Wednesday, January 25, 2006

Drug and Device Reps and Academic Medical Centers

JAMA published an article on health professionals interactions with the pharmaceutical and medical device industries today and it is already making some of the news talk show circles. After discussing recent congressional hearings, and lawsuits against the pharmaceutical industry crossing ethical boundaries, the article focuses on the role of academic medical centers (AMC) and the need for larger reform from the physician side of the interaction. They state that AMCs are influential to the surrounding community and that training physicians learn their practice patterns there and should be free of biased influence.

Now, for anyone who has been in training you are very familiar with the cries of..."It's just lunch" "I won't prescribe that JUST because they gave me a pen." And my favorite of all, "I'm too busy (read: lazy) to get my own lunch, pen, etc." So the article goes on to state what construes a 'conflict of interest.' Here is their list of issues to be addressed:

  • Gifts (even small value)
  • Meals
  • Payment for attending conferences and lectures - 314,000 sponsored events for physicians in 2000
  • Payment for online activities
  • Free CME
  • Payment for travel to meetings
  • 'Scholarships' for meetings
  • Payment for Speakers Bureau participation - Hundreds (if not thousands) of physicians on advisory boards or speakers bureaus
  • Providing ghostwriting services
  • Providing free drug samples
  • Payment for 'consulting services'
  • Grants for research projects
The authors note there are guidelines but they are not in complete agreement nor are they stringent or enforced. So they call for more rigorous guidelines such as 1) NO GIFTS, MEALS, TRAVEL, OR CME regardless of amount; 2) vouchers for low-income patients instead of samples; 3) exclusion of health care professionals from formulary committees if they have any financial relationship with industry; 4) elimination of Speaker's Bureaus; and 5) funneling travel through a central office at the AMC.

They also have a great section explaining the 'myth of the small gift' and the principle of reciprocity regardless of the size of the gift. They even quote research stating the motive of gift-giving is to receive back in return regardless of situation (birthdays, anniversaries, etc.)

Now as you may be able to tell, I am not a large fan of this aspect of medical and pharmaceutical interactions. I have seen misconduct in regards to these interactions, and whenever I try to set an example I have been ridiculed, such as when I brought/purchased my own lunch during residency, while other residents dined away on 'drug rep food.'

In the effort of full disclosure I have received money from a drug company in 2004 to give a talk on pain control in Las Vegas. I did it once, and determined I would not do that again. There was no undue pressure, but I just came home feeling obligated to the drug company. And I hate the excuse I hear from some docs of "Everybody else does it so I'll just do it a little bit."

Luckily, the palliative medicine field is not inundated with drug reps and device companies, but I have a feeling that may change in the future. Last year at the AAHPM talk a lunch symposium was held touting the benefits of Palladone (long acting hydromorphone), which has since been withdrawn from the market (07/05). Many people I spoke with at the Assembly were dismayed at such a blatant 'detailing.' Should organizations like AAHPM and NHPCO join JAMA in proclaiming no more gifts? No Free Lunch?

I think so. I am too proud to take someone's free pen, when I can buy my own.

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