I would love to encourage all of you to share this with the relevant power
brokers at your hospital to see if they plan to go Pharm Free and if they
will sweep the Formula reps into their plans.

http://www.latimes.com/news/local/la-me-pharma4feb04,1,6974397.story?coll=la
&ctrack=1&cset=true

Young doctors see drug makers' freebies as a bad habit Shunning gifts of
pens, meals and samples of medications, medical schools are beginning to
challenge the tradition.
By Mary Engel
Times Staff Writer

February 4, 2007

Casey KirkHart was in many ways a typical medical student, which is to say
he was usually hungry, always pressed for time and keenly aware of his
mounting loan debt. 

Unlike many of his peers, however, he routinely passed up the lunch that
accompanied a weekly lecture, even though the food was everything a student
could want: tasty, convenient and, thanks to the pharmaceutical company that
catered it, free.

After getting "weird looks" from peers and instructors alike, KirkHart, then
at the New York College of Osteopathic Medicine, put together a PowerPoint
presentation to explain why. Using charts and graphs, he cited studies
showing that about 90% of the drug industry's $21-billion marketing budget
went to physicians and that all those mugs, meals, drug samples and
speakers' fees influenced doctors' prescription decisions. 

He slipped in a photo of himself dressed in a white doctor's coat plastered
with enough drug-company logos to rival a NASCAR race driver. The caption
read: "The White Coat of the Future?"

KirkHart is now a second-year resident at Harbor-UCLA Medical Center, and
the future is starting to look a little different. 

The "pharm-free" movement he championed is spreading around the country in
the wake of an article in the Journal of the American Medical Assn.
challenging academic medical centers to ban drug industry freebies.

In October, Stanford University Medical Center, following Yale University
and the University of Pennsylvania hospitals, barred students, faculty and
medical staff from accepting even small gifts. UC Davis passed a similar
policy late last year that is to take effect July 1. 

UCLA's David Geffen School of Medicine approved one in November and sent it
to its affiliated hospitals and clinics for a final review. The guidelines,
expected to take effect by the end of the school year, will be among the
toughest in the country, stripping all clinics and hospital buildings of
pens, pads, clipboards and calendars bearing any signs of drug promotions.

And the UC Office of the President is working on systemwide rules for its
five medical schools. 

"It's not fringe people," KirkHart said. "These are reputable, world-class
universities. There's a real culture change happening. We're going to wean
ourselves off drug money." 

But Scott Lassman, senior assistant general counsel to the Pharmaceutical
Research and Manufacturers of America, a marketing and lobbying group based
in Washington, D.C., called such restrictive policies "unnecessary and an
overreaction."

"They're going to be cutting themselves off from a lot of useful
information," he said, referring to bans on meals with sales
representatives.

"I can tell you that the sales reps would just as soon not bring in the
pizza and the meals," Lassman said. "But often the physicians are extremely
busy, and the only time they can get access is over a working lunch or
dinner. We thought it was appropriate to pay for that."

In 2002, the industry group and the American Medical Assn. responded to
rising criticism by issuing voluntary ethics guidelines. Such lavish gifts
as fishing trips, expensive football tickets and greens fees at swanky golf
resorts were out. Gifts had to be relatively small - pens, pads,
stethoscopes - and related to patient care. Drug reps, all 90,000 of them,
were urged to deliver educational programs over modestly priced lunches or
dinners. 

Last month, the International Federation of Pharmaceutical Manufacturers &
Assns., which represents drug companies worldwide, issued similar rules.

Doctors in private practice have been courted by "drug reps" for years and,
with the exception of Kaiser Permanente, the California-based managed-care
group, few private hospitals or physician groups have enacted restrictions.
Many doctors, for instance, have drug samples to give to patients.

But academic institutions need to set an example, according to the AMA
magazine's article last year. "Academic medical centers, which include
medical schools and their affiliated hospitals, should provide leadership
for medicine in the United States," said the article, signed by doctors from
Harvard Medical School, Columbia University and other schools, including two
UC campuses. "Research reveals that the habits learned or acquired during
training persist into practice."

The article called on academic centers to ban every free offering, even
inexpensive note pads.

The article was notable, given the prominence of the magazine, but it was
just the latest in a string of journal articles decrying drug marketing's
influence on medicine. 

