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Sunday, May 15th, 1977

Mail Reporting Team:  John Millar,  Alex Scotland, Frank Curran and Ian Sharp.

“THE GIFTS THAT RAIN DOWN ON DOCTORS

Drug salesmen are offering Scots doctors an amazing bonanza of cash, gifts and perks.

Some Scots GPs are so horrified by the ever-increasing “gravy train” of perks that they are refusing to see drug sales reps. And salesmen have been banned form the department of medicine at Glasgow’s Victoria Infirmary—one of Scotland’s biggest teaching hospitals. But thousands of pounds are being paid to doctors who agree to use particular firm’s products. A big German drug firm is even wooing GPs with the offer of a free round of golf and a meal. Other manufacturers tempt them with “drug dinners” and “drug lunches,” with food, drink—and a sales-film. GPs are also being offered book tokens, brief cases, pocket calculators, medical equipment and fees when they try out new drugs on patients.

BLAMED

And a woman GP, who does not want to be named, said yesterday:

“Some Doctors feel that the system is unethical. But there is no danger—although a new drug might mean a little discomfort in some cases.”

Another side-effect is that sales techniques are being blamed for Scotland’s soaring drugs bill—now £48 million compared with £29 million in 1972. For it is claimed that manufacturers spend £800 per doctor per year to promote their products. In the past, when the NHS negotiated the price they were prepared to pay a drug firm for a new medicine, part of that deal included the promotion costs. Now the Government is to cut the amount it will pay towards promotions which, in two years time, will mean a saving of £13 million a year. And East Kilbride Labour MP Dr Maurice Miller, vice-chairman of the back bench committee on health, wants a nationalised drug company.

Said Dr Miller:

“ A nationalised company in direct competition with private firms would save the NHS millions a year.”

THE WEALTH SERVICE?

Drug firms pay doctors to use their patients as guinea pigs.

Patients are being used as guinea pigs in secret drugs trials conducted by their own family doctors—and some GPs are paid hundreds of pounds for running the experiments.

 One doctor who is paid by a drug company for this service told the Mail:

“Some practitioners feel it is unethical, but I must point out there is never any danger—maybe a short period of discomfort—to patients.”

The patients are unaware that they are being used to …. HELP giant drugs firms—usually based in Germany, Holland or the U.S.A.—to get a product passed by the medical safety council; HELP promote a particular drug into general use which makes the companies vast profits. They are also unaware that they are being kept for long periods on drugs that have little, or no good effect on their ailment.

We found that hospital doctor and consultants are also paid by the drug firms to carry out experiments on patients. Patients—especially in the gig teaching hospitals—are being given new or alternative drugs, unaware of the tests. The consultant in charge of their medical care is being paid anything up to £1000 for his thesis.

One Glasgow doctor, who asked not to be named by the ‘Mail, admitted that he had been paid £3 a patient for testing 200 patients on a new anti-biotic, and added £600 to his bank balance.

He said:

“As it turned out it was a very effective product and I tested it over eight months. If there had been anything wrong with it I would have stopped treatment immediately and switched to a regular brand.”

Another GP told us:

“I conscientiously tested a new drug for blood pressure for a drug company. I did a thorough, professional job for them and returned accurate results. But when a cheque for £48 arrived from them I sent it back.I know I am in a minority of doctors who feel taking payment for these tests is unethical and can lead to wrong results of a nationwide test.  If a doctor doesn’t carry out the test properly, and just fills in the patients’ forms to claim his fee, then the results eventually published and used to prove the drug has a particular effect are untrue. That’s what I object to. If we were doing these tests for nothing—and why shouldn’t we if they are safe and might help mankind—then the results would be accurate. Green for money wouldn’t play any part.”

Another woman GP said:

“Sometimes we are asked to do a survey for a medical investigation firm on what drugs we are prescribing and for what ailment. We are reasonably well paid for this because the information we supply to the firms is in turn sold back to the big drug companies. Sometimes we are asked to test a drug which the Government’s committee on drug safety has expressed concern over. The drug company will have added a safe ingredient, or taken out an ingredient, and we will run tests for them on its effects, and will be paid either £3 a patient, or receive a record or book token for that amount for each case.But really the boys who make a real killing out of this kind of thing are the research doctors and hospital consultants : who have a never ending supply of willing patients.”

There are 2,800 general practitioners in Scotland, and Dr. Dale Falconer, Scottish secretary of the British Medical Council told us:

“We suggest to our members that it is inappropriate to receive lavish hospitality from drug firms.  “On the other hand, when I am invited along to functions laid on my drug companies and offered a glass of champagne, I don’t say—’this is too lavish for me, I’ll have a glass of beer instead.’ There have been examples where drugs firms have been guilty of overdoing the hospitality in order to sell their products, but after all, it is their money which they are spending. It does not mean that because they entertain a doctor he will prescribe their drugs. Doctors will only prescribe a drug if they are satisfied that it is in the best interests of their patients. Because drugs firms are involved in the N.H.S., a certain amount of anxiety is expressed sometimes in connection with hospitality. Certain doctors have an easy relationship with drugs firms. Others disapprove of any form of hospitality and refuse to attend functions. Our view is that there should be a reasonable intercourse between doctors and the pharmaceutical industry.”

