In a move to reduce excess influence that could potentially arise from close relationships between doctors and the drug industry, Duke University Medical Center has banned pharmaceutical companies from presenting its medical staff with giveaways.
Everyone knows the general public is inundated with promotions for newly developed drugs from major pharmaceutical companies. They’re not the companies’ only target—physicians who prescribe medicine and administrators responsible for entire medical departments are also targets of pharmaceutical advertisements. But the messages they receive are much more enticing, ranging from stationery and pens to golf outings, expensive dinners, tickets to major sporting events and lavish trips.
In a move to reduce excess influence that could potentially arise from close relationships between doctors and the drug industry, Duke University Medical Center has banned pharmaceutical companies from presenting its medical staff with handouts, giveaways and other enticements. DUMC has also changed its policies regulating company-sponsored events and interactions with sales representatives.
The policy, presented by DUMC’s Pharmacy and Therapeutics Committee and implemented last year, requires all vendors to sign in, disclose the names of the Duke staff they are visiting and report the purpose of each visit. Furthermore, promotional materials such as pens and bags may not be distributed to the staff at all; only appropriate educational materials are allowed. The policy also dictates that no displays or exhibits can be placed in public and patient care areas and that food may be delivered to the Medical Center only if it is part of an approved educational activity.
“The freebies and giveaways have been a problem for many years,” said Dr. Peter Kussin, chair of the Pharmacy and Therapeutics Committee. “Duke physicians have traditionally avoided taking part in these sorts of activities, but they did occur in both private practice settings and in medical school faculties.”
Kussin noted that he did not wish to cut all ties between DUMC and pharmaceutical companies. “They’re a major source of philanthropy, research support and support of medical students and post-graduate trainees,” he said. “They are rightfully partners, and our whole effort is to treat them as partners—to take the commercialization out and focus on partnership.”
Kussin said when he began medical school, he and his classmates were all given stethoscopes branded with a drug company’s name. He noted that he received other drug company enticements that have now been eliminated by DUMC’s new policy.
Dr. Joseph Miller, School of Medicine ’73 and a specialist in high risk obstetrics and clinical research at Louisiana State University Health Sciences Center, said he understood Duke’s decision to ban drug company giveaways.
“In an educational setting, it would be best to avoid any hint of conflicts of interest,” Miller said. “Most physicians use drugs that they know and establish brand loyalties early in their career. Freebies may influence new starts; hence it would be desirable for drug companies to have their medication available for physicians in the office.”
In a study published in the October 2003 issue of Archives of Internal Medicine, physicians and residents completed questionnaires that presented scenarios of the interactions between doctors and drug companies and were asked to rate whether the scenarios were “ethically problematic.” Scenarios included accepting an “all-expenses-paid weekend trip to a resort hotel… [with the] physician’s only obligation… to spend several hours in seminars focusing on the company’s products.”
While some physicians in the study believed that even trivial giveaways influenced their judgment when prescribing medications, results showed that a significant number of both trained physicians and inexperienced residents in the study did not view the gifts as ethically problematic.
The label “freebie” can encompass a broad range of items and activities. For example, unrestricted grants allow physicians to determine their own educational programming about a company’s products, whereas a company-sponsored trip rests programming decisions on the company trying to sell the product. Among physicians, there are differing views on what should actually be called a “freebie.”
“If there’s an educational aspect, and it entails time away from the office and the family, is that really a gift?” asked Dr. David Pisetsky, director of DUMC’s Arthritis Center and chief of rheumatology and immunology.
Moreover, Pisetsky noted that information from companies about the dosage and mechanisms of their drugs is important because clinical trials may not always compare two drugs of the same class.
“In a highly competitive market, there may be several drugs for a given category, but the relevant studies may not always be designed to tell you which drug is better,” he said. “So, the company-sponsored sessions are useful for information to guide decision-making about the available products, as long as it’s open and you have access to multiple viewpoints.”
In many cases, the information provided by the drug companies during free events is hard to find elsewhere.
“When you’re the number-three drug, it’s not likely that you’ll be publicized in major journals,” Pisetsky said. “Most doctors find [company sponsored events] a good source of information, especially for updates that are not found in literature.
From the drug company’s point of view, they are looking for communication with busy physicians. What’s more likely to get the time and attention of physicians? It’s an incentive for doctors to get there. And if the companies are doing their jobs, they’re going to make it as educational as possible.”
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