For years, many doctors shrugged off such studies. Some were insulted that
anyone would think a few free doodads and dinners could affect their
judgment. Others defended interactions with sales reps as a way to stay up
to date on the latest drugs or as a source of free samples for low-income
patients. 

And some physicians liked the gifts, the meals and the company of affable
and often attractive salesmen and women, especially after a day spent
dealing with difficult patients and cost-wary insurers. 

"Doctors in practice say, 'I'm overworked. I'm underpaid. I'm besieged on
all sides by insurance companies. The only solace I get all day is a sales
rep taking me to dinner and not complaining about anything,' " said Dr.
Jerry Avorn, professor of medicine at Harvard Medical School and author of
"Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs."

But in recent years, Avorn said, drug recalls and rising prices have
undermined consumer confidence in pharmaceutical companies. Doctors began to
fear getting caught up in the backlash.

Even small gifts and modest meals open doors and promote friendly relations
between sales reps and physicians, according to a roundup of research
published in the American Journal of Bioethics in 2003. The studies
suggested that the more doctors interacted with drug marketers, the more
likely they were to prescribe expensive new drugs when less costly generics
would do.

"It was indisputable that small gifts had tremendous power in influencing
favorable attitudes toward products," said Arthur Caplan, director of the
University of Pennsylvania's Center for Bioethics and an author of the
research paper. 

In fact, he said, frequent small gifts, especially when combined with
regular treats like doughnuts or pizza, carried as much sway as the
occasional extravagant trip or hefty consultant fee. 

"With a big gift, you're on guard right away," he said. "The very act of
giving a small gift creates a cultural sense of obligation. Yet it's subtle.
Your guard isn't up."

Most of the medical centers that have announced new rules began the process
before the AMA magazine's article appeared, but some consider it to have
been a tipping point.

"It gave us the green light," KirkHart said. "If you want to make changes
happen in your institution, go for it." 

At UCLA's medical school, Dr. Andrew Leuchter, professor of psychiatry and
chairman of the faculty executive committee, has already emptied his desk
drawers of drug-logo pens and instructed his researchers and students to do
the same.

"It's quite remarkable the things you find," he said, listing refrigerator
magnets, penlights, computer memory sticks and, because he's a psychiatrist,
models of the brain. "Anything they can put a brand on, they'll give to
you." 

Leuchter, who wrote the new policy, said medical students have been
especially supportive. 

"They come in very sensitized to the idea of industry influence," he said.
"Some of us who have been doing this for years had become desensitized to
it." 

Some student activists became aware of the cause through an undergraduate
ethics class or by reading some of the many recent books about drug company
marketing. Many, including KirkHart, drew inspiration from the American
Medical Student Assn., an independent, nationwide group of physicians in
training. 

The group launched an ongoing pharm-free campaign in 2002. Members signed a
pledge to accept no money, gifts or hospitality from the pharmaceutical
industry and to seek unbiased sources of information. The group invited
medical students to turn in their drug-logo pens for ones bearing the slogan
"No Free Lunch." 

The debate has been vigorous even on campuses that have adopted new rules.
At Stanford, for example, some students and instructors opposed the ban on
drug samples, which had been used to treat low-income patients. The AMA
magazine's article argued that such samples drive up healthcare costs by
inducing physicians and patients to "rely on medications that are more
expensive but not more effective." 

Often the biggest controversy is the ban on free meals.

Dr. Tim Albertson, director of clinical care at UC Davis, said he has
received many e-mails about food. "But for every one of those, I've gotten
one that said, 'It's about time we did something. It's about time we make a
stand.' " 

At UC Irvine, which has not yet issued a policy, about 20 of 100 third-year
students signed a voluntary pharm-free pledge. 

"The typical reaction I get from my peers," said Boback Ziaeian, a
pharm-free backer who helped circulate the pledge, "is, as medical students,
we work long hours and are the lowest on the hospital totem pole. We should
enjoy whatever we can."

Still, Ziaeian, who takes a big bag of granola to munch on during lectures,
said he believes that the young idealists will prevail.

He recently shared a hospital elevator with a distinguished oncologist. The
older physician noticed that Ziaeian was wearing a pharm-free pin and called
him a modern-day Don Quixote.

"I hope that when the UC system institutes an extensive pharm-free policy
like Stanford, Yale and the University of Pennsylvania, he'll realize that
other, more influential people saw windmills too," Ziaeian said.

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html