Med schools asked to shun drug firm freebies
■ The Assn. of American Medical Colleges also wants schools to ban or limit drug industry programs such as speakers' bureaus.
By Myrle Croasdale — Posted May 26, 2008
Free lunches, pens or trips to resorts from drug companies should not be accepted. Ghostwriting of pharmaceutical research should be prohibited. And participation in industry-backed speakers' bureaus should be discouraged.
A report by the Assn. of American Medical Colleges calls for these and other restrictions to limit drug and medical device companies' interactions at the nation's medical schools and teaching hospitals. The report's recommendations seek to free the educational environment of industry marketing activities, put buffers in place when industry funding is accepted, and distance physicians and trainees from sales representatives' influence, medical leaders said.
AAMC Chief Scientific Officer David Korn, MD, said the recommendations were prompted by concerns that industry funding is increasingly eroding the objectivity and integrity of medical education.
"Those [industry] influences may not be in the best interest of individual patients and may not be in accord with the best evidence available about particular illnesses," he said.
The AAMC's governing board is expected to adopt the report's findings next month, then the organization would urge its member schools to embrace the recommendations. Supporters say the stricter standards should bring sweeping changes to academic medical centers.
"We feel this is a really important starting point," said Robert Restuccia, executive director of the Prescription Project, which helps academic centers and others eliminate conflicts of interest.
The report, released last month, calls for limiting drug reps' access by allowing them to meet with physicians only by appointment and away from patient care areas. Drug samples, if accepted, should be distributed through a central system or pharmacy, the report said.
Cutting out freebies
The AMA permits physicians to accept gifts if they are not of substantial value, $100 or less. But physicians may not accept payment for attending or traveling to conferences. The AMA's Council on Ethical and Judicial Affairs is reviewing policies and may submit changes at the AMA's Annual Meeting in June.
The drug industry's influence on medical education was addressed in 2006 in a Journal of the American Medical Association opinion piece that challenged academic medical centers to take the lead in conflict-of-interest reforms. The AAMC created a task force of pharmaceutical executives, academic leaders, medical students and others to consider reforms, which were detailed in the new report.
"The report came down very strongly on the side of ensuring objectivity and evidence-based decision-making for students and physicians," said Jordan J. Cohen, MD, AAMC past president and co-author of the JAMA article.
However, not everyone supports the recommendations. Task force members Jeff Kindler, CEO of Pfizer, and Sidney Taurel, board chair at Eli Lilly and Co., co-signed a letter stating they oppose discouraging physicians from being in speakers' bureaus. The Pharmaceutical Research and Manufacturers of America disagreed with the AAMC's description of the motives behind industry interactions with academics.
Some schools already have bans and restrictions in place.
R. Van Harrison, PhD, continuing medical education office director at the University of Michigan Medical School in Ann Arbor, said several years ago the school banned free drug samples, discouraged faculty participation in speakers' bureaus and restricted drug reps' campus access.
Faculty members still take part in speakers' bureaus, but trainees' relationships with sales reps have changed. "A couple of reps told me the residents don't recognize them walking down the hall anymore," Dr. Harrison said.
Similar practices were implemented two years ago at Stanford University School of Medicine, said Clarence H. Braddock III, MD, MPH, an associate internal medicine professor at the school and a member of the Stanford Center for Biomedical Ethics.
"Students and residents still attend teaching conferences [but] without the lure of complimentary lunches," he said. "And banning gifts has removed the lingering presence of free advertising on pens and pocket liners."
AAMC's Dr. Korn said it may be easier to change the behavior of students and residents than faculty.
"Physicians and medical scientists are highly trained and believe they behave with extreme rationality and integrity," he said. "They don't believe the free meals -- the apocalyptic pizza -- can possibly influence their decision-making, but there is a rich body of evidence on how effective these activities are."