Healthy Skepticism Library item: 7005

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

Griffith D.
UCD to reject drug gifts: In ethics ruling, the medical center tells doctors to just say no to drug company reps bearing free samples and lunches.
The Sacramento Bee 2006 Nov 30
http://www.sacbee.com/101/story/85056.html

Abstract:

In a shift in medical ethics at UC Davis Medical Center, the university health system will refuse all pharmaceutical company gifts, including drug samples and widely relished free lunches.

The changes, which take effect July 1, are round one in what is expected to be a series of efforts in coming years to curb the influence of drug companies and others who sell or market products to the medical center.

“At some stage in life, you have got to ask, what is the right thing to do, and this is clearly the right thing to do,” said Dr. Ralph deVere White, UC Davis Cancer Center director. “We will adapt.”

Beyond the prohibition of freebies such as pens, notepads and meals from drug makers, the new rules will prohibit what are called preceptorships, in which drug company sales representatives had occasionally been allowed to tag along with doctors as they went about their daily routines.

In place of free drug samples, patients who meet income criteria will be able to participate in various programs for free or discounted drugs.

By adopting the changes, UC Davis joins a small but elite cadre of academic medical centers that have begun to restrict pharmaceutical company gifts and other marketing schemes.

They include Yale University, Stanford University, the University of California, Los Angeles, and the University of Pennsylvania.

“It is widely viewed by people on both sides of this issue that those gifts are the currency the industry spends to get access to professionals in training and in practice,” said Dr. Garen Wintemute, a UC Davis emergency room doctor who helped spearhead the recent changes.

“That currency has been taken away.”

The pharmaceutical industry opposes such measures: “Restricting the ability of sales representatives to give health care professionals valuable information … would be a serious mistake,” the Pharmaceutical Research and Manufacturers of America (PhRMA) said in a recent policy statement.

PhRMA argues that drug companies and their representatives are the most knowledgeable about the medicines they sell and are schooled in ethics and regulatory guidelines.

Dr. Timothy Albertson, executive director of clinical care for the UC Davis Health System, predicted that at least one change — the end to free lunches
— will have a “huge” impact, both on the university’s bottom line and on those who rely on the convenience of a free meal.

He cited as an example reports that one medical department at UCLA estimated it lost $150,000 worth of meals per year when it did away with industry’s free lunches for its staff.

Medical lunch meetings are frequently catered by drug makers regardless of the meeting’s topic.

The meals bolster attendance, since a lot doctors wouldn’t otherwise have time to get lunch, Albertson said.

“If they can’t get their food delivered to them, they either bring it from home, or miss part of the meeting,” he said. “It has an impact.”

DeVere White said medical staff at the cancer center have come to expect the meals provided during “tumor boards,” meetings during which individual patient cases are discussed over sandwiches.

Industry representatives also cater lunches for cancer patient education sessions.

DeVere White, who applauds the university’s move, said his department will likely spend up to $70,000 paying for the meals so the lunchtime meetings can continue.

Albertson acknowledged that staffers are anxious about how the changes will be implemented.

In one recent e-mail, he said, a doctor wondered whether giving an asthma patient a drug delivery device — typically provided free by asthma drug makers to help teach patients how to use their medication — would be prohibited under the new policy.

“Do we consider these free samples? Or are they teaching aids?” Albertson asked.

The university may resort to purchasing the devices for patients or ask the pharmacy to distribute them to medical clinics.

“Being ethical is a lot of work,” he said.

Still, there is far more work to do.

A new committee has been assembled to consider restrictions on interactions with the makers of medical devices — everything from pacemakers to the radiation machines used in cancer therapy.

Dr. Jerome Kassirer of Tufts University, a leader in the reform movement, applauds the Davis decision, but said the school should go further. He said doctors should not be allowed, for example, to serve on speaker’s bureaus for the pharmaceutical industry or collect consulting fees.