Gifts worth giving
 When
the Washington-based Pharmaceutical Research and Manufacturers of
America adopted its Code on Interactions with Healthcare Professionals
in July 2002, its aim was to leave a number of questionable, yet
relatively common, gift-giving practices behind -- from offering
branded golf balls, mugs and other such items to providing lavish
dinners and sporting event tickets. While the code was developed to eliminate potentially inappropriate influences on physicians' prescribing habits and minimize the appearance of impropriety, it also served another vital purpose: to foster more effective relationships between drug reps and clinicians, and better meet the needs of patients by ensuring that giveaways are educational in nature and medically relevant. The PhRMA code clearly states, "Interaction should be focused on informing healthcare professionals about products, providing scientific and educational information, and supporting medical research and education." The guidelines also stipulate that the value of any item should not exceed $100. "The code makes it crystal clear that the interactions of company sales representatives with healthcare professionals are to benefit patients and enhance the practice of medicine," noted former PhRMA President Alan F. Holmer at the time of the code's publication. Obviously, so-called "dine-and-dash" programs, concert tickets and daylong golf outings would no longer fit the bill. Items of minimal value that are primarily associated with a healthcare professional's practice, such as pens, notepads and other "reminder" items with company or product logos, are still deemed acceptable under the PhRMA code, as are occasional, modest meals offered in connection with informational presentations. Interpretation challenges As with many other voluntary guidance documents, some contend that the PhRMA code -- which supports the acceptable gift guidelines set forth by the Chicago-based American Medical Association -- contains gray-area content that may leave some of the guidelines open to interpretation and may also leave pharmaceutical companies and sales reps open to potentially bad decisions. Complicating matters further are the various state regulations that supersede the PhRMA and AMA codes. Vermont passed a prescription drug law requiring sales reps to report gifts valued at more than $25 (drug samples are excluded). Nevada, New Mexico and Maine have followed suit, and numerous other states are pursuing similar regulatory requirements. In Minnesota, it's illegal for a manufacturer to offer any gift with an aggregate value greater than $50, and Massachusetts has made physicians responsible for reporting all gifts received from pharmaceutical reps -- a requirement that some fear may make physicians leery of accepting any freebies, regardless of their value or educational benefits. State representatives have been vocal about why they're pushing for tighter regulations. Some believe that while the PhRMA and AMA guidelines initially succeeded in curbing excessive and inappropriate gift-giving, their impact has already begun to wane -- a charge that has been both supported and disputed by various industry stakeholders. Whatever the case, sources agree that pharmaceutical companies and their sales reps should err on the side of caution in their interpretation of the guidelines. The general consensus: If there's any question about whether a gift is medically relevant, it likely isn't. Some pharmaceutical companies have explicitly spelled out their own guidelines for reps. In some cases, any giveaway -- even one as nominal and inconsequential as a pen or notepad -- must first be approved by the appropriate review committee or regulatory affairs and legal personnel. Sales reps who circumvent such corporate guidelines could be subject to disciplinary action, loss of bonuses and even dismissal. Giveaway firms make good Fortunately, a number of reputable companies specialize in providing medically relevant, PhRMA-compliant products, making it easier for drug manufacturers to get the most appropriate and appreciated items into the hands of their sales reps. These companies' product portfolios are quite varied -- from anatomical models, stethoscopes and textbooks to foreign-language translation products, drug compliance aids and various other brand-reminder products. "We understand the challenge reps face in just getting in to see physicians," says Martin Eldridge, president of Warren, NJ-based PharmaDesign Inc. "It helps to have something worthwhile and relevant to offer physicians. We can feel good about offering products that can help reps build more effective relationships with physicians." Eldridge says his company's anatomical models have garnered a particularly positive response from sales reps, as have compliance pieces like pill dispensers that physicians can give to their patients. "Prescription noncompliance is one of the biggest challenges for a pharmaceutical company," he notes. "Physicians appreciate having a product they can give their patients to help them remember to take their medication. The patient benefits, the physician benefits, and so does the pharmaceutical company." PharmaDesign also offers a range of other products, such as computer clips, clipboards, X-ray clips and call-room reading lights, among others. All PharmaDesign products, including the anatomical models, comply with the PhRMA code in terms of medical relevance and value. New York-based Medsite has also found