Stanford bans drug reps' gifts

0 Comments | Oakland Tribune, Sep 18, 2006 | by Suzanne Bohan, STAFF WRITER

Coffee mugs, pens, notepads and tote bags adorned with drug company logos won't be cluttering offices at the Stanford University Medical Center, under stringent new rules soon to take effect.

As of Oct. 1, medical students and physicians at Stanford University won't be allowed to accept any gifts, regardless of how small, from a representative of a firm selling drugs, medical devices or related products.

The university also is abolishing a time-honored tradition of allowing medical staff and students to accept free lunches such as when a health care firm, often a pharmaceutical company provides a mealalong with an educational seminar staffed by the company's marketing employees.

In addition, under the new guidelines, a company sponsoring an off-campus event can't control the speaker selection or content, or have any of its representatives present at the event. Nor can industry sales or marketing staff visit clinics or the university's two hospitals without an appointment.

"It's a very big step, given the magnitude of the activity going on," said Dr. Jordon Cohen, the previous president of the Association of American Medical Colleges, which this year launched an initiative to examine conflicts of interest between academic medical centers and pharmaceutical and medical device companies.

For example, of the estimated $21 billion spent annually by the pharmaceutical industry on marketing, 90 percent is spent on physicians, giving free meals, gifts, drug samples and sponsorship of seminars, according to a widely cited Jan. 25 article in the Journal of the American Medical Association on conflicts of interest in medicine.

The Pharmaceutical Research and Manufacturers of America, an industry trade group, objected strongly to the trend of banning gifts and limiting sales staff's access to physicians, citing the role company representatives play in educating and training doctors.

"The fact is America's pharmaceutical research companies naturally have the most comprehensive information about the medicines they research and develop," said Scott Lassman, senior assistant general counsel with the trade group. "And their sales representatives -- many of whom are health care professionals themselves -- are well-trained technically and are prepared to answer questions about the benefits, proper use and side effects of drugs."

However, Dr. Harry Greenberg, a professor of medicine at Stanford and a member of the task force that adopted the new policies, said virtually all information on drugs and devices is now available online.

"There used to be a bigger need for getting information from pharmaceutical representatives, because they could bring you literature," he said. "With the Internet, that issue doesn't really exist anymore."

Cohen, with the medical colleges association, said he doesn't fault industry for promoting its goods.

"They're perfectly entitled to market their services as best they can," he said.

But the onus, he said, rests on medical institutions.

"The indictment is on the medical profession," Cohen said. "The profession hasn't properly prepared itself to withstand or defend itself against these activities. It's taken the path of least resistance without really analyzing the unintended consequences."

Stanford officials stated that the university adopted the measures to counter the growing perception that medical institutions are intertwined too tightly with health care corporations, which have an inherent interest in promoting their own products.

"It is essential that medical professionals and scientists reclaim the moral high ground and avoid the appearances of conflict of interest," said Dr. Philip Pizzo, dean of the School of Medicine at Stanford.

Even proponents of the new rules emphasize that drugs and devices offered by these firms form a pillar of modern medicine. But these physicians are concerned that their aggressive marketing tactics may influence doctors to offer treatments that are more costly or less effective than those getting less promotion, but which are nonetheless supported by strong scientific evidence.

"The perception that industry is supporting (medical) education erodes the trust by the public that information used to educate new doctors is as unbiased as can be," Cohen said.

Stanford joins a small number of academic medical centers, including Yale University and the University of Pennsylvania, that are erecting barriers between sales representatives and medical staff and students.

Doctors are already prohibited from accepting gifts valued at more than $100 at most institutions, under guidelines from the American Medical Association. But until now, little attention has been paid to the influence of free meals and smaller gifts.

"Giving a gift to someone creates an expectation of reciprocity," said Dr. Michael Steinman, a University of California, San Francisco, geriatrician and co-founder of NoFreeLunch.org, a nationwide group of physicians advocating no-gift policies like those adopted by Stanford. "Even though it's subtle, it can influence decisions," he said.