http://www.insidebayarea.com/dailyreview/localnews/ci_4355623

Stanford bans drug reps' gifts
Medical staff can no longer accept lunches, other freebies
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

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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.

And even the new policies at Stanford don't address the full extent of
the influence of industry, emphasized Steinman, with NoFreeLunch.org.
Many medical center faculty members, he pointed out, are paid
consultancy fees by pharmaceutical or medical device companies, or sit
on their boards of directors, arrangements that create real or
perceived conflicts of interest.

"This is one small step," Steinman said of the new rules. "But we still
have to think critically about how doctors interact with industry, and
how those interactions affect patient care."

To read Stanford University's new policies, visit med.stanford.edu/coi.


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TC