success by offering a range of product options. Through its Medsite Rewards program, pharmaceutical and biotech companies can choose from more than 20,000 different medical and educational items that are valued at $100 or less and designed for use in the patient care setting or physician's office, such as textbooks, scales, thermometers and stethoscopes. Medsite works closely with each pharmaceutical client and its legal department to discuss the guidelines, the company's interpretation of the guidelines and which of the available products they would like to offer physicians. Once the pharma company selects the items it wants to make available, Medsite issues reward certificates to physicians, who may redeem them later. According to Medsite Executive Vice President and co-founder Sanjay Pingle, the company has been committed to staying out of the interpretation business and offering a service flexible enough to cater to each drug company's interpretation of the guidelines. "We'll spend six to eight months making sure the system is compliant" and works for that particular client, says Pingle. The goal is to spend time tackling the difficult compliance issues upfront so companies can then have a standardized program for physician gift-giving across the board, he explains. Medsite also helps pharmaceutical companies stay in compliance by centralizing and tracking physician gifts, as well as issuing program performance reports that keep companies up-to-date on certificates they've provided to physicians. Other providers of medically relevant products have found success by narrowing their focus and sticking to a particular niche or specialty. One Web-based product provider, www.stethoscope.com, specializes in quality stethoscopes that can be laser-engraved with a physician's name or branded with a company's logo or drug name. According to the company's owner, Paul Paresky, business has boomed since the implementation of the guidelines -- a fact he at least partly attributes to the direct mention of stethoscopes as an acceptable gift in the PhRMA code. While stethoscope prices can range from $10 to $500, Paresky says a high-quality stethoscope can be purchased for around $60 and can be engraved for just $25 (or less, depending upon volume). MEDI-FLAG Corp., McHenry, MD, has carved out its niche in the PhRMA-compliant gift segment with its Foreign Language Assessment Guide -- a 3-by-5-inch laminated bilingual booklet that helps medical personnel communicate with patients with limited English proficiency. The FLAG contains questions designed to obtain patient information and facilitate communication of symptoms, reasons for seeking help, pain index, medical history and simple requests. Soon after the product's release, one major drug manufacturer purchased 6,000 Spanish FLAGs for its sales reps and advertised a new product on the backside. In fact, the flagship product was such a hit, according to MEDI-FLAG President Michael Pellet, that the company added to its translation product portfolio with eFLAG, a computerized version of the FLAG that provides audio and can be used on a Pocket PC or standard computer. The eFLAG software costs $69.95, is available in 14 different languages and comes equipped with three languages, which are specified by the customer. "With 30% of the U.S. population being Spanish-speaking and a greater influx of visitors from many different foreign countries, there's a growing need for physicians to be able to communicate with these patients," Pellet says. "These products can help bridge that gap between physician and patient, and can be easily customized for the [pharmaceutical] company that provides them." Reps hold the key Pharmaceutical reps still stuck with less-than-stellar items to offer physicians should not underestimate their own power to drive change within their organizations. "Some product managers simply aren't providing their sales forces with quality items that benefit physicians and patients. The good news is, the sales rep force is the biggest army. If they stand up, make their voices heard and tell the drug companies what they need, I believe that would go a long way in driving positive change," notes Eldridge. Still, he warns that not all product suppliers are worthy of a drug company's business -- even those whose product portfolios appear to meet all the compliance criteria of the PhRMA code. When the PhRMA guidelines were released, Eldridge says, a number of product suppliers that previously dabbled primarily in non-medically relevant merchandise quickly began to shift their focus in an attempt to stay viable in the marketplace. Many of these "me too" companies claimed they could offer a broad range of medically relevant products, including anatomical models, that could be branded with a company name or logo. "Unfortunately, there is a real issue with poor-quality [products]," Eldridge explains, citing examples of cheaply made models that are actually anatomically incorrect. "This defeats the entire purpose and can negatively impact the relationship between rep and physician." His message to pharmaceutical companies looking to broaden their giveaway product offerings: "Like anything else, there are reputable suppliers with quality products and suppliers that are more concerned about making a sale than quality. Be sure to do your homework and partner with suppliers that are experts in the products they carry. When you do, everyone wins."
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