HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, April 29, 2008

Banning Medical Freebies

The New York Times yesterday reported that the Association of Medical Colleges has recommended  a ban on free  items, including food, gifts, trips, and "ghost-writing services" from pharmaceutical companies and medical device manufacturers.  Gardiner Harris writes      

The proposed ban is the result of a two-year effort by the group, the Association of American Medical Colleges, to create a model policy governing interactions between the schools and industry. While schools can ignore the association’s advice, most follow its recommendations.  Rob Restuccia, executive director of the Prescription Project, a nonprofit group dedicated to eliminating conflicts of interest in medicine, said the report would transform medical education. “Most medical schools do not have strong conflict-of-interest policies, and this report will change that,” Mr. Restuccia said. The rules would apply only to medical schools, but they could have enormous influence across medicine, said Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University. “We’re hoping the example set by academic medical colleges will be contagious,” Dr. Rothman said.

Drug companies spend billions wooing doctors — more than they spend on research or consumer advertising. Medical schools, packed with prominent professors and impressionable trainees, are particularly attractive marketing targets. So companies have for decades provided faculty and students free food and gifts, offered lucrative consulting arrangements to top-notch teachers and even ghost-wrote research papers for busy professors.  “Such forms of industry involvement tend to establish reciprocal relationships that can inject bias, distort decision-making and create the perception among colleagues, students, trainees and the public that practitioners are being ‘bought’ or ‘bribed’ by industry,” the report said.

A group of influential doctors decried these practices in a 2006 article in The Journal of the American Medical Association, and said that medical schools should ban them. In the article’s wake, the medical college association created a task force.

With Dr. Roy Vagelos, a former Merck chief executive, serving as the task force’s chairman and the chief executives of Pfizer, Eli Lilly, Amgen and Medtronic on the roster, some who advocate for greater restrictions on industry influence in medicine predicted that the report would be weak. They were wrong. . . . .

It recommended that schools set up centralized systems for accepting free drug samples or “alternative ways to manage pharmaceutical sample distribution that do not carry the risks to professionalism with which current practices are associated.” It suggested that schools audit independently accredited medical education seminars given by faculty “for the presence of inappropriate influence.” And it said the rules should apply to faculty even when off-duty or away from school.

Speakers’ bureaus and drug samples are pillars of the industry’s marketing operations, and many medical school professors have resisted efforts to restrict them. Only a handful of medical schools presently bar faculty members from serving on speakers’ bureaus, so if this recommendation is widely adopted, it could transform the relationship between medical school faculty and industry, and it could change substantially the way medical education is routinely delivered.

Indeed, the chief executives of Pfizer and Eli Lilly dissented from the report’s recommendation regarding speakers’ bureaus. “We continue to believe that these types of programs, which are subject to clear regulations regarding their content, can be worthwhile educational activities,” wrote Jeffrey B. Kindler of Pfizer and Sidney Taurel of Lilly. . . .

Today's Times has an editorial approving of the ban and urging further reform,

Outright bans would be imposed on personal gifts, industry-supplied food and meals, free travel that is not reimbursement for services and payment for attending industry-sponsored meetings. Also outlawed are the notorious ghostwriting services, in which a drug company drafts a journal article and then persuades a respected academic to sign on as the lead author, giving it a gloss of objectivity that it may not deserve.

Free drug samples, though not banned, would generally have to be accepted by a central pharmacy, presumably capable of assessing their value, not by individual doctors more susceptible to sales pitches.

Unfortunately, the task force, appointed by the Association of American Medical Colleges, flinched on some important issues.  It urged medical schools to “strongly discourage” faculty from participating in industry speakers’ bureaus, which pay influential doctors to promote the benefits of products, but it stopped short of calling for a complete ban on the highly dubious practice.

Similarly, the group did not call for an end to industry subsidies of continuing medical education programs that doctors must take to retain their licenses. Instead, it simply proposed steps to audit the content of the programs and ensure that they are scientifically objective. It is hard to see why doctors should not pay the full cost of their own continuing education.

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