Healthy Skepticism Library item: 6191

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Publication type: news

Griffith D.
UCD may curb doctors' drug-company freebies
sacbee.com 2006 Oct 3
http://www.sacbee.com/101/story/32968.html

Full text:

UCD may curb doctors’ drug-company freebies
http://www.sacbee.com/101/story/32968.html
By Dorsey Griffith – Bee Medical Writer
Published 12:00 am PDT Tuesday, October 3, 2006
You’ve seen them in your doctor’s office: pens and notepads labeled
with the
names of leading drugs or medical devices. What you don’t see are the
free
lunches, expense-paid trips and lucrative consulting deals for
physician
lectures and conferences.
Concerned that the goodies and other tactics by drug or medical device
companies can drive medical decisions, the UC Davis Health System is
considering strict limits on meals and on payments for doctors to
attend
meetings or participate in online medical education classes.
If UC Davis ultimately adopts the policies, it will join an elite group
of
academic medical centers taking the same tack: Stanford and Yale
universities and the University of Pennsylvania.
“We need to reaffirm the social contract under which we practice
medicine,”
said Dr. Garen Wintemute, an emergency doctor and UC Davis professor
who is
leading the charge for reforms. “Our primary responsibility is to the
welfare of our patients. Industry marketing practices interfere with
our
ability to fulfill that responsibility”
The medical center’s Pharmacy and Therapeutics Committee, which
oversees the
purchase of drugs and devices for the health system, voted last week to
send
three recommendations to the medical center’s executive committee for
consideration:
. A ban on all gifts, free meals, payment for travel time or time spent
at
meetings, and payment from drug or medical device companies for
participation in online medical education programs.
. An end to the system that allows pharmaceutical sales representatives
to
give doctors free drug samples for patients. The former arrangement
would be
replaced with a voucher system to benefit low-income patients.
. The exclusion of any medical professional with ties to drug or device
manufacturers from hospital and medical group committees that oversee
the
purchase of drugs or medical devices.
Four other recommendations aimed at eliminating potential conflicts of
interest are pending at the Pharmacy and Therapeutics Committee level.
The
suggested changes come from a proposal outlined for academic medical
centers
in a January article in the Journal of the American Medical
Association.
One such proposal would prohibit manufacturers from funding medical
education programs for health care providers. Instead, companies could
contribute to a central repository overseen by the medical center for
spending on education. Currently, about 90 percent of funding for
physician
education comes from industry.
That was obvious last week during a conference on psychotic disorders
at the
UC Davis MIND Institute. The conference was supported by “educational
grants” from four companies that make anti-psychotic drugs. The drug
makers
had display tables just outside the meeting room, where they handed out
pamphlets about their products, free pens and other goodies labeled
with
their brand names.
In a statement last week, the Pharmaceutical Research and Manufacturers
of
America (PhRMA) called efforts to restrict such marketing efforts “a
serious
mistake.”
“The general concern we have is that some of these very restrictive
policies
are not necessary and may in fact cut down on interactions between drug
company reps and physicians,” said Scott Lassman, senior assistant
general
counsel for PhRMA.
“This is not good for patients, because the reps have very useful
information about the medications.”
Lassman added that PhRMA adopted its own code of ethics a few years ago
that
asked industry members to end lavish gift-giving.
Dr. Tim Albertson, chairman of Davis’ Pharmacy and Therapeutics
Committee,
said the proposals are the most recent in a decadelong effort to
re-evaluate
drug company ties to the university and to narrow relationships between
doctors and the drug and device industries.
Still, any proposed changes pose challenges to the health system. He
said
drawing a line between marketing and legitimate physician education can
be
difficult.
“What we are trying to do is bring light to the subject,” he said. “We
are
not going to be police. But if we as an institution make a statement,
that
has power.”
If successful, UC Davis would be the second health system in the
Sacramento
region to tighten its conflict of interest policies. Two years ago,
Kaiser
Permanente adopted several sweeping restrictions.
Those limits are working, said Dr. Sharon Levine, associate executive
director of Kaiser Permanente Northern California.
“It is protecting professionalism and ensuring our members never have
to
worry about whose interests are being served when a drug is prescribed
or a
hip implant is chosen for a surgical procedure,” said Levine.
UC Davis medical students have launched their own effort. Second-year
student Nelson Conley circulated a petition calling for an end to
industry
freebies he said are used to curry favor among students when they are
most
vulnerable to influence.
Even as an undergraduate, Conley said he shadowed a neurologist in
private
practice and enjoyed free Subway sandwiches, deli platters and Chipotle
burritos in exchange for half-hour sessions with drug company reps.
“We will remember who helped us when we didn’t have money and we were
hungry
all the time,” he said. “I think it’s inappropriate.”
Conley has been asked to draft proposals for consideration by the
medical
school’s Committee on Educational Policy.
“I’m hoping it’s the beginning of a tide shift,” he said. “It’s a very
slow
process.”
Conley and other proponents of policy changes say many medical students
and
doctors don’t believe they can be swayed by the marketing tactics in
question.
“They have almost always a universal view that none of this has an
influence
on them because they are scientists and accustomed to evaluating data
objectively,” said Jerome Kassirer, former editor of the New England
Journal
of Medicine and author of the book “On the Take: How Medicine’s
Complicity
with Big Business Can Endanger Your Health.”
“That’s a lot of baloney,” he said.
Several studies in recent years have found that the rate of drug
prescriptions by doctors increases substantially after they see sales
representatives, attend company-supported meetings or accept free
samples,
according to an article published earlier this year in the Journal of
the
American Medical Association.