KRIS HUNDLEY

James P Orlowski may not be the only doctor in the Tampa Bay area who has given pharmaceutical sales reps the boot.

But he's the only one listed in the online directory of No Free Lunch, an organisation opposed to accepting freebies from the pharmaceutical industry.

That means Orlowski, chief of paediatrics at Tampa University Community Hospital, rejects all drug company goodies, from free pens to expensive dinners.

By doing so, he's rebuffing a well-oiled marketing machine that spends about R50billion a year wooing doctors and another R125billion on sample drugs.

Pharmaceutical salesmen generally cast themselves as trusted resources for research and free medicines. But when they talk to doctors, well-trained reps know exactly how much of their product the doctors have prescribed. Their goal is simple: increase it.

Orlowski said that when he was a struggling medical student 33 years ago, no one discussed the ethics of accepting drug company gifts, and freebies such as medical instruments and textbooks were hard to resist.

"Then I saw research that showed these gifts have tremendous influence on prescribing practices, though physicians always deny it," Orlowski said. "There's no way I was going to let a drug company gift influence my decision making."

Orlowski, 60, refuses to see drug reps and has used his position to influence hospital policy. Where reps once wandered freely through its halls, dispensing doughnuts and free lunches, they are now restricted to certain areas and are not allowed to approach students, doctors or nurses or host lunches.

Orlowski also tries to instil a wariness of reps in the medical students who rotate through his department. A recent survey of all US medical schools found that only five institutions completely restrict drug reps' access to their campuses and hospitals.

Orlowski said he often found drug companies' pens in students' pockets.

"I ask them if their interactions with drug reps are in the best interests of patients or if they help them in the practice of medicine," he said. "I believe the answer is no."

Though Orlowski was an early opponent of pharmaceutical marketing, there is a growing sensitivity among doctors in private practice, hospitals and medical schools.

Research has shown that even inexpensive giveaways like coffee mugs influence prescribing habits. According to a study earlier this year in the journal of the American College of Obstetrics and Gynecology, "even small gifts produce a disproportionately powerful willingness to reciprocate in some manner".

While free samples might seem to help patients initially, they also result in doctors prescribing expensive brands over generics which may be just as effective. And "research" on new products provided by drug reps is often biased and incomplete. "Free information is worth about that," said Orlowski, who relies on the independent Medical Letter for drug research.

Rob Restuccia, executive director of the Prescription Project in Boston, said the billions spent on drug marketing to doctors undermine professionalism, increase costs and undermine care.

The intensity of the industry's marketing blitz was tracked recently by a member of the National Physicians Alliance, a 10000-member group that supports a ban on all gifts.

Over a six-week period, an internist in Minnesota turned down 12 free breakfasts, 18 lunches, 16 branded pens, notepads, a pocket Physicians Desk Reference, a coffee mug, a poster, a highlighter, a diagnostic manual, a ruler, a History of Viagra book and a Viagra soap dispenser, among others.

About a dozen states require drug companies to disclose gifts to doctors. Earlier this year, some senators introduced a bill that would make such reporting mandatory nationwide.