Net profits lure doctors to drug reps

DOCTORS are being offered up to £1,500 a year in return for letting drug industry sales reps into their surgeries, Scotland on Sunday can reveal.

Under the controversial ‘cash-for-access’ scheme, GPs will be paid 15 each time they fill in an ‘appraisal’ of the pharmaceutical firm representative who visited them.

Critics say the move sidesteps rules which ban drug companies from making direct payments to doctors for agreeing to see their reps. It is expected to guarantee up to a third of a million extra visits annually to GPs by reps who will plug the latest branded drugs.

Concern is growing about the close links between GPs and the pharmaceutical industry. The tendency of some doctors to prescribe branded drugs where generic alternatives are available has left the NHS with a multimillion-pound headache.

NHS administrators estimate that questionable tactics to protect branded drugs cost Scotland 14m a year, at a time when prescribing budgets are spiralling out of control and health boards are in financial deficit.

Greater Glasgow’s drug costs are currently increasing by about 1m a month.

The new internet-based service, GPreply.net, was launched two weeks ago to provide "feedback" on marketing to pharmaceutical companies. It has already recruited hundreds of doctors and has a target of 3,000 GP members across the UK.

Doctors are being offered 15 each time they send in their view about an individual visit from a drug rep. That information will then be sold to drug companies who want to monitor the efficacy of their field marketing.

The catch is that doctors also have to agree to a minimum of two appointments with a rep per month.

Advertising in the medical press points out that sending an appraisal via computer should take no longer than three minutes, equivalent to 300 an hour.

It also says "just two" appointments every week will net a doctor 1,500 a year, which can be paid directly into their individual bank account.

If GPreply.net reaches its target of 3,000 GPs, and each of them agrees to see two reps per week, the total number of rep visits generated will be 312,000 per year.

The industry code of practice, drawn up by the Association of the British Pharmaceutical Industry (ABPI), prohibits manufacturers paying doctors to see reps.

Dr Des Spence, who has set up a lobby group called No Free Lunch to campaign against undue incentives from drug companies to doctors, said: "I am very uneasy about this. It seems from an outsider’s point of view to be paying doctors to see reps."

Spence, a GP in Maryhill, Glasgow, said the industry’s marketing guidelines were being "consistently bent or interpreted in their broadest sense".

He added: "This is how they [the industry] wield their influence. But all this money is circular. It comes from the cost of drugs, so that is then passed on to the NHS."

Spence called for tighter regulations on companies to curb abuses.

Margaret Davidson, chief executive of the Scotland Patients’ Association, said: "Blatantly trying to get into doctors’ surgeries like this is wrong. Not only that, but if doctors see as many reps as this how are they going to see enough patients? It’s ridiculous."

Shona Robison, the SNP’s health spokeswoman, said: "I’m very concerned about this. Doctors should see reps from pharmaceutical companies because they want to know more about the product. Any financial incentives could raise concerns that the best interests of patients are not the primary consideration."

The British Medical Association Scotland, which represents the country’s GPs, declined to comment specifically on GPreply.net.

A spokeswoman said: "We would have no fundamental objection to doctors taking part in market research or other similar activities and being paid appropriate sums of money for their time.

"However, the important issue to be addressed is whether or not GPs’ or any other doctors’ prescribing practices are inappropriately influenced by pharmaceutical companies. It would not be acceptable if this were the case."

SRMD Ltd, the company behind GPreply.net, strongly denied it was aimed at anything other than market research.The firm, based in Guildford, Surrey, is run by managing director Mike Hawthorne and chairman Tony Norrington, who both have experience in the pharmaceutical marketing industry.

Norrington said: "This is strictly a market research tool. We definitely would not pay a doctor to see a rep because it’s the feedback that’s important. Research has shown that doctors find seeing medical reps a valuable source of information."

Norrington, who has worked as a rep in the past, said the total number of visits to doctors produced by the new system was "very small" and "absolutely miniscule" compared with the millions made each year in the UK in total.

He said there had previously been a culture of offering doctors "freebies", but added: "The profession and the industry have decided those sorts of things have to stop."

Jim Eadie, director of the ABPI Scotland, said: "The code of practice for the pharmaceutical industry prohibits company representatives from paying or offering a fee for the grant of an interview. Companies can conduct genuine market research in order to obtain feedback from GPs."

Earlier this year, Scotland on Sunday revealed that the number of times pharmaceutical companies have been caught breaking the industry’s own marketing rules has risen by nearly 50% over the past two years.

The Prescription Medicines Code of Practice Authority, an arm of the Association of the British Pharmaceutical Industry, recorded 315 breaches of its code of practice in 2001, representing a rise of 48% from 213 in 1999.

Companies have also been accused of inventing conditions, such as complications of diabetes and female sexual performance problems, in order to promote new drugs as treatments.

MARKET FORCES

DRUG companies aim to protect their products against competition from cheaper ‘generic’ alternatives. By law, a manufacturer is allowed 10 years’ protection for a branded drug under a patent, during which time competitors are not allowed to produce copies.

Shopping online with Boots the chemists, eight Nurofen pain relief tablets currently cost 99p. Nurofen is a brand name for tablets which contain ibuprofen, which is also sold generically. Boots’ own-brand ibuprofen costs 1.20 for 16 tablets. Clarityn, a branded hayfever remedy containing loratidine costs 4.89 for seven tablets, compared with own-brand loratidine tablets at 4.39. Prescription drugs show much more variation. Prozac, the anti-depressant developed by US firm Eli Lilly, can cost four times as much on the internet as its generic equivalent.

Generic drugs are estimated to save the NHS in the UK 4.6bn per year. The average cost for a generic prescription is 4.07, while the average cost of a branded ‘originator product’ prescription is 18.49. However, manufacturers of brand-name drugs point out that they pioneer the medicines and pay for years of research and development.