US campaign tackles drug company influence over doctors

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A US foundation is funding a US$6million campaign to reduce the influence of pharmaceutical industry marketing on physicians and doctors-in-training. But critics say the project could inhibit the free exchange of ideas between researchers and industry. Michael McCarthy reports. The Pew Charitable Trusts, a Philadelphia, Pennsylvania-based foundation, has given US$6 million to fund a national campaign to reduce the influence of pharmaceutical-industry marketing on the prescribing practices of US doctors. The campaign, called the Prescription Project, will be led by Community Catalyst, a health-care consumer advocacy group based in Boston, Massachusetts, in partnership with the Institute of Medicine as a Profession (IMAP), a project at Columbia University in New York City that has long been involved in conflict-of-interest issues in medicine. The Prescription Project, will promote the implementation of guidelines that either ban or severely restrict many practices that pharmaceutical companies now use to promote their products to doctors, doctors-in-training, and medical students, including the provision of free meals and gifts, even of such inexpensive items as pens and notepads, and free drug samples. According to a recent report by the US Government Accountability Office, an investigative agency of the US Congress, pharmaceutical companies spend more than $7·2 billion a year on marketing directly to doctors and provide doctors and medical centres with free drug samples with a retail value of about $16 billion. For comparison, the industry spends $31·4 billion a year on research and development. David J Rothman, president of IMAP and a professor of social medicine at Columbia, said the Prescription Project will work with academic medical centres, professional medical societies, and public and private payers to help them implement guidelines laid out in a special article that appeared in the Journal of the American Medical Association, in January of last year. The paper called for academic medical centres to ban all gifts, free meals, payment for travel or time at meetings, or payment for participation in online continuing medical education (CME) programmes from pharmaceutical or medical device companies. The paper also called for the exclusion of anyone with financial relations with drug and device manufacturers from hospital and medical group drug formulary committees and purchasing committees. Free drug samples would be replaced with vouchers that will allow help with low-income patients to purchase prescriptions. The authors also called for a ban on CME programmes sponsored by pharmaceutical and medical device companies. Under the proposed guidelines, companies wishing to support education programmes could contribute to a central fund from which the medical centre could draw to pay for accredited CME programmes. In recent years, several academic medical centres and private health-care providers have adopted such guidelines, including Yale and Stanford Universities, and the University of Pennsylvania Health System. Rothman said the new project will study how these medical centres drew up and implemented their guidelines and measure the impact of the guidelines on prescription practices, educational programmes, and other outcomes. The goal of the project will be to produce a practical toolkit that other centres can use to adopt similar regulations, Rothman said. But some argue that such guidelines will reduce the educational opportunities for physicians. Thomas Stossel, a Harvard Medical School haematologist and outspoken critic of many conflict-of-interest initiatives, says initiatives such as the Prescription Project are inhibiting the free exchange of ideas between researchers and industry and are preventing the kinds of partnerships that created the biotechnology revolution. Many of the restrictions advocated by the Prescription Project are trivial and unnecessary, Stossel says. “I'm not going to fall on my sword for pizzas and pens”, he said, but “if doctors in practice are too dumb to figure out that when a drug rep takes him out to play golf that the rep is trying to sell him something, we're in trouble”. But Columbia's Rothman feels doctors and medical centre leaders have come to realise that medicine's cosy relation with the pharmaceutical and medical device industry is undermining patients' confidence in the medical profession. The tide has turned in the debate, he said, and more and more institutions will adopt tough anti-conflict of interest rules. “I think the jig is up; I think people now get it.”