Don't know if this will also apply to formula companies sales reps?
Their pediatric office manager is not in today.  But I'll get to speak
with her on Monday and ask her point blank.
Judy Ritchie

http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/d
isplay?slug=polyclinic06m&date=20020606&query=polyclinic


Local News: Thursday, June 06, 2002 

Clinic charging drug-firm reps: Polyclinic demands $30 an hour before it
will hear sales pitch 

By Carol M. Ostrom and Luke Timmerman 
Seattle Times staff reporters 
 
Tired of incessant pitches by drug-company representatives, a large
Seattle clinic is forcing them to fork over cash to get in the door. 

The move by the Polyclinic, a physician-owned, multi-specialty group
serving about 100,000 patients, marks a new level of discomfort in the
relationship between doctors and drug companies, a symbiotic pairing
that has grown increasingly tense with rising drug costs. 

The "pay per view" policy, which went into effect Monday, will levy fees
ranging from $30 for one hour's access to the clinic to $200 for eight
hours — payments that won't guarantee physician contact. 

The Polyclinic's decision, rare among clinics, startled drug-company
officials. They warned of a chilling effect on the flow of free drug
samples and educational programs aimed at doctors. And the American
Medical Association's ethics-committee chairman said such fees may
violate ethical guidelines for doctors. 

The Polyclinic's medical director, Dr. Richard Clarfeld, said the value
of information provided by drug salespeople has been outweighed by the
disruption they cause and their promotion of expensive drugs, which
undermines the clinic's effort to promote lower-cost alternatives to its
doctors. 

Drug-industry officials disagreed. 

"Physicians receive important information about new medicines and their
characteristics, including potential side effects, from technically
trained sales representatives," said Jeff Trewhitt, spokesman for PhRMA,
a drug-manufacturers trade group. 

Some companies said they won't pay to get in. Mariann Caprino, a
spokeswoman for Pfizer, said, "We don't pay for access." 

Others, however, just wanted to get through the door. 

One saleswoman showed up at the Polyclinic yesterday with both her
checkbook and credit card, unsure how to buy some face time with those
who hold the prescription pad — but sure she needed to get inside. 

By the end of the year, even money won't buy access to the Polyclinic,
Executive Director Lloyd David said. 

By then, the clinic plans to have developed a list of approved drugs,
called a formulary, and will close its doors to all drug reps. For now,
said David, the clinic is just trying to cover the costs of watchdogging
legions of drug-company salespeople. 

"Once the light bulb went off that we really are incurring costs having
them here, we said, 'Why not charge them?' " 

The Polyclinic isn't the first physician group to try to get a grip on
the ubiquitous drug-company sales representatives, who often come
bearing gifts, including tickets to sports events, lunches, and other
freebies. 

And it's not the first to charge for access. Last fall, one of
Cincinnati's largest physicians groups began making sales reps pay $65
per 10-minute session with a doctor and set up a spinoff company to
schedule appointments. The money goes to offset costs of an electronic
patient-records system, said Pamela Coyle-Toerner, president and chief
operating officer of Queen City Physicians. 

Before the new policy, she said, sales reps were competing for chairs in
waiting rooms. 

"I had a patient sitting on the floor! It got to the point where it was
ridiculous," she said. "I applaud the physicians trying to take back
some control." 

But such control could spell trouble for the Polyclinic and its doctors,
drug company officials warned. 

Paul Clark, chief executive of Icos, a Bothell biotech company that's
developing a competitor to Viagra, said the decision would have
consequences. He said that educational programs and free samples
provided by sales reps may be "less available" at clinics that charge
entry fees and that such a policy would have a "chilling effect" on
whether sales reps provide information to doctors. 

Another Northwest pharmaceutical executive, who requested anonymity,
predicted that drug firms will be afraid not to pay entry fees. That's
because if they abandon a clinic, their competitors may be better able
to sway doctors' prescribing habits. 

The executive said he believes the Polyclinic made the decision to boost
its cash flow rather than to ban sales reps. But the Polyclinic's David
said the clinic will likely bring in only about $3,000 a month from the
fees. 

"This is such a modest amount," he said. "I can't imagine that the kind
of dollars we're talking about here could be construed as anything other
than just covering the cost of having (salespeople) here." 

The larger issue, he said, is how doctors get their information about
pharmaceuticals. "We think a more objective process for sorting through
the information makes more sense," he said. 

To that end, the Polyclinic has hired a consultant — the pharmacy
director of the Everett Clinic, which barred pharmaceutical reps in 1998
— and set up a committee to make scientifically supported choices for
the approved-drug list. 

Clarfeld, the medical director, said the committee already spends a
great deal of time countering the claims of drug companies that patients
and doctors see on TV, in magazines and in promotional literature. 

This is not about drug-company salespeople personally, he emphasized.
"They're very nice people. But the special dinners or trips ... that has
to in some ways influence behavior. That's basically what they're
about." 

The plan to ban drug-company reps has grown out of an effort that
started last year at the Polyclinic to improve outcomes for patients,
said Howard Springer, associate administrator. 

However, like other clinics, the Polyclinic wants to retain access to
samples, which benefit low-income patients as well as those whose
doctors may want to try a particular drug to check possible side
effects. "We want to figure out how to continue to give that help to a
patient," said David. "We want to do that in a smooth way." 

Around Seattle, other physicians groups and clinics have limited sales
visits, but charging for entrance is a twist. 

Minor & James Medical charges a $75 cleaning fee for educational lunches
sponsored and catered by drug companies. "Food would get tracked across
the carpets, and cleaning was an expense for us," administrator Lowell
Doyle said. 

For the American Medical Association, the interactions between
drug-company representatives and doctors have been a focus of attention
for some time. Recently, the Council on Ethical and Judicial Affairs
updated its policies to clarify the problems with payments by
drug-company representatives. 

Dr. Frank Riddick, chairman of the ethics committee, boils it down:
Doctors shouldn't take money, directly or indirectly, to be "educated"
by drug reps, nor should they accept gifts. Fees paid to doctors should
be for professional services, he said, and drug-company visits don't
qualify. 

"Either way you slice it, it's in violation of the existing rules on the
interaction," he said. "Our decision was: Physicians shouldn't be paid
to educate themselves, and if it's not education, then it's a gift." 

Riddick emphasized that the AMA's guidelines are voluntary, and meant to
apply to doctors. When it comes to a clinic's decision to charge for
time, "then it's not all that clear what we've said," Riddick said.
"It's somewhat murky. However, by extension, if one doctor can't do it,
then 80 doctors shouldn't do it." 

A practicing endocrinologist in a 500-physician group in New Orleans,
Riddick said he worries about the role of money in the relationship
between doctors and drug companies. 

"The clinic has a right to make certain business decisions. If they find
they're overrun with pharmaceutical reps and patients can't get in, then
they have a right to limit hours, or the number. ... I'm not sure I
would choose a cash payment," he said. 

"If money's changing hands, then the money may create a conflict of
interest in making the right decision. That's the real reason we put
those little rules out there."

Copyright © 2002 The Seattle Times Company 

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html