Healthy Skepticism Library item: 12861

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Publication type: news

Fahy J.
Implications of UPMC's ethics policy far-reaching
Pittsburgh Post-Gazette 2008 Feb 10
http://www.post-gazette.com/pg/08041/856084-28.stm

Full text:

As he delivered a typical $120 lunch order to a doctor’s office last week — three chicken or salmon entrees, three appetizers, a chicken sandwich and four salads — Robert Bishop was mindful that his business, Mobile Menus, soon would be filling fewer orders.

On Friday, he expects to lose the deliveries he makes to doctors affiliated with the University of Pittsburgh Medical Center.

A new UPMC conflicts-of-interest policy
(http://www.coi.pitt.edu/IndustryRelationships/policy.htm) will take effect that day aimed at making doctors’ decisions free from influence created by gifts or improper relationships with the drug or medical device industries.

Among other provisions, the policy bans gifts such as pens, note pads and food provided by industry representatives as they work to present information about their products at doctors’ offices.

Losing that food business for the UPMC doctors he visits, Mr. Bishop said, will cut his $5,000 weekly sales by about 20 percent. He said nearly all the lunches he provides to doctors’ offices are paid for by drug industry representatives.

“I think they’re overreacting,” he said of UPMC’s new policy.

The policy directly applies to about 50,000 faculty, staff and students of the university’s Schools of the Health Sciences and other professionals and staff employed or contracted by UPMC’s U.S. operations.

But many others also will be affected, including local business owners such as Mr. Bishop, patients and industry representatives.

Patients could especially notice new provisions related to sample medications.

Those are still being finalized, but some sample-related changes will take effect Friday.

Doctors were given the option of whether to continue offering samples.
Patients seeking them may instead get information about other ways to obtain their medicine, such as manufacturers’ assistance programs.

Nearly 45 percent of UPMC’s more than 530 outpatient sites have chosen to distribute samples beginning Friday, said Dr. Barbara Barnes, associate dean for continuing medical education at the Pitt School of Medicine.
Officials are unaware of how many have done so prior to that date.

By summer or fall, officials hope to have in place a centralized process for UPMC to accept samples from companies, then provide them to doctors’
offices. Once it is established, doctors can continue to opt in or out of the sample program, she said.

An earlier draft policy had proposed more severe restrictions on sample use, but concerns were raised that some uninsured or underinsured patients could lose access to needed medication.

Still, the subject is controversial, with some suggesting that free samples can influence prescribing behavior.

A study published this month found that poor and uninsured Americans are less likely to receive free drug samples than the wealthy or insured.

“Our findings suggest that free drug samples serve as a marketing tool, not as a safety net,” researchers with the Cambridge Health Alliance and Harvard Medical School wrote in the American Journal of Public Health.

The new UPMC policy will bring other changes Friday.

Sales and marketing representatives can continue to visit physicians, if invited, and bring along samples. But they must comply with other policy provisions, including completion of an online training and a quiz about the new guidelines.

So far, at least 635 company representatives have complied, Dr. Barnes said.

Other provisions generally ban gifts from industry, including food, though there are some exceptions, such as food provided at continuing education events.

The policy also includes stipulations on consulting relationships with industry, attendance at off-campus industry-sponsored meetings, and industry support for scholarships and fellowships.

Presentations have been made to UPMC and Health Sciences physicians and staff about the new policy, Dr. Barnes said.

Working groups also are identifying ways to inform students about the policy before they begin clinical rotations, she said.

A Web site, www.coi.pitt.edu/IndustryRelationships, provides more information, including telephone numbers where alleged violations can be reported.

For UPMC or Health Sciences personnel, penalties could include counseling, written reprimands, revocation of hospital privileges, fines or termination. Companies repeatedly violating the policy could have their sales and marketing personnel suspended from UPMC and the Health Sciences schools for a year or more.

The number of academic medical centers imposing such restrictions is growing every year, one pharmaceutical company, AstraZeneca, said in a statement.

Reacting to the new UPMC policy, the company suggested guidelines preventing physician interaction with pharmaceutical specialists could inhibit patient access to needed products or correct product use.

Dr. Barnes said UPMC has a number of ways to inform doctors about new drugs, including newsletters, e-mail alerts and visits to outpatient sites.

“We also will allow our business units to invite representatives to come to talk about new drugs,” she said.

Mr. Bishop said the effect of the new policy will be mitigated in part by his other business interests. His family operates a gymnastics facility and he also works as a bakery distributor.

But he worried that other medical centers would follow UPMC’s lead, and about the effects the change would have on other area businesses.

“Some restaurants are heavily dependent on our service,” he said. “But I realize it’s out of my control. I’m not a player in this whole thing.”