RICHMOND, VA. - A growing number of U.S. medical schools and hospitals are realizing that there’s some truth to the saying “There’s no such thing as a free lunch” and are banning drug salespeople from providing meals and other gifts to doctors, medical students and residents.
The move comes in response to concerns about whether the pharmaceutical industry’s expensive marketing efforts influence which drugs doctors prescribe and whether those costs get passed on to patients.
“It’s about maintaining the right balance, having a constructive relationship with (pharmaceutical) companies and maintaining independence,” said Dr. Madaline Harrison, a neurologist and chairwoman of a committee reviewing ethics policies at the University of Virginia Medical Center. The committee is drafting regulations on a range of issues, including the gifts.
A number of academic medical centers already have tightened their drug-rep guidelines in recent years, including Yale and Stanford and the universities of Michigan and Pennsylvania.
When pharmaceutical reps visit doctors, they hand out items such as pens and notepads imprinted with the name of their drug to increase their product’s visibility in a competitive selling environment. They also provide lunches or sponsor medical-education conferences to build relationships with physicians, the gateway between the drug and the patients.
Justin Sanders, national coordinator for the American Medical Student Association’s PharmFree campaign, praised the universities that have scrutinized their policies to make sure prescribing habits aren’t unduly swayed by drug reps, at the expense of patient care.
“The pharmaceutical industry spends billions of dollars a year to influence us,” said Sanders, a medical student at the University of Vermont. “How can a pen make a difference? But it’s hundreds of thousands of pens, tens of thousands of lunches.”
The practices create a sense of entitlement among doctors, which pharmaceutical companies engender because it’s good for business, he said.
“Sales is a relationship. Then when the resident gets out into the field, that’s what the pharmaceutical rep is trying to breed,” Sanders said. “It only takes one lunch to make a medical student feel entitled. You see it all the time in medical school, and it’s amazing.”
The Yale Medical Group last year banned all gifts to physicians, regardless of whether it’s a pen, notepad or meal. Industry-provided meals are banned from the medical school campus.
Among private hospitals, the Detroit-based Henry Ford Health System has banned gifts and perks from medical salespeople. The policy, which took effect Jan. 1, also requires pharmaceutical and medical-equipment reps to make appointments before visiting physicians, instead of showing up unannounced.
The faculty at the David Geffen School of Medicine at the University of California at Los Angeles in November adopted new guidelines for the medical school, hospital and clinic system. The rules ban all gifts and will strip all patient areas of all promotional materials for drugs and medical devices.
Dr. Andrew Leuchter, a UCLA psychiatry professor who helped draft the guidelines, said that the school wants to ensure that its clinical and educational decisions are in the best interests of its patients and health care professionals under training, and free of any real or perceived impropriety.
While the gift ban is straightforward, there’s some disagreement among medical schools on whether to accept free drug samples. Stanford bans them. Yale accepts them for distribution to patients but cautions doctors about distributing costly brand-name drugs.
“A lot of people have said, ‘We consider pharmaceutical samples or medical devices as gifts and they should be banned,’” Leuchter said. “Others say that they’re not a gift to doctors but to patients. They’re of tremendous value to patients, especially indigent patients.”
UCLA discourages the practice, he said, but allows their distribution when patients can’t afford them or if a drug offers a “significant advancement in patient care.”
For its part, the Pharmaceutical Research and Manufacturers of America (PhRMA), the industry trade group, said that sales representatives must comply with strict Food and Drug Administration regulations as well as a PhRMA code on interacting with health care professionals.
“In the end, pharmaceutical marketing is one of several important ways for health care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated,” PhRMA senior vice president Ken Johnson said in a statement.
Sanders agrees that the pharmaceutical industry plays a vital role in health care, but said that physicians — starting in medical school — must better define that role.
“We can criticize all the drug companies all we want for advertising on TV, but it’s a free market,” Sanders said. “We as professionals have to regulate ourselves. As people who are fallible like everybody else, we are able to be influenced, and we have to take steps to separate the two.”
A study published in the Journal of the American Medical Association last year found that third-year medical students get one gift or attend one event per week sponsored by the pharmaceutical industry, which spends $12 billion to $18 billion annually on marketing to doctors and medical students