Healthy Skepticism Library item: 12111

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Publication type: news

Linker A.
UNC med students say drug firms have too much sway
Triangle Business Journal 2007 Nov 30
http://triangle.bizjournals.com/triangle/stories/2007/12/03/story2.html?b=1196658000^1557919&page=1

Full text:

CHAPEL HILL – Medical students at the University of North Carolina at Chapel Hill are asking the school to rein in the influence of pharmaceutical industry representatives on campus, including a ban on gifts and free meals.

The students, most of them represented by the American Medical Student Association, or AMSA, first presented Dr. Etta Pisano, vice dean for academic affairs at the UNC School of Medicine, a letter in March requesting that the school recognize the influence of “pharmaceutical promotions in our hospitals and clinics,” restrict industry gifts to students and physicians, and incorporate ethics and conflict-of-interest training into the regular curriculum.

And in October, the group released a scorecard grading the guidelines at schools that restrict industry influence. AMSA gave UNC a “C-”, noting that the university is “discussing the formation of a policy.”

Duke University scored a “B” on the survey, the second highest rating, for setting limits on the movement of pharmaceutical representatives.

Anthony Fleg, a fourth year medical student at UNC, is coordinating AMSA’s national drive to limit the access of drug companies to academic medical centers such as UNC.

Fleg points to a 2006 article published in the Journal of the American Medical Association as inspiration – a piece that argues that even small gifts influence physicians and students and that academic medical centers are considered models in the world of health care.

“Drug companies are always eager to talk to students,” Fleg says. “The bull’s-eye is definitely on us.”

Students face steep obstacles in their bid to limit corporate influence as branded buildings and programs – the FedEx Global Education Center, the Glaxo building and the GSK Global Health Program – proliferate across the UNC campus.

Much of the influence of pharmaceutical companies, Fleg says, comes from gifts left at departments, free samples of brand name drugs and lunch lectures sponsored by corporations where doctors – sometimes with industry ties – discuss new research and treatments.

“You will not find a clinic at UNC that does not have clocks, pads and pens sponsored by drug companies,” Fleg says.

And the pressure is even greater during off-campus training rotations, Fleg adds. At one clinic, Fleg recalls, he had to run a gantlet of drug reps to see a patient.

Administrators at UNC, including Pisano, declined to comment for this article.

An examination of UNC’s policy shows that the school does not limit gifts and “acknowledges that transactions and relationships with pharmaceutical and other vendors” are important to UNC and “may contribute to continued improvements in patient care.”

The UNC policy contrasts with policies that AMSA uses as models, including guidelines set by Stanford University that forbid industry gifts at Stanford or at any of its affiliated hospitals and clinics.

The concerns raised by students come on the heels of a U.S. Senate report issued this month concluding that John Buse, a doctor at UNC who raised concerns about the diabetes drug Avandia, subsequently had been the target of a pressure campaign by the manufacturer of Avandia, GlaxoSmithKline.

The report notes that GSK scientist Dr. Tachi Yamada called Dr. Fred Sparling, Buse’s department chair at UNC. Although Buse says he was not pressured by Sparling, he did send a letter to Yamada that ended: “Please call off the dogs. I cannot remain civilized much longer under this kind of heat.”

In an interview for this article, Buse said he does not believe that UNC needs a formal procedure protecting professors from the complaints of drug companies.

He said he understands the objections raised by students – that continuing education classes sponsored by drug companies could influence the types of treatments recommended in favor of a particular drug company.

“But it’s a difficult question,” Buse said, “because we have evolved a certain system where at some clinics, if drug companies didn’t sponsor continuing education, it wouldn’t happen.” Buse recalls when drug companies 10 years ago would treat doctors more lavishly – golf outings, for example. Now they’re limited to such favors as feeding doctors during educational lunches.

Fleg says AMSA is currently working on a more comprehensive scorecard and will continue to pressure UNC to change its relationship with the industry. Pisano, he says, is receptive to the idea.

“We have the power to clean up shop,” Fleg adds. “But we have been complicit in giving industry what it wants.”

Reporter e-mail: alinker@bizjournals.com.