Healthy Skepticism Library item: 2536

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Lenzer J.
Doctors refuse space to group fighting drug company influence
BMJ 2005 Sep 24
http://bmj.bmjjournals.com/cgi/content/full/331/7518/653-a?ehom

Keywords:
AAFP

Notes:

Ralph Faggotter’s Comments: This article was written before the public outcry and a campaign by AAFP members had the effect of causing Dr Henley to reverse his decision and allow No Free Lunch to have a small stall at the conference.
See below for Howard Brody’s comments on the widespread nature of the phenomenon of inappropriate sposorship for medical organisations and Bob Goodman’s comments on the AAFP U-turn.
Unfortunately all of the inappropriate sponsors remain at the conference.

see also: DeAngelis CD. Rainbow to dark clouds (editorial). JAMA 2005;294:1107.

Bob Goodman’s Comments: Date: September 21, 2005.

The American Academy of Family Physicians changes its mind, says yes to No Free Lunch.

Contact: Bob Goodman, bob@nofreelunch.org, tel: 212-305-6263

Following an outcry from among its members, the American Academy of Family Physicians has reversed its earlier decision to deny a booth to No Free Lunch and has invited the organization to exhibit at its meeting next week in San Francisco.

In August, The AAFP rejected No Free Lunch’s application to exhibit at its annual meeting-which will be attended by some 5,000 family physicians and slightly fewer exhibitors-stating that No Free Lunch’s position was “not within the character and purpose of the Scientific Assembly.” This despite the fact that the Coca-Cola Company, The McDonald’s Corporation, and The Distilled Spirits Council of the U.S. were all allotted space in the hall, as were countless pharmaceutical companies.

Many members were upset and even outraged that a society which they had supported for many years, and which gives industry almost unlimited access to physicians at its meetings, would not allow a small organization of health professionals to voice an opposing view. Allen Pelletier, for example, a family physician from Memphis, Tennessee, a long time AAFP member and newly elected fellow of the Academy, in an e-mail to AAFP CEO Dr. Douglas Henley, wrote “To my embarrassment, the organization that represents me as a practitioner and teacher of family medicine has shut down the possibility of open (and yes, critical) dialogue about how our practices are influenced by the pharmaceutical industry.” A family physician and AAFP member for 25 years from East Lansing, Michigan, wrote “. . . if an organization like No Free Lunch, well known for the role that it has played in encouraging awareness among physicians of the negative impact of pharmaceutical marketing, is denied the opportunity to set up a booth at the meeting, while commercial sponsors are encouraged to pay extra for more access to members and attendees, then the professional values of our specialty society have truly reached a new low.”

No Free Lunch has accepted the AAFP’s invitation and plans to be present at the session which opens September 28 at the Moscone Center. Attendees are encouraged to visit The No Free Lunch booth, #1613, immediately adjacent to that of the California Table Grape Commission.

No Free Lunch (http://nofreelunch.org) is a not for profit organization whose mission is to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion. It discourages the acceptance of gifts from industry by health care providers, trainees, and students. Its goal is improved patient care. It was founded in 1999 by Bob Goodman, a general internist at Columbia University Medical Center in New York City.

Howard Brody’s Comments: When I read …‘s accounts of what he had found on the websites of
various national medical-professional societies, I realized that I had
been remiss in not checking out the website of my own national
organization, the American Academy of Family Physicians. The 2004
scientific assembly in Orlando had just been completed when I looked up
the website; but the “exhibit prospectus” was still posted on the web.
The prospectus boasted to would-be advertisers and renters of exhibit
booths how many family physicians would be attending, how the attendees
were considered the local opinion leaders and trend-setters, and how
many of them had purchased or picked up items at booths at last year’s
assembly. Among the places firms were invited to advertise: the AAFP
assembly TV program that ran 18 hours a day in each attendee’s hotel
room; the “Shuttlevision,” a promotional tape playing constantly in the
shuttlebus taking attendees back and forth from the convention center;
and the “Doctor’s Bag door hanger” delivered to attendees’ hotel rooms
(“This is the official . . . hotel door delivery program; absolutely no
materials may be delivered to registrants’ hotel rooms by any other
means”).

