Pharmaceutical Industry Disclosure Practices

Drug makers foot bill for UIC doctors' Italy junket
by Robert Becker and Bruce Japsen, Chicago Triune (April 16, 2005)

When Dr. Enrico Benedetti decided to hold a medical symposium on transplant surgery in his hometown of Gubbio, Italy, he faced a daunting challege: finding money to pay for the event.

But Benedetti, chief of the division of transplantation at the University of Illinois at Chicago, knew what to do. He contacted pharmaceutical companies for financial support.

"We could not do a medical meeting in any discipline without support from drug companies -- right or wrong," Benedetti said. "That's not my place to say [it] is right or wrong. It's just the system as it's working now."

Drug companies have long been under fire for supplying individual doctors with trips and meals--gifts critics say are given to influence their prescribing patterns.

Now, with drug companies spending nearly $1 billion a year in support of medical symposiums--and drug costs spiraling upward--legislative attention is turning to continuing medical education.

Congress, in particular, is examining marketing practices members say can lead to unnecessary prescribing or doctors choosing a brand-name drug over a cheaper alternative.

"There is growing concern in Congress and among the profession that the (drug) industry is assuming responsibilities that it should not properly have," said Dr. Arnold Relman, professor emeritus at Harvard University Medical School and former editor of the New England Journal of Medicine. "There is a conflict of interest here. They are interested in marketing their products."

UIC officials contend their Italian meetings -- co-sponsored with the University of Minnesota -- are serious scientific conferences that raised the profile of the school's transplantation program. And while they acknowledge that some university travel rules were violated during the Gubbio conference, they stress that no taxpayer or student tuition dollars went toward the events.

Benedetti raised $174,000 from drug companies like Fujisawa Healthcare Inc., Novartis AG and Abbott Laboratories for his June 2002 meeting in Gubbio on living donor transplants, which offered speakers and special guests "luxury hotel accommodations," and business class airline tickets and featured concerts in a medieval cathedral and lavish dinners.

He raised at least $185,000 from pharmaceutical companies for a second conference in June 2004 at a similarly scenic venue, the Sicilian coastal town of Taormina.

Additional funds came from the doctors who weren't speakers and paid a $450 registration fee.

Critics of phamaceutical company-supported meetings like Relman said hospitals and medical schools traditionally provided continuing medical education programs that doctors are required to take to keep their licenses. Illinois is one of 39 states that generally require 50 hours a year of continuing medical education.

Conferences getting ritzier

But conferences became more elaborate when drug companies stepped in, spurring a spending race in a bid to outmarket rivals.

"What is happening now is the doctor's education is being provided through the auspices of the pharmaceutical companies, which have exceeded their proper bounds," Relman said.

The increase in pharmaceutical company funding for continuing medical education, which has tripled since 1998, comes as the medical establishment has encouraged doctors to distance themselves from drug company largess.

Indeed, tapping drug company money to pay for meals, business class airline tickets and string quartets at medical conferences like UIC's Italian meetings seemingly conflict with American Medical Associations' ethical guidelines that say, "Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or other personal expenses of physicians attending conferences or meetings."

"When physicians attend an educational meeting, the value is accruing to the physician by virtue of the education," said Dr. Michael Goldrich, chairman of the AMA's Council on Ethical and Judicial Affairs. "All other scenarios, where their costs of transportation or payment for attending the educational meeting raise questions about these payments and their influence on prescribing behaviors."

In a recent interview, Benedetti, who oversees a small but growing program that ranks fourth nationally in living donor liver transplantantions, pointed to a stack of brochures from transplantation conferences sponsored by major medical organizations and other universities--all indicating financial support from pharmaceutical companies.

Benedetti said that by accepting contributions from every drug company, "there's no way you can be influenced."

"And in fact we are not," he said. "We never choose a drug because they support [us]."

Drugmakers say they fund conferences like the UIC's to support science and research of life- saving treatments.

Deerfield-based Fujisawa Healthcare Inc., which earlier this month changed its name to Astellas Pharma Inc., , paid $50,000 each in 2002 and 2004 to support the UIC's Italian conferences, as a "platinum" supporter, the highest level solicited from the doctors who organized the meeting. A half dozen other drug companies paid similar amounts or more than $20,000 to be a "gold" supporter or between $5,000 and $10,000 to be a silver supporter.

"What we are committed to is furthering the science and the education of the field of study of transplantation, in this case," Astellas spokeswoman Maribeth Landwehr said. "We are a leader in transplantation."

