US drug industry bans expensive freebies for MDs, Canada raises fines

The new marketing code of ethics for drug detailers in the US has outlawed a battery of expensive giveaways, while the revised Canadian code has simply expanded on what giveaways are allowed and increased potential fines facing drug companies.

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The new voluntary code from the Pharmaceutical Research and Manufacturers of America (PhRMA), which went into effect July 1, states that all interactions between physicians and detailers must be focused on information. This means that tickets to sporting events and Broadway plays, free music CDs, rounds of golf or expensive dinners are now forbidden, while pizza lunches or other modest meals are acceptable as long as the gatherings also deliver benefits to patients and cost under US$100. The code also spells the end of free travel to medical conferences (except for speakers) and of payment for time spent at CME events.

The changes are at least partly in response to public objections to free items or benefits for doctors, says PhRMA spokesperson Dr. Mark Horn, the director of medical alliances in corporate affairs at Pfizer. Adbusters, W-FIVE and the New York Times have drawn attention to the close relationship between the drug industry and physicians. The new code “clearly recognizes that there were a lot of actions under the rubric of education that weren't. We need, as an industry, to get back to basics.”

This is PhRMA's first code — previously it followed American Medical Association (AMA) guidelines.

US pharmaceutical companies spend about $16 billion annually on drug promotion.

Dr. Bob Goodman, director of the watchdog group No Free Lunch (www .nofreelunch.org), says the US code is a public relations exercise that may, inadvertently, be effective because the public has taken over the role of watchdog from the industry. He praises PhRMA for “taking the higher road because the AMA hasn't been a leader in ethics for us.”

In Canada, a revised code for members of Canada's Research-based Pharmaceutical Companies (Rx&D) doesn't limit freebies but it does get more precise about limits. For example, it spells out how to pay physician consultants and fund physician travel to international health education events. The maximum penalty for violating the Canadian code has tripled to $15 000, and there are now only 3 levels of violation instead of 4.

Jacques Lefebvre, Rx&D's executive director of communications and public affairs, says the latest revisions to the 10-year-old code are “a bit more precise. We don't want grey areas.” He said the changes are an effort to “ensure best possible marketing practices” and “respond to the environment,” but he declined to define “environment” or to comment on the new limits imposed by the US code.

Maximum fines in the US are $15 000, which Horn admits isn't much of a deterrent — Pfizer had sales of US$32 billion last year. “But we care deeply about our reputation, and that's the driver here.”

Industry watchdog Joel Lexchin, an associate professor at the University of Toronto, doesn't think any code set and monitored by pharmaceutical associations without public input can be effective. “I don't think industry should be monitoring its own promotions,” he argues.

Lexchin, who says industry marketing should be governed by an independent body with legal status, advocates a meaningful, escalating series of sanctions. The maximum sanction would be a ban on the promotion of individual products for a year “so that if companies keep violating, they will suffer substantially.”

He estimates that Canada's research-based companies spent $1.2 billion promoting their products in 2000. — Barbara Sibbald, CMAJ