Full text:

BMJ 2005;331:653 (24 September), doi:10.1136/bmj.331.7518.653-a

http://bmj.bmjjournals.com/cgi/content/full/331/7518/653-a?ehom

One of the largest doctors’ groups in the United States, the American
Academy of Family Physicians, has refused to rent exhibition space to a
campaigning group that says that pharmaceutical industry promotions are
leading to bad patient care. But the academy has agreed to rent space
at its annual scientific assembly to the fast food giant, McDonalds,
alongside various pharmaceutical companies.

The academy, which will hold its annual scientific assembly in San
Francisco from 28 September to 2 October, has refused to allow the non-
profit making organisation No Free Lunch, based in New York, to rent
exhibit space at the conference.

No Free Lunch is an organisation of doctors and other healthcare
professionals who want to “encourage healthcare practitioners to
provide high quality care based on unbiased evidence rather than on
biased pharmaceutical promotion.” The group urges doctors not to accept
gifts or food from drug companies because “there is ample evidence in
the literature” that such gifts “exert significant influence on
provider behaviour.”

According to the academy’s executive vice president, Douglas Henley, No
Free Lunch was excluded because the presence of the group was “not in
keeping with the purpose of the scientific assembly’s exposition, which
is to promote a dialogue between the exhibitors and our attendees.”

“There is an important and healthy dialogue that goes on at our
meetings between the exhibitors and attendees and No Free Lunch would
like to see that type of dialogue go away,” he said.

He stood by the decision to allow McDonalds to exhibit: “Family
physicians care for lots of patients who obviously get food at many
fast food restaurants . . . To the credit of McDonalds, they have begun
to promote healthier choices.”

Dr Henley said that the purpose of the McDonalds’ exhibit was “to
discuss with our members who attend the [exposition] these healthier
choices-information they can then use to better educate and counsel
their patients.”

No Free Lunch’s founder, Bob Goodman, said, “This is a scientific
assembly. You would expect differing points of view. Why wouldn’t they
allow a small doctors’ group whose primary focus is to provide good
patient care to exhibit? This is nuts.”

Dr Michael Wilkes, professor of medicine and vice dean for medical
education at the University of California, Davis, called the academy’s
decision “ridiculous and embarrassing.” He said, “As a physician I am
insulted. This does not represent the interest of mainstream family
physicians who are working hard to get the best information they can to
care for their patients. They need to hear from people with differing
opinions. The academy has gone out in right field – this is all about
finances not about education. There can be no other reason for
excluding a group like [No Free Lunch] than fear of offending sponsors.”

Conference exhibitors and corporate supporters of the academy’s
conference include the Distilled Spirits Council of the United States,
Abbott Laboratories, Coca-Cola, AstraZeneca, Boehringer Ingelheim, Eli
Lilly, GlaxoSmithKline, Merck, and Pfizer among others.

The academy’s Advertising and Support Opportunities brochure assures
exhibitors that advertising at the conference offers “proven traffic-
builders that will help you achieve the greatest return on your exhibit
investment and provide year-round visibility in the physician’s office”
and that “over 71% of assembly attendees write more than 20
prescriptions a day-with over 32% writing 40 or more per day!”

Booth rentals are available to exhibitors for prices ranging from $2500
(£1380; ?2060) to $111 375 per booth; advertisements in the academy
newsletter cost between $5250 and $23 300; and providing free lunch to
attendees can be purchased for $60 500 per day.

No Free Lunch was also barred by the American College of Physicians
earlier this year when the college refused to rent exhibit space to the
group. The college has previously acknowledged that “the acceptance of
even small gifts can affect clinical judgment and heighten the
perception (as well as the reality) of a conflict of interest.”

But when several medical students in No Free Lunch t shirts handed out
literature at the college’s annual meeting this April, security
officers, including armed police, “shadowed their every step,”
according to Dr Goodman. The students were handing out copies of the
college’s own guidelines on interactions with industry.

See www.nofreelunch.org.