescribe expensive medicines.

Dr Peter Yan, a cardiologist in private practice, said overseas conferences are good as they help doctors keep abreast of new medicines and their effects.

They can influence a doctor's choice of drugs to prescribe, he said, but only if the results of large-scale trials are convincing.

The social programme on such trips is least important to him. 'I often fly in for the conference and leave immediately after,' he said.

He has found that Singapore doctors who attend overseas conferences generally do use the time well.

Dr Yan approved of Sapi's new rules, but added that some drug companies are now so stringent, they no longer provide even breakfast or transport between hotel and conference venue.

'Now, I sometimes feel neglected,' he said with a laugh.

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