OT: Group Urges Ban on Medical Giveaways

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New York Times

April 28, 2008

Group Urges Ban on Medical Giveaways By GARDINER

HARRIS<http://topics.nytimes.com/top/reference/timestopics/people/h/gardiner_har\

ris/index.html?inline=nyt-per>

Drug and medical device companies should be banned from offering free food,

gifts, travel and ghost-writing services to doctors, staff members and

students in all 129 of the nation's medical colleges, an influential college

association has concluded.

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<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtop\

ics/medical_schools/index.html?inline=nyt-classifier>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. Rothman, president of the

Institute on Medicine as a Profession at Columbia

University<http://topics.nytimes.com/top/reference/timestopics/organizations/c/c\

olumbia_university/index.html?inline=nyt-org>.

" 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<http://topics.nytimes.com/top/reference/timestopics/organizations/a/\

american_medical_association/index.html?inline=nyt-org>,

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.

In addition to the gift, food and travel bans, the report recommended that

medical schools should " strongly discourage participation by their faculty

in industry-sponsored speakers' bureaus, " in which doctors are paid to

promote drug and device benefits.

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 B.

Kindler<http://topics.nytimes.com/top/reference/timestopics/people/k/jeffrey_b_k\

indler/index.html?inline=nyt-per>of

Pfizer and Sidney Taurel of Lilly.

Beier, an Amgen senior vice president, wrote a letter that endorsed

the report's recommendations but disagreed with some of its text " because we

have a different view about the accuracy concerning representations about

the motives of the participants in industry-academic interactions. "

Ken of the Pharmaceutical Research and Manufacturers of America,

said his group would review the report.

" Providing physicians — and medical students — with timely, accurate

information about the medicines they prescribe clearly benefits patients and

advances healthcare throughout the United States, " Mr. said.

Dr. J. Alpern, dean of the

Yale<http://topics.nytimes.com/top/reference/timestopics/organizations/y/yale_un\

iversity/index.html?inline=nyt-org>School

of Medicine, said that the university presently had no limits on

participation in company speakers' bureaus, but that because of the medical

college association's report he was thinking of taking them on.

" I don't have a problem with doctors making $3,000 or $5,000 a year on the

side, " he said, " but it's a totally different thing when it's $80,000. " Even

more distasteful, Dr. Alpern said, is that the slides used in many of these

presentations are created by drug makers, not the speakers.

" That's like ghost-talking, " Dr. Alpern said.

Dr. Arthur S. Levine, dean of the University of

Pittsburgh<http://topics.nytimes.com/top/reference/timestopics/organizations/u/u\

niversity_of_pittsburgh/index.html?inline=nyt-org>School

of Medicine, said that when he graduated from medical school in 1964,

Eli Lilly gave him his first doctor's bag, and Roche gave him an Omega watch

for being valedictorian. He still has the watch.

But this year's graduating class of doctors at Pittsburgh will not be

allowed to accept any of these gifts, and the daily pizza lunches brought by

drug companies are gone, he said.

Gottlieb, assistant dean of policy coordination for s Hopkins

University<http://topics.nytimes.com/top/reference/timestopics/organizations/j/j\

ohns_hopkins_university/index.html?inline=nyt-org>School

of Medicine, said Hopkins had adopted some of the association's

recommendations and was considering others.

" This report is bound to influence our deliberations, " she said.

Dr. Vagelos, formerly of Merck, said that the report's recommendations were

certain to face resistance among faculty who liked the present system.

" The outcome of this for the industry is that those companies that are

strong in science will always be welcome at medical colleges and others

won't, " Dr. Vagelos said.