Healthy Skepticism Library item: 12696

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Publication type: news

Ward G.
Vanderbilt bans most gifts from drug firms
Tennessean.com 2008 Jan 31
http://www.fairviewobserver.com/apps/pbcs.dll/article?AID=/20080131/BUSINESS01/801310366/1321/MTCN06

Full text:

Vanderbilt University Medical Center has decided to stop doctors, faculty members and others who work on campus from accepting meals or gifts from the drug industry in a bid to reduce the companies’ influence on patient care and trim spending on drugs.

Under a new conflicts of interest policy, most employees and students would no longer be allowed to accept lunches, pens with logos or other freebies from pharmaceutical companies or other suppliers.

The move comes as a vocal cadre of doctors, including many at other top academic medical centers such as Stanford and Yale, as well as patient advocates, say overly close ties to drug companies can hurt health care and expose patients to the costliest of drug choices.

Employees and students also would be barred from wearing any clothing with the name or logo of a non-Vanderbilt health-care service or product. And the drug companies could no longer sponsor or attend conferences or continuing medical education classes on Vanderbilt’s campus.

The new policy would be phased in by July 1, administrators said. The goal is to reduce the marketing influence of the drug industry, which spends $25 billion a year on promotions to influence patients and doctors who write the prescriptions.

“We want to reduce the possibility that the industry would influence patient care and our educational process,” said Dr. David Raiford, associate dean for faculty affairs and head of the medical center’s conflicts of interest committee.

Previously, medical center faculty and staff members could accept gifts worth under $25 or up to $300 a year from vendors. Food items pre-approved for certain educational programs or meetings also could be brought to the medical center.

Under the new policy, drug representatives can still meet with doctors and supply free samples through an outpatient pharmacy that serves patients directly.

Vanderbilt reviewed conflicts of interest policies at several major academic medical centers, Raiford said.

Its latest policy applies to the more than 400 pharmaceutical representatives and about 1,300 device and equipment representatives that frequent the medical center and comes as it recently found itself in the spotlight after Dr. Harry R. Jacobson, Vanderbilt’s vice chancellor for health affairs, was elected to the board of pharmaceutical giant Merck & Co.

Medical center officials estimate that the new rules should save $2 million in annual spending on drugs, devices and materials, about 2 percent of expenditures in those categories. School officials expect it to lead to the purchase of more generic drugs.

“My sense it that it would help the American people if we drive the $20 billion that’s spent on promotions out of the cost of drugs, but I don’t suspect that drug companies will reduce the prices they charge for drugs anytime soon,” said Eric G. Campbell, associate professor at Harvard Medical School in Boston.

Policy has no penalties

Campbell said a shortcoming of most policy changes is the lack of oversight, few penalties and poor definitions of what accounts for a violation.

Vanderbilt’s policy doesn’t include penalties for violators, but there are plans to educate those affected about the importance of the changes, said Dr. Steven Gabbe, dean of the medical school.

Arthur Caplan, chairman of medical ethics at the University of Pennsylvania, said teaching students how to deal with drug representatives and limiting their exposure to industry pitches and gifts are important.

“Most people don’t think they’re influenced by a free pen, a box of doughnuts or a ticket to a hockey game, but as every person in marketing knows, they are,” Caplan said. “If you get them in the habit of prescribing your drugs early, they’re likely to keep doing it.”

Vanderbilt’s latest policy could be among the most stringent in Nashville.

At Saint Thomas Hospital, employees can accept items of minimal value, including pens and notepads, but managers must report gifts worth more than $75 annually.

Hospital chain HCA Inc., whose local operations include TriStar Health System, allows its employees to accept gifts worth a total of $50 or less in any one year from an individual or organization with business ties to the company.

Dr. Corey Slovis, chairman of the department of emergency medicine at Vanderbilt, generally agrees with the policy change, but has mixed feelings. “On the whole, it’s a good policy that doctors should not be influenced by bribes or food to listen to a sales pitch on why you should use the newest, latest drug,” he said.

“The only thing negative is that many of the pharmaceutical representatives did have important information to relay, and physicians are going to have to be more diligent in learning about some of the new drugs.

However, the prescription a doctor writes needs to be based on facts, and not friendships or dinners.”

Researchers excluded

Vanderbilt’s policy applies to employees who work with patients and prescribe drugs, but not to researchers, said Gabbe, the medical school dean.

The faculty researchers are encouraged to develop research programs with industry colleagues, and it isn’t unusual for collaborators to share meals at each other’s expense.

“It really doesn’t matter who pays,” Gabbe said. “It’s really more about people coming to our campus, bringing a lunch and discussing a product and influencing the way that our faculty, staff or residents might treat a patient or prescribe medications for that patient.”