Physicians Try to Limit Outside Influence in Prescribing of Drugs

As sales representatives for pharmaceutical companies brought doughnuts and lunch over the years to physicians at the 20 Kelsey-Seybold medical clinics in the Houston area, Patrick Carter worked to limit their presence.

Carter, a family physician and managing director of care coordination for Kelsey-Seybold, said he wanted to remove the appearance that drug representatives influenced the decisions made by doctors when writing prescriptions. Since 2012, pharmaceutical representatives cannot stop by Kelsey-Seybold clinics or meet with its 370 doctors unless the physicians request an appointment for guidance in prescribing certain drugs. 

“It eliminated the idea that the drug rep is there every day bringing breakfast or lunch for everybody in the clinic,” Carter said.

While the rule banning drug representatives from visiting with doctors has been embraced at the Houston clinics, it is not standard procedure at most medical practices in Texas. But advocates for improving medical ethics say that it is a step in the right direction and that more doctors and medical facilities are imposing a ban throughout the state and across the nation. And it has some support from the pharmaceutical industry, which is looking to help improve ethical standards in health care while maintaining some aspects of the physician-drug representative relationship.

Since Kelsey-Seybold instituted the rule, Carter said he had heard from other doctors, particularly those who work at academic medical facilities, who are considering similar action.

Stephen Brotherton, a Fort Worth physician and outgoing president of the Texas Medical Association, said no specific figures exist on how many Texas practices have approved such bans. But he said that the direct physician-drug representative relationship is becoming less common because medical practices are trying to reduce disruptions to patient care while emphasizing the need to obtain medical information on pharmaceutical drugs from scientific sources instead of “trade sources.”

“It’s probably a little more unusual for a clinic or group to say ‘Don’t come at all unless we call you,’ but it’s quite common for people to be saying we’re going to reduce our contact with the pharmaceutical reps,” Brotherton said. 

As more medical practices adopt similar rules, pharmaceutical companies have worked to help with the medical industry’s transition away from having drug representatives in doctor’s offices, Brotherton added.

The pharmaceutical industry has also taken action to negate the appearance that gifts to doctors provide companies with special influence. In 2009, the pharmaceutical industry set a voluntary moratorium on giving branded merchandize — including pens, notepads and mugs — to doctors.

The moratorium was reflected in a revised set of guidelines from the Pharmaceutical Research and Manufacturers of America, a major Washington-based industry group that represents research-based pharmaceutical and biotechnology companies.

But the guidelines do not forbid all interactions with health care professionals. Drug representatives are permitted to provide physicians with “modest meals” but only if they are accompanied by an “informational presentation.”

Robert Zirkelbach, senior vice president of communications for PhRMA, said in a statement that organization respects “the independence of Texas physicians and entities involved in clinical research” who want to ensure that medical information is “interpreted fairly.”

But he added that representatives for biopharmaceutical companies do serve a purpose in doctors’ office by helping to keep physicians up to date on changes in medical treatments.

“Patients rely on advances in medicines to help them live better, healthier lives,” Zirkelbach said. “And achieving this medical progress requires collaboration between biopharmaceutical research companies and physicians.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Disclosure: Kelsey-Seybold has been a corporate sponsor of The Texas Tribune. The Texas Medical Association is a corporate sponsor of The Texas Tribune.  A complete list of Texas Tribune donors and sponsors can be viewed here.