Offers of "medical tours" to the Caribbean, "scientific congresses" and
"cultural retreats" were among the incentives British pharmaceutical giant
GlaxoSmithKline used to persuade thousands of Italian doctors to recommend
its products.

This type of "marketing" is common practice in Italy among many of the
global drug companies, however the problem is not confined to Italy.
Throughout Europe instances of this kind are absolutely rife and doctors
have been offered cars or holidays as inducements to prescribe a particular
brand. Alternatively they may be given 'research grants' without directives
or limits on how they can spend the money.

A large scale investigation by the Italian tax police, the Guardia di
Finanza, has uncovered a huge industry that is corrupt. Glaxo spent euros
228 million over four years, on incentive for doctors, chemists and medical
professionals. The alleged bribes ranged from cameras, computers and
holidays to outright cash payments.

Often sales representatives approached specialists directly to get them to
prescribe a cancer drug produced by the company. The illicit incentives were
said to have been disguised in the firm's accounts under the headings of
"field selling", "other promotion" and "medical phase IV".

Of the 4713 people from all parts of Italy who have been named in the
scandal, around 4400 are doctors, while 270 are employees or former
employees of the company.

The tax police have published incriminating emails they uncovered during the
investigation, including one written by the director of a vascular science
department demanding that he get "more than my associate, which is 35,000
euros per year for four years."

In another email a hospital pharmacist and wife of a respected surgeon
agreed to use the company's products if, in return, the company bought 140
copies of her husband's book, for a total cost of 4000euros.

The most serious accusations have been leveled at doctors, pharmacists and
sales representatives alleged to have been involved in a programme intended
to promote Hycamtin, a drug used mainly in the treatment of lung and ovarian
cancers. In some cases specialists received a pro rata cash payment based on
the number of patients treated with the drug. Prizes were around 400 euros
for a new patient with cancer (which meant a life client for the drug
company) and a PC for the doctor who could sell company general drugs to 15
new patients.

But there is another side to this scandal. The money used to entice the
doctors to sell medical products comes from research and development coffers
destined for new discoveries and innovations.
Most of drug companies fund research in special units of Italian medical
universities particularly in the fields of leukemia and cancer.

As the government cuts funding of the health system, the funds for medical
research are generally the first to go, pushing medical research units to
find other sources of income and sponsorship from their research programs.
This makes the extra funds from the drug giants essential for the Italian
national health service. For example the special lens used by the nurses in
Italy's foremost heptology unit (liver specialists) cost 2,500 euro. The
National health service does not fund the purchase of the lens and the
shortfall in funds is meet by the research funding from the private drug
companies.

While not being very ethical, no-one can deny the positive effects for
patients of the clinics.

So if you see a doctor on the ski slopes of the Dolomites or the beaches of
Sharm-al-Sheikh - think that he might be founding a new cure against cancer.