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Prescriptive payoffs

MagazineFebruary 1991 (Vol. 1 Issue 11)Prescriptive payoffs

Doctors prescribing vitamins from Lamberts for a variety of illnesses have been receiving 'royalties' whenever patients phone in ordering the supplements

Doctors prescribing vitamins from Lamberts for a variety of illnesses have been receiving 'royalties' whenever patients phone in ordering the supplements.

According to Duncan Campbell, writing in the the Independent on Sunday, Lamberts Dietary Products, based in Tunbridge Wells, set up a doctor commission scheme for any supplements mail ordered by their patients. Speaking on behalf of Lamberts, Lynn Collins affirmed that Lamberts had a royalty scheme entitled 'optional professional consideration' but that the company had decided to terminate the practice in early September.

WDDTY abhors any practice that provides an incentive, however small, for doctors to prescribe in a particular way. We suggest that when readers being prescribed vitamins phone up for orders that they ask if doctor royalties are being paid from their order and to request that they be deducted from their their final bill. What Campbell failed to do, in an article brimming over with the outrage of a new discovery, was to place this practice in context by mentioning how riddled all of medicine is with such inducements.

In February 22 issue of the New England Journal of Medicine, one Michael A. Jenike of Harvard Medical School defended his receipt of support from pharmaceutical companies for clinical trials of new drugs 'both through financial reimbursement and in supplying experimental agents that have been of great help to patients.' Although he has rarely been pressured to adopt a certain viewpoint when paid to speak at a drug sponsored symposium when it has happened, he says, thankfully it has been 'low key'. He drew the line, however, at one all-expense-paid symposium where not only he but all 100 of the attendees and their spouses were being put up by the drug company, with travel expenses, hotel room, open bar and meals being paid for. Each doctor was personally invited by his drug company sales rep assigned to him; of the two mornings' worth of lectures, the final two related to the company's drugs, one of which was presented by a doctor in the employ of the drug company.

In a series of letters in the New England Journal wrestling with the issue of where, ethically, to draw the line, Dr Sheldon D. Solomon of Cherry Hill, New Jerse, provided a particularly graphic example of the lengths to which drug companies will go to peddle their wares to individual doctors. 'Recently, one of the local drug-company representatives asked to bring lunch to our entire office crew. We have 22 people, plus four physicians, who work here on any given day,' wrote Dr Solomon. 'The next day another drug representative offered me a series of fine prints if I would allow her to come to the office more frequently to visit me.'

In our view, Dr Allan Glass of Washington, D. C. has the best idea. An Army medic, he believes the only position to take is the purist one adopted by the American military for all personnel, which prohibits the acceptance of any gift over $10 from any company doing business with the government. For military doctors, this means no free lunches, no paid holidays, no honorariums - nothing much besides ballpoint pens. The advantage of the military is a means of enforcement with some teeth in it - in this case, criminal prosecution.

The only way to keep doctors impartial is to make acceptance of any kickbacks, gifts, vacations, fine prints or any other inducements, however small, illegal. In attempting to single out 'alternative' practitioners treating with 'possibly dangerous' supplements, Mr Campbell might also mention that these kickbacks, however deplorable, are small potatoes compared to the perks, incentives, funding and seduction carried out by drug companies on doctors treating patients with drugs whose actions and long-term effects are often far less understood.

Lynne McTaggart

See you in court, doctor

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