The stakes are high for companies like Astellas, which sells Prograf, capsules taken daily to prevent liver and kidney transplant patients from rejecting their new organs.

Should a physician choose Prograf over a rival drug, it could mean $10,000 or more a year in revenue to the company per patient, considering transplant recipients are on such drugs for years if not for life, doctors say.

Drugmakers say the conference location did not influence their decisions to sponsor the event. "It could have been in Peoria, but we do not have any control over where the meeting is being held," Landwehr said. "Our concern is that the educational content is there and that it has scientific value."

None of the approximately 180 doctors attending the conference in Gubbio or the 88 traveling to Taormina would have confused Peoria with the Umbrian countryside or Sicilian coast.

Effort to attract speakers

UIC's Benedetti said he knew that to attract top speakers to a meeting co-hosted by UIC, which has a relatively new program, "we had to offer an attractive venue, quite frankly."

"We thought that Italy would do well because people like to go to Italy," Benedetti said.

That decision worked out well for the Gubbio-born Benedetti, who said his family is "quite prominent" in the Umbrian town 80 miles northeast of Rome.

"I know all the people that count in the city," he said.

With the location settled, Benedetti pursued funding.

Benedetti said he met with local drug representatives and sent out letters asking for support, but "the initial response was not very warm."

Benedetti, however, pressed his case, stressing to drug companies the strength of the conference's scientific program and the involvement of the University of Minnesota, which is a leader in living donor transplantation.

"It took some explaining," said Benedetti, who added that "once one company starts supporting, there's sort of an avalanche effect."

Companies jumped on the Gubbio bandwagon.

"After reviewing your proposal, it is my pleasure to inform you that we have elected to award an unrestricted educational grant in the amount of $60,000 to support your endeavor," one drug company official wrote to Benedetti.

Pharmaceutical company contributions went to the University of Illinois Foundation, which set up a special account to handle the funds.

UIC spokesman Mark Rosati said the money went to the foundation "because that is the arm of the university that accepts charitable donations."

By all accounts, the setting and trappings of the conference were elegant.

Benedetti reserved the Park Hotel ai Cappuccini, a 17th Century Capuchin monastery with its own art collection.

"As our guest, your four-day stay in Gubbio will be all-expenses paid; business class airfare, four nights of luxury hotel accommodations including dining expenses, and a variety of social and cultural activities will be complimentary," a UIC transplant official wrote to another UIC department head invited to attend.

The three-day conference featured an opening ceremony with performance by the Gubbio Flagthrowers and appetizers in the Piazza Grande. There was also an evening in the Cathedral of Gubbio with operatic entertainment, and another event featuring a quartet playing in a garden.

Hometown help

"All my classmates now run the city ... so I knew they would help me," Benedetti said. "If I want to do the concert in the church, the bishop will give the permission, which he did; if I want to close a street to do a party in the street ... they would close the street, which they did."

School officials paid about $10,545 to the Villa Montegranelli hotel for a reception dinner and spent $6,200 for the concert. The university ordered three chandeliers for $819 for the gala dinner; a photographer to capture the event cost another $979; $1,500 for a local hostess for the event and another $3,500 for a conference planning liaison. The school also paid 775 Euros for the Gubbio Flagthrowers to perform.

Invited speakers, including UIC doctors, were also allotted $2,600 to cover a business class ticket to the conference. Benedetti, in letters to university officials, explained that speakers "had the choice of accepting this ticket or getting two economy fare tickets."

In total, the conference cost $221,000 but collected $222,000 in drug company contributions and attendance fees.

Benedetti said he made a mistake in "good faith" by allowing speakers to fly business class--or exchange those tickets for two coach class tickets, which violates university policy.

"I didn't know I was breaking university policy doing that," he said.

Benedetti said he did not make the same mistake for the conference held June 2004 in scenic Taormina on the Sicilian coast, between the towns of Messina and Catania.

UIC, again using drug company donations, arranged for the conference to be held at the San Domenico Palace Hotel, which was built around a still-intact monastery dating from the year 1400 and offers a "a panorama which embraces the ancient Greek theater and Etna's misty peak," according to hotel literature.

University officials said the Taormina conference brought in $200,600 in donations and attendance fees, while costing $186,000.

Benedetti said beyond the nice meals and beautiful hotels, the conferences had medical meaning.

"In Italy there is a problem with living donor--they are not doing many," Benedetti said. "And I think this conference has contributed to raise the awareness. ... That's something that saved lives."

Pharmaceutical Industry Disclosure Practices