Wednesday, June 20, 2001

Doctors question motives of drug 'charity' Ethics of sales-linked donations by drug companies under fire By Kate Swoger Abbott Laboratories believes it has found a way for sick children to help others in need -- but skeptics think there's a big catch. For every child who peels stickers off a box of the widely prescribed antibiotic Klacid and sends them to a local Abbott address for a diploma an colored pencils, the American pharmaceutical giant will donate 5 Kc (12 cents) to a charity that runs a youth crisis hot line. While Abbott insists the marketing effort helps improve the health-care system, at least one doctor fears that the company -- and others like it -- may be crossing the line between benevolence and self-promotion, entering an ethical gray area. "If someone is giving something to you, he cannot make it conditional on ... something you do," said Jan Hnizdil, a doctor and head of rehabilitation at Prague's General Teaching Hospital. He has filed complaints against three companies -- Abbott, Ivax and Leciva -- with the Health Ministry's ethics committee as well as the pharmaceutical industry's trade association. A similar complaint to the Czech Chamber of Doctors was ruled out of its jurisdiction. In recent months, all three companies have created mechanisms for awarding revenue-based cash or grants to charities. Hnizdil thinks the connection between purchase and reward encourages doctors to over-prescribe. He fears patients will consume more drugs, paying no heed to side effects and long-term consequences. In their defense, the drug companies explain that they are simply being pragmatic by tying how much money they give to how much they make. "To give part of the revenues back to the health-care system was the primary vision," said Alice Cerna of Ivax in an e-mail. Ivax, formerly known as Galena, has pledged 3 Kc (7 cents) on each sale of its heart medications to a foundation that funds study-abroad trips for young doctors. "We do not believe there is a conflict of interest," Cerna added. But to Tomas Dolezel of Charles University's department of pharmacology, the sales-linked charity funds are unsettling. Pharmaceutical companies operating in the Czech Republic are allowed to advertise in specialized publications aimed at doctors. But unlike companies in United States, they cannot market their products through the mass media. "Of course, many semi-legal ways of sales support exist for pharmaceutical products among doctors -- souvenirs, gifts, sponsorship of foreign trips to conferences and even commissions," Dolezel said in an e-mail. He worries that overmedication of antibiotics only fosters the creation of resistant bacteria, which can make existing drugs ineffective. "These promotions indirectly force patients into higher consumption of drugs, along with their undesired side effects," he said. "Every improperly used medicine or medicine given to the inappropriate patient becomes like a poison." Abbott Laboratories spokesman Milan Stepanek said the ethics committee of the International Federation of Pharmaceutical Manufacturers (IFPM) will decide on the propriety of his company's sales-linked charity in the coming weeks. RX for giving Ivax For each package of its heart medicines sold, Ivax donates 3 Kc toward study-abroad trips for young doctors. Abbott Laboratories Children collect stickers from packages of the prescription antibiotic Klacid and send them to the company. Abbott donates 5 Kc for each to a youth crisis hot line. Leciva For each package of ibuprofen sold, the company donates 1 Kc toward the construction of a rehabilitation center for the physically disabled. Hnizdil filed a complaint against Abbott, the only one of the three companies operating a foundation that is under the auspices of the federation. "I'm sure we didn't break any law, any code. ... Our objective is not to increase sales," Stepanek said. But he refused to elaborate when asked for more detail about Abbott's strategy. Pavol Mazan, who runs the IFPM's Czech branch, thinks pharmaceutical companies should avoid sales-linked charity. The public, he notes, already pays for medication directly and helps fund state health insurance through taxes. "It's the right of any company to establish a fund ... but it shouldn't be linked to a particular drug," Mazan said. Jan Horacek of the Czech Chamber of Pharmacists is also critical. He believes the patients' best interest should be the only factor doctors take into account when writing prescriptions. "If [the pharmaceutical companies] want to do charity, they should simply donate a million crowns to a charitable organization. That, they can deduct from their taxes," Horacek said. Both Horacek and Hnizdil say charity funds are the fruit of a system that automatically places medication ahead of alternative therapy. "Patients are being motivated, mainly children ... to [believe] that every medical problem, every pain can be fixed by some medication," Hnizdil said. -- Vojtech Saman contributed to this report. Kate Swoger's e-mail address is kswoger@praguepost.cz