PBS Debate: Should doctors be paid by pharmaceutical companies to promote their drugs?

As Policy and Medicine reported on Dec. 17, GlaxoSmithKline (GSK) announced it will no longer pay doctors to promote its drugs, nor reward sales representatives based on how many prescriptions doctors write. PBS interviewed Dr. Jerry Avorn and Dr. Thomas Stossel, both of Harvard Medical School, about the business and ethical issues surrounding GSK's decision and whether doctors should be paid by pharmaceutical companies to promote their drugs.

Dr. Stossel spoke to the benefits of industry supported education. The relationship between doctors and drug companies "has been in parallel with improved longevity and life quality," he said, "so the idea that it somehow is problematic is just not clear." Dr. Avorn took the opposite side of the spectrum, stating: "I think it's much better for me to learn…from somebody who is an expert in the field, but who is not being paid to teach me by the company that is making the product that he is teaching about."

"I think Dr. Avorn and I would agree that it's very hard for doctors to keep up with information," Dr. Stossel responded. "New information is coming in all the time, and so it's vital that doctors have exposure to as much information as possible." Dr. Stossel believes that, especially in "orphan disease or a cutting-edge area such as cancer," new information about rapidly emerging technologies should get to doctors quickly. He stated, "whether or not they're scripted," doctors paid by industry "know a lot about the product in question," and can best help their patients.

GlaxoSmithKline

The doctors had differing views on GSK's decision to no longer pay doctors to promote its drugs or use sales targets for drug representatives. "I do think they're setting a good example," Dr. Woodruff said. "I wonder whether some of the other companies are going to hang back and see what is this doing to their sales, because you can probably sell more drugs when you can totally control the flow of information than if you just pay a hospital or a medical school to do whatever kind of education it wants."

Dr. Stossel believed that a one-size fits all approach is not the best for healthcare education. He worried that if companies, which don't have "the Glaxo profile," restricted the cutting-edge information given to doctors, the real victim would be patients.

Finally, Dr. Avorn put a plug in for "good old-fashioned generics," which he argued "work perfectly well, but no drug company is going to be paying somebody to go out and teach about that." Dr. Stossel again debated the over-expansive view of Dr. Avorn, stating, "The idea that old generics are as good as new products is sometimes true, but it is not always true, and that it needs to be viewed on a case-by-case basis."

Discussion: As the anti-industry commentator, Dr. Avorn raised some well-intentioned, but oversimplified point.

Dr. Avorn’s explanation of industry-supported education distorted the way the system actually works.  Because of the  FDA, mandates companies are forced to have physician speakers stick to scripted slides.   If the speaker, speaks off label, the companies can face significant fines and penalties.  Also, the physicians who speak  for companies are not forced to do so, but out of a myriad of motivations including helping other physicians understand new therapies.  The general argument is that doctors should not be paid for their time educating other doctors, but this does not make sense, one would not expect your plumber to work on your house without getting some type of compensation.  Why should doctors be forced to give away their time from their busy practices without some type of enumeration.

As GSK implements its new policies, it will be interesting to see both if competitors follow suit and the effect on GSK itself. Forbes.com argues that "one shouldn't underestimate the ultimate impact this will have on GSK's performance as a company." For one thing, "a really good sales representative would rather work at a company where he or she can maximize efforts – and income." Perhaps more importantly, GSK could lose licensing opportunities. Smaller companies, looking for an established company to partner their new experimental medicines, would likely prefer partners with a greater chance to maximize sales of the new drug. "If other pharma companies don't follow suit," Forbes believes, "GSK will be in a riskier competitive position in generating revenues for its product pipeline."