The revised marketing code from the Pharmaceutical Research and Manufacturer's of America severely restricts how sales reps can provide meals to physicians, but it does not entirely eliminate the opportunity for companies to feed doctors.

PhRMA's ¹ new code on company interactions with healthcare professionals is considerably stronger than the association's ² 2002 code; the new limits were announced July 10 and will go into effect in January (see ³ Also see "PhRMA’s Marketing Code Touts Sarbanes/Oxley-esque Compliance Mechanism" - Pink Sheet, 14 July, 2008.).

The headline news from the code is that sales reps cannot provide even minimal gifts, such as pens, and that reps can only provide meals to doctors in their offices - if the meals are accompanied by an educational message.

"The single biggest change" in the new code, according to PhRMA President Billy Tauzin, "is that it eliminates the gifts and the meals that have been the source of a lot of criticism.

"I don't think you'll find a physician who will acknowledge that the gift of a pen or a cup with a company's name on it influences their prescribing patterns," Tauzin told a July 10 briefing on the code, "but there are people who believe that, and as long as that perception was out there, we thought we ought to end that."

The code continues to draw some distinctions between the rhetoric of elimination and actual practice. For example, the code will still permit some educational gifts, such as anatomical models, "patient self-assessment tools" and subscriptions to medical journals.

Several items that were previously permitted, such as notepads and stethoscopes, have been moved to the prohibited category.

The distinction: gift items should be intended primarily for education of the doctor or patient, not to help the doctor's practice.

"While medical equipment, such as stethoscopes, obviously plays an important role in patient care, such equipment is primarily designed for patient treatment, not for patient or healthcare professional education, and therefore it would be inappropriate for companies to offer such equipment to healthcare professionals," the code states.

The Power of Food

Similarly, the rules regarding meals are also designed to ensure that the activity is educational, but stop short of a firm prohibition against meals. During the development of the code, the discussion of meals was one of the thorniest issues, according to people involved.

Tauzin reflected on how the importance of food helps create time in the busy schedules' of doctors.

"Even the counter-detailers will tell you," Tauzin pointed out, that meal times "are the only times they can visit with staff," he said. The meals must be modest and occasional. The code gives the example of "sandwiches or pizza" for the type of meal.

The food rules focus mainly on who is involved in the dining and where it takes place. For the most part, sales reps should not be involved in dining with doctors and what meals do take pace with the sales staff should occur in a doctor's office.

PhRMA stopped short of ruling out other company officials from providing "occasional" meals to doctors outside the office. The rules for those types of meals: (1) the meal is modest as judged by local standards; (2) the meal is not part of an entertainment or recreational event; and (3) the interaction takes place in a venue and manner conducive to informational communication.

"Outside the office, meals in restaurants have the look of something untoward," Tauzin said. The rules are meant to erase that public perception.

Under the code, a sales rep could attend an outside meal with physicians if it were part of a presentation by an expert speaker. In the Q&A section that elaborates on the code rules, PhRMA explains, "speaker programs may include modest meals offered to attendees and may occur in locations outside of the office or hospital setting, as long as they occur in a venue and manner conducive to informational communication."

Sales reps could participate in those events. "It would be appropriate for a local field representative in the company's sales organization to attend a speaker program for purposes of assisting the speaker with logistics and helping to assure that the content of the presentation complies with FDA requirements," the code permits.

- M. Nielsen Hobbs (n.hobbs@elsevier.com)

Drug Rep Repasts Are In The Past: PhRMA Code Further Restricts Free Meals

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