Home The Washington Diplomat March 2007

Doctors Debate Drug Makers' Influence on Medical Students

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At last count, there were about 90,000 “drug reps”—sales representatives for the pharmaceutical industry—trolling the hallways of hospitals, doctors’ offices and medical schools, wooing doctors (and future doctors) to prescribe their products with everything from free samples to free lunches to trips to Aspen, Colo.

At last count, there were about 90,000 “drug reps”—sales representatives for the pharmaceutical industry—trolling the hallways of hospitals, doctors’ offices and medical schools, wooing doctors (and future doctors) to prescribe their products with everything from free samples to free lunches to trips to Aspen, Colo. There’s at least one pharmaceutical salesperson for every 10 practicing physicians. In fact, there are more drug reps in the United States than there are medical students.

“The top nine pharmaceutical companies spent about billion on marketing alone in 2004—a figure that is twice the size of the NIH [National Institutes of Health] annual budget then,” Dr. Thomas Lawley, dean of the Emory University School of Medicine, said in his “state of the school” address last year. “The money was spent on free samples, drug representatives and direct-to-physician promotions, direct-to-consumer advertising, and physician education, including funding of medical meetings, journal advertising, company educational events … travel and expenses for faculty, and my personal favorite, speakers bureaus.”

That cozy relationship between the pharmaceutical industry and the institutions that turn out tomorrow’s physicians is rubbing more and more people the wrong way. In January 2006, a panel of experts—which included the then-president of the Association of American Medical Colleges, officials from several medical schools, and members of the Institute on Medicine as a Profession—published an article in the Journal of the American Medical Association calling for academic medical centers to adopt stringent conflict-of-interest policies aimed at diluting drug makers’ influence on campuses.

Specifically, the article urged restrictions on outside income and a ban on gifts, meals and samples. In addition, it advised that “medical education contributions” be funneled through centralized university accounts rather than individual physicians. At the time, the recommendations raised a few eyebrows—and some drug company hackles—but it didn’t take long for medical schools to respond to the call.

In February 2006, Yale University School of Medicine announced that it had developed a new industry conflict-of-interest policy. The University of Pennsylvania School of Medicine quickly followed suit, and in October, Stanford Medical School announced the adoption of one of the nation’s most stringent policies on drug company access to medical schools.

Stanford prohibits physicians (and medical students) from accepting industry gifts of any size, including drug samples, anywhere on the medical center campus or at off-site clinical facilities. It also bans pharmaceutical, bio-device and related industry representatives from patient care areas and medical school facilities except for in-service training on devices and equipment or by appointment only. That means no more dropping off pens emblazoned “Lipitor” or “Plavix,” and no more pizzas and sandwich trays dropped off at lunchtime.

“We do not want industry dollars to have the potential to influence how we train people or give clinical care, and I think this document sets out ways of minimizing this potential,” said Dr. Harry Greenberg, professor of medicine and chair of the 23-member task force that developed the policy at Stanford.

Yale, Penn and Stanford may just be the first dominos to fall. The University of California, Davis, and University of Michigan have since come out with similar policies. The UCLA David Geffen School of Medicine has begun approval of a policy that will likely go into effect before the end of this year, and Emory Dean Lawley announced the appointment of a task force to make recommendations on a conflict-of-interest policy for his school, which will be presented in the spring.

“I do think the climate is changing,” said Dr. David Korn, senior vice president of the Division of Biomedical and Health Sciences Research at the Association of American Medical Colleges (AAMC) and former dean of Stanford.

Korn serves on a new AAMC panel examining the pharmaceutical industry’s support of medical education, identifying best practices and guiding principles for relationships between the industry and medical schools. Co-chaired by P. Roy Vagelos, the former chairman of drug giant Merck, and Dr. William Danforth, former chancellor of Washington University in St. Louis, the task force held its first meeting in January. “There wasn’t a lot of consensus at that first meeting,” admitted Korn. “We have a challenging task ahead of us.”

But it’s not as easy as saying “drug companies are bad.” “For example, having a stock of medicines in the doctor’s office, or clinic, can sometimes be a very important therapeutic advantage,” Korn said. “Physicians have mentioned that the availability of samples in the office allows them to start sick people on medication right away. Think of an elderly person who goes to the doctor with breathing difficulties. Instead of having to take a prescription to the pharmacy, and maybe wait quite some time for clearance from Medicare Part D, if the doctor has a couple of sample inhalers, he can have the patient start using the medication right away and then fill the prescription.”

And doctors who treat indigent patients speak very passionately about the importance of having drug samples available for emergency treatment of people who would otherwise have to choose between buying prescriptions or feeding their children. “It’s not necessarily as black and white as it’s been painted,” Korn said.

“We have to be thoughtful and nuanced in reaching recommendations and guidelines—it’s an educational process to change our culture, which will take time and persistence and reinforcement,” Korn explained. “The dependence on these funds is so deep and extensive. If you tell a division or department that they’re going to lose half a million dollars that they’ve been used to having, they can’t necessarily just say, ‘OK, we don’t need it. We’ll take that money from here instead.’ There are some real economic adjustments that are going to have to happen.”

About the Author

Gina Shaw is the medical writer for The Washington Diplomat.

Last Edited on November 29, 1999