Pharmfree week
A Pharmfree event at the university of Pittsburgh showing from left to right: Thomas DeCato, Anriada Mehmeti, Dr. C. Bernie Good, Gabriel Silverman, and Sarah Ramer
The American medical Students Assocation have just organised Pharmfree week. Heather Finlay-Morreale tells us more. You may want to take the CAGE test- Rhona
Heather FM
This past week nearly everything I read or talked about involved medications. For one, I have spent the week holed up in study animal mode. I am now halfway through my “bugs and drugs” examinations. Only two more to go!
When I look up from my Pharmacology syllabus or my atlas of disgusting-things-that-can-happen-to-the-human-body it seems like everybody else has their minds on drugs too.
The cover of a national newsmagazine was about doctors saying no to handouts from pharmaceutical reps. A bill was proposed in the national legislature to create a national online database of all gifts given to physicians. The proposed database would allow patients to look-up if their doctor received free sports game tickets or lunches from Company X.
In my mail I received a notice that the unless physicians opt-out a large US medical association will sell biographical information to third party companies that will link that info to actual prescription info from pharmacies. Then drug companies can pay for access to a database linking a doctors name, practice address, where they went to school, what drugs they prescribed and how often. That’s disturbing to me. When my grocery store wanted my biographical information in order to give me the sale rates I gave an imaginative identity. When I shop for lettuce I don’t want it to be an Orwellian world when people are analyzing my choices and trying to predict or manipulate my future decisions. If I don’t want people tracking my vegetable decisions I sure do not want my prescribing decisions analyzed by marketing agents.
This past week the relationship between physicians and the pharmaceutical industry has been hotly debated at many medical schools across the US. It was national PharmFree week organized by the American Medical Student Association.
Vivek Kalia, a medical student, sent the photo below from an event at Johns Hopkins University. There was a panel discussion titled “Dancing with porcupines - debating physician’s relationships with big pharma.”
From the session!
PharmFree, as part of AMSA, is one of several organizations, including No Free Lunch, working to eliminate gifts by pharmaceutical marketers to medical students and physicians. They are collecting pledges from students, doctors, hospitals, and schools to be PharmFree. This means no coffee, pens, books, stuffed animals, travel awards, or pizza at grand rounds paid for by drug companies.
A couple weeks ago I was eating lunch with a few residents and fellows. One or two had spent an evening at a lavish event funded by pharmaceutical dollars. “Free” drinks and dinner and so on. One attendee felt that the only damage done was to the profit margin of the company. I disagree. Research studies have been done showing that doctors attending events and conferences prescribe more of the expensive, patented drugs being promoted instead of alternative, cheaper drugs. The effect can be subtle. For example, let’s say drug A and drug B are about the same you tend to choose drug A because you are more familiar with that drug. Slowly drug B turns out to be better but you are wedded to drug A. One article found that when a medical practice eliminated all sales rep visits, gifts, lunches, and samples, that prescriptions for first-line anti-hypertensive medications increased. This was a shift towards greater adherence to evidence-based medicine. Attendance at these events and acceptance of gifts changes prescribing habits. Changing what drugs are prescribed to patients for non-medical reasons is not good practice. If accepting gifts leads to NON-evidence based medicine then I’d have to agree with the PharmFree movement.
Now, if late in the night, a PharmFree activist snuck into my school bag, what would they find? I admit it. I have post-its saying the name of a pricey antibiotic. Last week I went to a regular weekly educational seminar. The food is purchased with pharmaceutical dollars. The pharma rep attends the grand rounds but does not have any materials out. The content being presented was 100% academic. I was hungry and had no lunch. I thought this isn’t so bad right? ?
On the No Free Lunch Website there is an article addressing exactly this point. “What’s the big deal with a piece of pizza”? Drug companies in the US spend more on marketing then on research. They spend tons of money on marketing - and most goes to doctors. When the math is done each 4-minute contact between a sales rep and a physician costs a great deal more than a slice of pizza. When I tried to justify my pizza eating to a non-medical professional, I quickly lost my ground. Maybe it starts with pizza. Maybe I have become hooked.
The numbers of physicians, medical students, and schools that are going PharmFree is growing but remains a minority.
Are physicians hooked on this status quo? Are you hooked on gifts from Pharma? Below is a screening tool from the No Free Lunch website. See how you score:
TAKE THE CAGE:
* Have you ever prescribed Celebrex?
* Annoyed by people who complain about lunches & free gifts?
* Is there a medication loGo on the pen you are using right now?
* Do you drink your morning Eye-opener out of a Lipitor coffee mug?
If you answered yes to 2 or more of the above, you
may be drug company dependent. Don’t despair!
Cigarette companies are no longer allowed to advertise to young people as their product is addicting. If pizza and post-its with drug names lead to dependence - perhaps they should be banned from academic medical centers.
What is the policy at your medical school?
What is in your book bag? Where did you eat lunch?
Are you ready to sign the PharmFree Pledge?
Visit the links below to read more and find the studies and articles listed below. Heather FM
(1) AMSA’s PharmFree Resource Page at www.pharmfree.org
(2) http://www.nofreelunch.com/ Source of the CAGE screening.
(3) http://www.nofreelunch-uk.org/
(4) Check out your medical school’s rating on the AMSA Scorecard at www.amsa.org/prof/scorecard07.pdf
(5) Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas SC, Cohen JJ, Goldman J, Kassirer JP, Kimball H, Naughton J, Smelser N. Free Full Text. JAMA. 2006 Jan 25;295(4):429-33. PMID: 16434633 [PubMed - indexed for MEDLINE]
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October 30th, 2007 at 10:17 pm
Thanks for this great post.
As for the PharmFree pledge, my view is that it’s a good thing to do. If we are so hesitant to give up the gifts/free lunches, then we must be more dependent on these perks than we thought, and perhaps these marketing efforts affect us more than we think as well. As you alluded to in your post, pharma companies can track exactly how physicians prescribe by buying access to databases sold by the AMA and data collection companies. Thus, the corporations can see precisely how prescribing changes after a lunch with one of their drug reps, after an all-expenses-paid, pharma-funded conference, or after dropping off a box of free samples of their newest, most-expensive drug (with the skimpiest track record for safety). The companies calculate their rate of return on these investments, and we know it must be quite handsome because the industry continues to increase their expenditures on this kind of marketing.
However, while the pledge is a fine thing to do for individuals, it’s not how we will ultimately achieve institutional and cultural change. For that, we need to bring these concerns to those who have the power to change institutional policy — our deans, for example, or the heads of clinical departments. Students can have a surprisingly powerful voice on this issue. At the University of Connecticut, for example, a comprehensive conflict of interest policy is now going into effect because one medical student approached his dean and asked how his school could receive such a low grade on the AMSA Scorecard and what could be done about it. Other medical students can have a similar impact.
AMSA has put together a step-by-step guide on how to approach one’s dean about this, including a couple of high-yield articles for students to read and a template cover letter to the dean. This can be found on pages 4-6 of the PharmFree Toolkit, which was just released here:
http://www.amsa.org/prof/PharmFreeActionToolkit.pdf
The pressure to institute such policies is building, and now is a critical moment when medical students can actually tip the balances simply by raising the issue.