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Pharmaceutical Companies Banned from Giving Gifts at Stanford

Stringent new rules will soon ban gifts like coffee mugs, notepads, pens and tote bags adorned with drug company logos at the Stanford University Medical Center offices.// The rules, expected to take effect from Oct. 1 will not allow physicians and medical students at Stanford University to accept any gifts, irrespective of its size from any medical representative selling drugs, medical devices or related products.

Besides this the university will also abolish the long time tradition of allowing medical staff and students to accept free lunches, as when a pharmaceutical company, provides a meal along with an educational seminar staffed by the company's marketing employees.

Besides this under the new guidelines, a company sponsoring an off-campus event can't control the speaker selection or content, nor are they allowed to have any of its representatives present at the event. In addition industry sales or marketing staff can only visit clinics or the university's two hospitals with an appointment.

Dr. Jordon Cohen, just previous president of the Association of American Medical Colleges said, "It's a very big step, given the magnitude of the activity going on."

This year the association launched an initiative to examine conflicts of interest between academic medical centers and pharmaceutical and medical device companies.

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

Cohen, who co-authored the JAMA study said, "The industry spends billions of dollars to 'inform' physicians." "They know it works. Why else would they spend all this money?"

Objecting the new proposals the Pharmaceutical Research and Manufacturers of America, an industry trade group, says that the company representatives have an important role to play in educating and training doctors.

Scott Lassman, senior assistant general counsel with the trade group said, "The fact is America's pharmaceutical research companies naturally have the most comprehensive information about the medicines they research and develop. 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."

According to Dr. Harry Greenberg, a professor of medicine at Stanford and a member of the policy making group, said that virtually all information on drugs and devices is now available online.

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

Cohen, said that while he doesn't fault industry for promoting its good the onus rests on medical institutions. He said, "The indictment is on the medical profession. 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 these measures were mainly undertaken to counter the growing perception that medical institutions are too intertwined with health care corporations that have an inherent interest in promoting their own products.

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

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

Other academic medical centers like Yale University and the University of Pennsylvania have also begun erecting barriers between sales representatives and medical staff and students.

Earlier prohibitions had already forbidden doctors from accepting gifts valued at more than $100 at most institutions, under guidelines from the American Medical Association. But only now attention has been given 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.

He said ‘Even though it's subtle, it can influence decisions.’

Steinman added, "Lunch is the prototypical freebie."

Free meals at seminars, while seemingly insignificant, have become important to many time- and cash-deprived residents and medical students. Many couldn't find the time to attend the educational seminars without the meals, said Dr. Roy Poses, president of the Foundation for Integrity and Responsibility in Medicine.

Poses said, "Interns and residents work extremely hard and have no time. One of the few times they can sit down and listen to a talk is when they can eat lunch."

Dr. Larry Shuer, chief of staff at Stanford Hospital said it's common for industry salespeople to walk the hallways of hospitals, looking for an opportunity to talk with medical faculty and residents.

Shuer said, "These policies are to stop the industry reps from freely roaming the halls and pinning people down to grab a few minutes of their time."

According to Lassman, who is with the pharmaceutical industry trade group, stated that the new policies are unnecessary, as sales representatives must already comply with U.S. Food and Drug Administration regulations, in addition to industry guidelines on developing ethical relationships with health care professionals.

How ever Shuer said that those government and industry rules, however, aren't sufficient.

He said "Their codes don't go as far as we'd like them to go."

According to Steinman, with NoFreeLunch.org many medical center faculty members 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.

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