Curbing big pharma

By 2011, UNM Hospital won't be quite as hospitable to pharmaceutical company reps.

The University of New Mexico Health Sciences Center recently adopted a new policy that keeps pharmaceutical salesmen at arms length.

ALBUQUERQUE -- American physicians write nearly 4 billion prescriptions a year. Wouldn't it be refreshing to know that your doctor wasn't writing under the influence of Pfizer, Eli Lilly or Merck?

Students at the University of New Mexico UNM Health Sciences Center thought so too, and through their efforts, the center is joining a national movement to keep pharmaceutical salesmen at arms-length. The conflict of interest policy approved last month means no more free lunches or tickets to a baseball game, no more T-shirts or ball caps emblazoned with "Lipitor" or "Viagra."

In fact, now the students are talking about having an "amnesty day," when they can return all the free schwag they've accepted in the past, said Health Sciences Center spokeswoman Cindy Foster.

The policy change won't ban drug company sales reps from campus but will restrict them to certain areas, according to a Health Sciences Center news release. Faculty, staff and trainees may not accept personal gifts from company representatives on the campus nor display items bearing industry logos. Reps can still give away drug samples, but the policy calls for physicians to "select the best and most economical medications for their patients."

Free mouse pads and pizza lunches may seem trivial, but consider this from a New York Times story in late April: "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."

It turns out that UNM was on the front of the wave when medical students started talking about the need for a conflict-of-interest policy three years ago. In 2006, after a group of prominent physicians wrote to the Journal of the American Medical Association and decried the cozy relationship between pharmaceutical companies and medical schools, the American Association of Medical Colleges (AAMC) formed a task force to study the issue. Its report on "industry funding of medical education" was issued April 27.

And today, the American Medical Student Association issued a report card on conflict-of-interest policies at 150 U.S. medical schools. It gave seven schools an A grade, and 14 others, including UNM, a B. Sixty of the schools got an F.

The companies' practices at UNM, according to Foster and to the news release, have ranged from complimentary hats and pens to providing lunch while a sales representative talked about a new drug. But the AAMC report said even those gifts are going too far.

“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.

Drug salesmen have been visiting U.S. medical school campuses since the 1950s to provide doctors with information on new drugs, the UNM news release says. But the number of drug reps doubled in the 1990s, to 90,000, just as drug companies started flooding the market with their own versions of similar drugs — and with average prices nearly double those of the original drugs, the news release says, quoting the U.S. Food and Drug Administration (USDA).

“While the increasing influence of the pharmaceutical industry on health sciences centers across the country has been a gradual one for our faculty, it is the only environment that our students know," Dr. Paul Roth, the executive vice president for UNM Health Sciences, said in the release.

Doctors across the nation have seen a steady flow of notepads and other office supplies bearing drug manufacturers' logos, said Dr. Eve Espey, a professor and member of the task force that wrote the UNM policy.

“Most doctors will tell you that they are not swayed by such items,” she said in the release. “However, data suggest that even small items influence prescribing in a potentially negative way for patient care and there is an increasingly strong public perception that physician acceptance of gifts is not good for patient care. We believe it is important to respond to the public’s concerns.”

One long-time practice of the drug company reps — providing meals on the UNM Health Sciences Center campus  — will be phased out by 2011. It will take that long because of the complexity of the financial relationship between the drug companies and the school, Espey told the New Mexico Independent. Resident medical students are required to attend instructional conferences as often as five times a week, she said. Food is provided to ensure high attendance and to make it easier for residents to attend the entire event, and drug companies pick up the tab. One department's tab is $100,000 a year, she said, and it will take time for the school to absorb that extra cost, Espey said.

While many schools have yet to consider potential conflicts of interest, some in the medical profession want academic institutions to go even further than banning free lunches and ballpoint pens. In February, the American Medical Association (AMA) published a report citing concerns about conflicts of interest rising to the institutional level, such as company payments to the schools themselves.

Many leaders and administrators at [academic medical centers] are asking how scientific objectivity can be maintained considering the potentially compromising relationships that can ensue from gifts, grants, royalties, equity holdings, and business ownership — not only to individual investigators and clinicians, but also to academic institutions.

Also chiming in on the idea is a nonprofit group called the Prescription Project, which is funded by the Pew Charitable Trusts. It seeks to eliminate conflicts of interest between all doctors, not just those at medical schools, and the pharmaceutical companies by promoting state- and national-level policy solutions as well as public awareness campaigns.

Espey said she believes stronger conflict of interest policies should be adopted by the medical schools and physicians to counteract the marketing power of pharmaceutical companies. "Drug companies would not be spending $25 billion a year to market to physicians if it didn't work," she said. "I'm a huge believer that this is really problematic."

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