Healthy Skepticism Library item: 12701

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Publication type: news

Fisher JP.
Future M.D. says no to handouts of drugmakers
News Observer 2008 Jan 27
http://www.newsobserver.com/news/story/905519.html

Full text:

As a medical student, Anthony Fleg is at the center of the latest wave of rebellion against the pharmaceutical industry’s cozy ties to doctors, hospitals and medical schools.

Fleg, in his fourth year of training at UNC-Chapel Hill, is national coordinator of the American Medical Student Association’s effort to wean medical schools from their pervasive relationships with drug companies. And he’s had quite a year.

Fleg helped AMSA’s PharmFree campaign, established in 2002, produce the first scorecard to grade medical schools based on whether they have policies curbing the pharmaceutical industry’s influence. The effort generated national press coverage. He also expanded PharmFree’s national annual awareness day to an awareness week this fall, giving the issue its biggest splash to date.

In October, Fleg testified before the U.S. Senate, explaining why he believes physicians who accept lunches and even small gifts such as notepads and mugs from drug companies open the door to influence. In the end, he contends, the sacred doctor-patient relationship is compromised. Next month, Fleg will lead a PharmFree delegation to Washington, D.C., to lobby for changes that would require physicians to publicly disclose all industry gifts valued at more than $25.

The bill would strengthen existing guidelines for industry gifts developed in the early 1990s, when organized medicine responded to a backlash over lavish golf outings and other favors provided to doctors. Now PharmFree and other activist organizations such as No Free Lunch are out to limit or abolish the token gifts that have continued to be acceptable under the current standards.

Even prescription samples don’t meet with Fleg’s approval, though the future family doctor sets aside his rules if that ensures patients get the medicine they need.

“My patients come before my ethical concerns,” says Fleg, 29. “But let’s call samples what they are. They are promotional samples; they are not free. It’s an ingenious way to ensure the patient goes home with a more expensive drug.”

The pharmaceutical industry, led by its advocacy group Pharmaceutical Research and Manufacturers of America, contends free samples help patients, especially those who are poor or uninsured and may not otherwise be able to afford needed medicines.

Bound to his cause

Fleg’s zeal for the cause is boundless.

He often wears his PharmFree T-shirt on campus, hoping to spark conversation. And he keeps alert to hospital clinics that overflow with drug company freebies. Fleg grins as he recalls a “covert operation” at a New Mexico hospital where he recently completed a family medicine rotation. He had a field day carefully plastering PharmFree stickers over the brand names of pharmaceutical products.

“That was some of my best work,” he says.

Fleg’s wife, Shannon Fleg, who is expecting the couple’s first child this summer, jokes that her husband will probably be at her side in the delivery room with a tiny PharmFree sign for the baby to hold.

It would be easy for such a strident advocate to become a figure of controversy and strife. But colleagues and mentors say Fleg, who stands 6-foot-4 and towers over most people, tempers his principles with a genuine respect for others’ opinions, even when they are at odds with his own.

He frequently uses humor to challenge the status quo and invite conversation. Fleg signs his e-mail messages with offbeat taglines such as, “Card-carrying member (with overdue fines), Chapel Hill Public Library,” or “Intramural Debate Team Alternative (occasionally), Atholton High School.” It’s Fleg’s way of getting a smile while poking fun at the self-important practice of following one’s name with credentials and associations — common among physicians.

“I look forward to those. I frequently go right to the bottom” of Fleg’s e-mails, says Dr. Alan Cross, chairman of UNC-CH’s Department of Social Medicine and a pediatrician whom Fleg considers a mentor. “He uses self-deprecation and a little bit of humor to poke fun at the pomposity of the rest of us.”

UNC-CH also graded

Fleg’s main purpose at UNC-CH this year has been to persuade the medical school to adopt a policy limiting pharmaceutical company involvement in hospital and academic programs. UNC-CH has no formal rules limiting or banning drug company activities on campus.

Drug company-sponsored lunches that feature lectures about the newest medicines are weekly or even daily events in some clinics, Fleg says. He says you can’t walk into many clinics without seeing brand names on clocks, staplers, clipboards, mugs, soap dispensers and other drug company freebies. UNC-CH rated a “C-” grade on PharmFree’s scorecard.

“The scorecard was a truly ingenious thing,” says Fleg, noting that the ratings were based on data collected by a pre-med student who interned with the student medical association. “Once you start grading schools based on whether they have a policy, it becomes much in their favor to say we do have a policy.”

A vice dean of the medical school recently indicated that UNC-CH will have a policy in place by the end of the school year.

“We were worried that people would get sick of hearing his message,” said Stephanie Wolfe, a second-year medical student at UNC-CH and president of the medical school’s chapter of PharmFree’s parent organization, the American Medical Student Association. “It really hasn’t happened yet.”

Fleg and others involved in the national PharmFree campaign are in the process of finalizing this year’s scorecard, to be released next month. He led efforts to make the ratings more detailed, judging medical schools not just on whether they have a conflict-of-interest policy but on what specific steps they take to limit drug company influence.

Community crusades

PharmFree isn’t Fleg’s only cause.

He and his wife, Shannon, a Navajo Indian from Arizona, established the Native Health Initiative, which partners with American Indian tribes in North Carolina to improve health and well-being. Fleg, who taught third- and fourth-graders in inner-city Baltimore before enrolling in medical school, is in the Chapel Hill public schools on a regular basis as a speaker and mentor. Today, the Flegs will serve as keynote speakers for Orange County’s observance of Human Relations Month.

Fleg is determined that a career in medicine, and the financial rewards that often accompany it, won’t change his principles. It’s a trait he gets from his parents, who are both physicians.

“I never tell anyone up front that I’m a doctor because I don’t want them to treat me any different,” said Dr. Rosemarie Fleg, Anthony Fleg’s mother and a radiologist practicing in Maryland. She said that she and Anthony’s father, Dr. Jerome Fleg, a cardiologist, still live almost as frugally as they did when they were medical students. “Money doesn’t make you happy. It’s what you do in life.”

It’s a lesson Anthony Fleg has taken to heart.

After completing his residency training, Fleg will practice in a federally designated health-care shortage area as a member of the National Health Service Corps. In exchange for Fleg’s commitment, the U.S. government is footing the bill for his medical education. The deal will allow Fleg to graduate from UNC-CH debt-free, liberating him from the pressure to make money to pay off school debt. But Fleg says serving in an area where doctors are most needed won’t be much of a sacrifice.

“It’s something I’d be doing anyway,” he says. “It’s ultimately what is going to make me happiest.”