concern over drug sales reps sitting in on treatments
2003 - Source: Associated Press
are letting drug company sales representatives sit in while they
treat patients - a practice called ``shadowing'' that is being questioned
by at least one professional group.
of psychiatrists says it intends to ask the American Medical Association
to review the ethics of the practice.
Sales reps have
been known to sit in doctors' offices and examining rooms and observe
routine checkups, various treatments and diagnostic tests, even
child psychiatric therapy. Some doctors are paid hundreds of dollars
Some, if not
all, of the pharmaceutical companies require the doctors to obtain
the patient's consent.
say these preceptorship programs, as they are formally known, are
purely educational, allowing sales reps to learn more about doctors'
jobs and better serve physicians who use their products.
see the efforts as an unethical marketing attempt that violates
the privacy of the doctor-patient relationship.
It is unclear
how widespread the practice is, but the players include major pharmaceutical
companies like Eli Lilly and Co.
Ed Sagebiel said the practice began at Lilly at least five years
ago and involves doctors of many types around the country.
Lilly's reps are told just to observe, not participate. Lilly's
policy says participating doctors must obtain patient consent.
say confidentiality and consent are especially problematic when
psychiatric patients and children are involved. Some question whether
parents can adequately represent their children's wishes.
Academy of Child and Adolescent Psychiatry plans to raise the issue
at the AMA's annual meeting in June in Chicago.
Dr. David Fassler,
a Vermont psychiatrist and member of the academy's governing council,
said he wants the AMA to come out against the practice unless patients
have ``full knowledge and informed consent.''
``It seems quite
inappropriate to have non-clinical personnel present during therapy
sessions,'' Fassler said in an interview this week. ``I'm also concerned
that patients may not always feel free to say no when asked by their
doctor if something like this would be OK.''
The AMA does
not have policy on shadowing, but one is needed - especially if
doctors are being paid, said Dr. J. Edward Hill, chairman of the
AMA Board of Trustees.
``I would be
extremely concerned about that being an ethical behavior,'' he said.
He added: ``We don't want anybody interfering with the patient-physician
relationship, whether it's a pharmaceutical representative or anybody.
That's such a sacred trust.''
While the extravagant
freebies that drug companies have lavished on doctors have come
under increased scrutiny in recent years, the industry's presence
in examining rooms is less well-known. But some recent cases have
raised concern among doctors and prompted calls for an end to the
In one of those
cases, a Lilly sales rep in Maryland sat in on a psychiatric therapy
session involving children.
In another case,
Parke-Davis, now part of Pfizer Inc., is accused of illegally marketing
the epilepsy drug Neurontin for unapproved uses through tactics
that included sitting in on patient visits. The allegations were
contained in a whistle-blower lawsuit filed last year in Boston.
The case has prompted an investigation into Parke-Davis' marketing
practices in 47 states.
an assistant attorney general in Washington state who is overseeing
the Parke-Davis probe, said that even if sales reps are not overtly
marketing, their presence would probably make a doctor reluctant
to recommend another company's drug to a patient.
``If the person's
there from `X' company, is the doctor going to have a lot of discussions
about the virtues of `Y' company's drug? I think not,'' Waterbury
Lilly pays doctors
$250 for one half-day session or $500 for allowing a sales rep to
accompany a doctor all day, Sagebiel said. Doctors may be paid directly
or their fee can be donated in the physician's name to a medical
school or a charity, he said.
paying doctors is appropriate because they are providing a valuable
service. ``It helps the reps have a hands-on observation to the
challenges of a physician and helps them to be a better partner,''
Dr. Bill Arnold,
an Indianapolis psychiatrist, said he has been paid to take part
in several such programs involving Lilly and others. He defended
the practice as a way to give sales reps exposure to medicine the
way it is practiced.
about schizophrenia and heard about Alzheimer's; here it is - live,''
Arnold said. ``They're going to market their products anyway, so
instead of them trying to beat down my door, why not have them learn
about what the market's really like?''
the money is minimal given the amount of time shadowing takes away
from his practice: ``It's not a lucrative thing to do at all.''
A Pfizer spokesman
declined to comment on the Neurontin case.
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