Infant formula investigation, scientific informants (Fedaiisf, Carinci): 'We are precarious, we risk corruption'

Pediatricians bribed by sales reps in exchange for infant formula prescriptions: is the hypothesis at the basis of the investigation which in Tuscany led to the arrest of 12 doctors, 5 informants scientists and an executive of a baby food company. A predictable scandal, second Fabio Carinci, president of the Federation of Italian associations of drug sales representatives (Fedaiisf). Carinci was not surprised. “Companies – explains a ilfattoquotidiano.it – use whistleblowers as men employed by marketing and sales departments. It's against the law. We have reported it to Aifa, the Italian drug agency, and to the Senate Health Commission for some time. But no one listens to us." What about pediatricians? For the president of the regional order of doctors of Tuscany, Antonio Panti, their involvement is not linked to an "error in the system". “I have absolutely no reason to believe that there are system problems – he says – No more than, for example, oncologists, who are more at risk by handling drugs worth 100,000 euros a year, it's like selling a Ferrari instead of a 500 But there are rules that doctors must follow. Surely we need to apply them better ".

Scientific informants: "Contracts are needed to avoid mix-ups"
For the scientific representatives sector, the law is clear: they must answer only to the scientific service of the company they depend on. “The Scientific Service – clarifies article 126 of the legislative decree 219 of 2006 – must be independent from the pharmaceutical company's marketing department”. “Scientific representatives must inform about drugs, not push doctors to prescribe them” Carinci reiterates. Quite the opposite of what happens in Italy, according to him. “Those who were arrested in the context of the Livorno investigation are not our members and we do not consider them scientific informants of the drug, because they are commissioned agents who take a lot a piece. This is why we have been strongly asking for a contract of employment for scientific representatives for some time, to avoid that there may be mess-ups between not very good people on one side and the other”.

14,000 informants fired in 6 years
The critical point of the system is this: companies prefer commission formulas to employment contracts, considered too expensive. In this way, scientific representatives link their earnings to the quantity of products sold. The opposite of what the law says. “We cannot in any way depend on marketing, commercial or sales management. And instead there are companies that have informants flanked by an area manager to see if he knows the doctors well and visits them regularly. We are aware of the danger of this situation which presents deformations and distortions. Scientific information is regulated by a state law, which no company complies with. By law, a scientific rep cannot hear about sales, the prescribing potential of a doctor, he cannot see the sales reports. He has to stay out of it. But the companies say: 'We give you the salary. If you don't make a turnover, I'll send you away.' This happens without an order that defends us (they have always rejected the establishment of an order) and without Aifa defending us. Meanwhile, 14 thousand scientific informants have been fired in Italy in the last 6 years, they have lost their jobs, five have committed suicide. Those who stay, to bring bread home, obtorto neck they have to submit to attitudes that they are against law“.

The Order of Doctors: “Gifts and travel? Serious"
The competent local health authorities have suspended all the doctors involved in the Livorno Nas operation. "I asked the local health authorities that, once the facts have been ascertained, the doctors involved should be fired and we are ready to form the offended party," said the president of the Region Enrico Rossi. Instead, you guaranteed the orders of the provincial doctors: it is up to them to order the possible suspension of the members. The one from Lucca lets it be known: “We are waiting for the judiciary to notify us of the arrest of our member. After that we will certainly proceed with the automatic suspension". In Pisa they don't answer. TO ilfattoquotidiano.it the president of the regional order of doctors of Tuscany, Antonio Panti, let it be known: “Based on what I read in the newspapers, because I have not had any other communications, I have summoned the doctors and will meet them soon. I don't know how criminally condemnable they are, the judiciary must work on this. But from an ethical point of view, if it is proven that they have accepted gifts and leisure trips from companies, they are certainly not. Surely. But I have absolutely no reason to believe that there are systemic problems, i.e. that the category of paediatricians and family doctors is exposed to corruption. No more than oncologists, for example, who are more at risk by handling drugs worth 100,000 euros a year: it's like selling a Ferrari instead of a 500. But there are rules that doctors must follow. Surely we need to apply them better ".

Ed.: for greater clarity, we also report article 122.6 of Legislative Decree 219/06 "Scientific representatives must report to the servizio scientifico di cui all’articolo 126, dal quale essi dipendono, ed al responsabile del servizio di farmacovigilanza di cui al comma 4 dell’articolo 130, tutte le informazioni sugli effetti indesiderati dei medicinali, allegando, ove possibile, copia delle schede di segnalazione utilizzate dal medico ai sensi del titolo IX”.