Wednesday, January 15, 2014

No more "Gravy Train"

According to the New York Times, drug manufacturers have paid doctors to "speak on their behalf at conferences and other meetings." The presumption being that doctors speaking highly of a medication will cause conference attendees to trust that medication and thus prescribe it. They note that "all such payments by pharmaceutical companies are to be made public next year under requirements of the Obama administration’s health care law." The new law is not precluding the activity, but will perhaps make the practice more transparent.

Thus, the announcement in mid-December that GlaxoSmithKline has decided to discontinue the practice or paying doctors may be of questionable importance, at least in this country. The recent Glaxo announcement says that it will cease paying doctors to speak “to audiences who can prescribe or influence prescribing.”

Another move announced by Glaxo will eliminate commission compensation for Glaxo sales representatives worldwide. The article says that Glaxo ceased using that system in America in 2011. Currently, some companies pay sales forces based upon how many prescriptions are actually written for a particular medication. It is unclear whether other pharmaceutical companies continue the practice in the United States.

According to the Times, some feel that commission compensation has "pushed pharmaceutical sales officials to inappropriately promote drugs to doctors." The Times article suggests that commission compensation encouraged sales representatives to promote prescribing various medications for "off label" uses. That refers to use for maladies or conditions for which the medication was not approved by the Food and Drug Administration. 

The medical new site Medpage Today, titled their coverage of this change by Glaxo as "GSK Halts the Gravy Train." In a second article the same day Medpage questions whether the Glaxo decisions/changes be the "tipping point" that will encourage change by other medication manufacturers. Both are interesting perspectives.

It will be interesting to see if other manufacturers follow the lead regarding payment to physicians for promotion of their medications. Is medication prescribed because it is the most effective or the most beneficial or because it is in someone's economic interest that it is prescribed?

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