Drugs firms have to conform to a code of practice enforced by the Association of British Pharmaceutical Industry. It says:

“Entertainment and other hospitality to members of the medical profession should be modest in nature and cost and always secondary to the main purpose of the meeting. It should not extend not extend beyond the members of the profession and should be appropriate, and not out of proportion, to the occasion.”

Complaints about lavish hospitality are dealt with by a code of practice committee headed by the famous London Q.C. Sir Joseph Molony. In 1975-76 the committee dealt with 20 complaints—and meeted out hefty fines to 14 companies. Although the committee meetings are surrounded by secrecy, the A.B.F. say they take a tough line with offenders.

A spokesman said:

“The code was drawn up because the abuse of hospitality was at one stage a cause for concern. However, the line between fair and excess hospitality is very thin. In general, companies adhere to these guidelines but there are always a few bad apples in every barrel.”

Scotland’s family doctors are paid by the amount of patients on their register but other factors like location are taken into consideration. Most earn about £7,700 a year. A recent report put the average expenses at about £2,700 a year, to cover staff wages, lighting, books, instruments, stationary and the surgery.    

THE PERKS

The gifts offered to doctors by the medical representatives are many and varied. They Include …

• Brief Cases.
• Pocket calculators.
• Medical equipment.
• Book tokens.
• Rounds of golf.
• Meals.

 And the salesmen, facing fierce competition, queue up outside surgeries with their perks.

MEN WHO TAKE

Twenty four Dunbartonshire GPs were recently entertained to an afternoon round of golf and high tea at Milngavie Golf Club near Glasgow. And the bill for the outing was picked up by a sales representative from Bayer UK Ltd., whose head office is in Sussex. Green fees for a round of golf at the private club are £2.50 plus VAT and high tea costs £1.50. The outing was booked under the name of the British medical Association.

But a spokesperson for Bayer said yesterday:

“I’m surprised to hear that one of our representatives would arrange a gold outing at our expense. We adhere to the code of conduct laid down by the Association of British Pharmaceutical Industry.”

GPs can either lunch at hotels where food and drink are unlimited and paid for by the drug companies, or if they agree to see a rep. during their lunch break in the surgery, bulging hampers filled with goodies are brought in.

MEN WHO GIVE

 One rep.—who asked not to be named—told us:

“Most doctors treat us like scruff because there are so many of us banging on their surgery doors. But other take a different attitude and are anxious to see us to get at our perks. SOME OF THEM MAKE ME SICK BY THEIR GREED. If their patients could see them when they are asking what’s in it for them they would have a different view of the man …There are too many drug companies with too much money, employing too many reps. pestering the doctors. Obviously we have to offer perks to get their attention. We are all well paid, but it’s a pretty humiliating way to earn your living at times . . .”

WHERE THEY WINE AND DINE

 Prestonfield House Hotel, Edinburgh’s priciest eating place, is where several of the top drug firms hold their super-junkets. Ciba, the Swiss firm, are holding a film show there on June 14, 15 and 16. They won’t say how many will be attending or how much it will cost. Another firm, Hoechat have reserved the hotel for film shows on May 25 and June 8. Other firms who use the hotel include Winthrop, Syntex, and Housth. Some of their “film shows” are believed to have cost around £1000. A spokesman for the hotel, which has won several top awards for cuisine, told the Mail:

“On average, drug companies meet here about twice a month. The normal booking is for a buffet and free bar.”

A simple buffet cost £5.45 a head and a one fifth nip of whisky 40p. Another favourite haunt for drug firms is the five-star Gleneagles Hotel. Pfizer, the American company, are among their regular clients.

THE FIRMS WHO PAY

 The drug firms were tight lipped about the hospitality they offered to the medical profession. At Ciba Laboratories in Horsham, Sussex, the company’s Scottish promotion agent, Mr Michael McAleer, said he could not comment on general company policy. But he did confirm that Ciba are to hold a three day conference for doctors in June at Prestonfield House. Mr McAleer was unable to say how much it would cost, or how many doctors would be attending.

The director of Knox Laboratories Ltd., Mr Peter Golding, said that his company only provided entertainment in association with educational ventures. They recently had a promotion at Kings College Hospital in London when a buffet supper with beer and wine was provided. Mr Golding’s board had not yet discussed the new Government regulations but he said that their only fear was that these regulations might inhibit genuine educational promotion.

Merck Sharp and Dohme Ltd., a British subsidiary of an American firm are giving Scots GPs hide briefcases if they agree to use a new anti-rheumatic drug called Clinoril to five of their patients. The GPs are also asked to fill in a questionnaire on how the patients react to the new drug. Once the GPs have completed this task they get another visit from the rep. and one offered a range of gifts including pocket calculators and medical equipment. A spokesman for the firm said yesterday:

“The gifts are a token payment for the extra work involved in evaluating our drug. It’s certainly not an attempt to influence them to use our product.”

A spokesman for Winthrop Laboratories said his firm did not consider the relationship between companies and doctors to be a matter for government regulation. He said the code of practice was a satisfactory method of controlling promotion.”