Art Caplan on med schools and industry freebies
Over at MSNBC, Art writes that a recent recommendation for medical schools to ban free stuff from industry is on target:
The American Association of Medical Colleges recently released a long-awaited report recommending that pharmaceutical companies and medical device manufacturers knock off their efforts to bribe medical students and faculty. The Association said in no uncertain terms: No more freebies. That means no more doling out free lunches, tickets, trips, pens, binders, flashdrives, bookbags, free samples and other trinkets in classrooms, offices, exam rooms and reception areas of medical schools.
What led the leaders of the schools that train American doctors to pull the plug on the free flow of chachkes, baubles and doughnuts to medical students and their teachers? The report says that the steady marketing of drugs using freebies raises questions about the “objectivity and integrity of academic teaching, learning and practice.” In other words, if you let young, well-coifed drug company representatives run around your school in short skirts or snazzy suits doling out gifts, it conveys a very bad image — that a school is an appropriate place to do marketing.
Worse still, making your medical school a drug company free-fire zone conveys the impression that the faculty believe there is a lot to learn from slanted drug company sales pitches. And worst of all, when the welcome mat is out for drug reps bearing small gifts, this says that the faculty believe the best way to educate the next generation of doctors about drug safety and efficacy is to make sure students remember a drug’s name by having it thrown in their faces 10 times a day on every pen, notepad, vase, clock, key ring, calculator and coffee mug that a pharmaceutical company’s marketing department can have their legions of salespeople lug into the hospital.
I think a ban makes good ethical sense. I am proud to say that my medical school and its teaching hospitals were the first in the country to boot the drug reps and freebie peddlers off campus.
But the policy of banning marketing in medical schools has drawn some predictable criticism.
Some physicians are incredulous that anyone would think they could be “bought” for the price of a pen or a box of doughnuts. A few argue that the best way to keep up with the latest developments regarding new drugs and devices is from drug and device company salespeople. Others bemoan the fact that now their department will have to pick up the costs of feeding students to get them to appear at grand rounds or to lure their alums into continuing education events. And some just disagree that allowing marketing in a medical school is an ethical problem. The critics are wrong.
The whole point of the free pens, notepads and coffee mugs is that this form of low level but pervasive marketing works. Study after study shows that prescription practices are influenced by small gifts. In a study that I did with two of my colleagues here at Penn five years ago we found that a particularly effective gift in terms of influencing behavior is food brought in regularly. In fact, small trinkets and gifts are effective precisely because most doctors, along with the rest of us, do not believe that they are susceptible to the blandishments of a free bookbag or a sandwich proffered by a smiling salesperson.
But we are. The strongest proof that doctors can be bought in this way is that pharmaceutical companies spend a fortune on this kind of marketing. Does anyone think the cornucopia of presents would continue year after year if it did not have an effect? Does it make any sense to believe that the costly horde of drug reps employed by Pfizer, Lilly, Merck, Glaxo, Amgen, Genentech, Schering Plough and so on simply want to hang out at baseball games with medical residents or breakfast with the 7 a.m. crowd at surgery grand rounds just because they enjoy the company?
No one, including doctors, is immune from advertising. The marketing done by pharmaceutical companies and medical device manufacturers is among the most sophisticated in the entire business world. This sort of marketing does not belong in academic medical centers where the next generation of health care professionals is being taught.
You would not tolerate it if a well-dressed, slick sales representative from Texaco or Lukoil showed up everyday at your kid’s high school dolling out free gifts for the students and free coffee for the teachers right in the middle of their homeroom, biology or environmental science classroom. Nor would you like it if your kid's college threw open their classroom doors so that every nutrition class began with free samples and gifts from a heavily accessorized and perfumed sales rep from Hershey’s, Nestle or McDonalds, or if every physics and chemistry class came with a nice meal along with a high-powered sales pitch from Toyota, Peabody Energy or Siemens.
That is why schools charge tuition and government gives subsidies — to avoid the need to rely on advertising to pay for teaching and thus keep the lecture hall a relatively commerce-free environment.
Business has no business selling or promoting in the middle of classrooms or other academic settings. Academic medical centers, if they want to teach their students how best to think about the medicines they prescribe and to retain the trust of the American people about evaluating them objectively, should do everything they can to keep the marketing, sales pitches, promotions and bribes — large and small — away from campus.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
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I enjoyed this post and agree with Dr. Caplan 100%. I will say that company reps can be useful in some specific circumstances. For example, we will often call and have a company rep come in to assist when we are training to use a new surgical device. But this isn't marketing so much as tech support for something we've already purchased.
My hope is that someday we will start to regulate the sort of profits drug companies are allowed to make and so take away the marketing incentive.
- by James on May 8, 2008 at 5:08 AM | link
If physicians want to access the best available drug information...how about instead of stuffing their empty heads with Pharma donuts and Pharma slant, try talking to a trained pharmacist? Obtaining drug information primarily though drug reps is just plain intellectually lazy and dangerous.
It is good to see some physicians taking strides to clean up this conflict of interest mess in an attempt to instill integrity back into the medical community. And after they finish this task, could you PLEASE work on taking all those millions of horrible drug commercials off the TV? Ugh. I am all drugged out just watching them! Help.
- by watchdogonscience on May 9, 2008 at 2:16 PM | link
Could it be those criticizing the ban were enjoying the freebies? Or here's another thought. Perhaps the notion of selling products based on scientific findings is scary because the facts alone might suggest less expensive products are equally successful. I'm writing a novel on this subject to be titled The Puppy Dog Closer.
Onehealthpro
- by Onehealthpro on May 11, 2008 at 1:11 PM | link
I use to work in the pharma industry. Although there are some examples of abuse in the past most of the industry strives to provide a beneficial service. I think the remedy is worse than the disorder. Painting the industry with one broad brush is analogous to saying that a few bad doctors - and there are some- should be the way we view the whole medical industry. Do companies make profits, of course. Do physicians or hospitals bill for services? Of course.
Dr. Kaplan's example of oil companies in the classroom is not applicable. There is no need for them to be there. However there are plenty of book companies and fundraiser companies in schools. Why? Because it is appropriate. Properly regulated promotion is a service. Bringing attention to new studies, information etc is not appropriate?
In today's medicine, the time demands on physicians are incredible. To think he or she can keep up with all the new data available through journals, conventions etc is naive. If you were a relative of a patient and found out about a new medicine that could have helped your mother, father, child, etc sooner, but you doctor was unaware of it, how would you feel?
If a patient is prescribed a drug and it does not work, their insurance company or they still need to pay for it. Does that have costs associated with it? Rather than look at the front end cost of the samples, one should look at the back savings for an entity that works.
There is an huge double standard in medicine regarding regulations. For example an ad on television for a drug company must have fair balance and a litany of adverse events in them. But a hospital with a great orthopaedic knee surgey group for example can make claims with no fair balance. What are some of the adverse events of total knee replacement? Some AE's are pretty substantial.
Regarding budgets for pharma companies, they can be substantial but it is relative to the number of physicians and patients that will be directly served. Even the largest pharma companies revenue, and promotional budget pales in respect to companies like ExxonMobil, Microsoft and others.
In summary, in 1908 the average life span in America was 44 years old. In 2008, the life span has increased by 30 plus years. This is incredible progress. Does it create strains on the system, yes. But it is a good problem. It is the collective efforts of medicine, science, public policy, industries of all sorts and others that have gotten us to that point. Lets continue to work together.
- by Joe on Jun 3, 2008 at 12:33 PM | link
It is not surprising that the public should expect that medical students should not be influenced by advertising from drug companies.
However, in many cases the drug reps that sell particularly to hospitals, play an important role in EDUCATION.
I am sure that academic physicians have a well deserved high opinion of their ability to educate their students, and to provide all the education that students need. However, speaking as a representative that has covered a territory with 100% teaching hospitals for the last 10 years, I can simply say that STUDENTS ARE STUDENTS.
I ROUTINELY supply dosing and safety information to not only students and residents, but even 3rd year fellows, and also experienced attending physicians that clears up confusion they have about my products. My products can be life saving if dosed correctly on the correct patient, or life threatening if dosed incorrectly or used on the wrong patient. STUDENTS NEED REINFORCEMENT AT THIS EARLY AGE IN THEIR CAREER. While many academic centers put in stringent protocols for treatment to help "resident proof" their processes to make sure mistakes are made, can think of at least 5 instances in my hospitals over the last 3 years where a mistake was made and someone died because of it. In 3 of those cases, which involved my product, maybe if they had more access to reinforcement of safety information from drug representatives
Believe me..most hospital representatives have 10+ years experience and working in an academic center are not trying to sell product by influencing residents and fellows with pens and free food. There simply is too much to learn for these students, and if you throw out access to the drug representatives you also exclude an important source of education for these young STUDENTS.
- by sam wilde on Jun 5, 2008 at 9:35 PM | link