"No Food, No Pens" HSC Has New Conflict of Interest Policy

The University of New Mexico Health Sciences Center recently joined a growing number of Health Sciences Centers across the nation in creating a policy to limit the conflict of interest inherent in physician and medical student interactions with pharmacy and other private healthcare industry representatives. The policy was designed specifically to promote outstanding patient care and medical student education, free from the influence of pharmaceutical promotion.

Until now, individual departments set forth policies for dealing with drug representatives. Under the new, HSC-wide policy, pharmaceutical representatives will be restricted to certain approved areas. HSC faculty, staff and trainees may not accept any form of personal gift from private healthcare company representatives on the UNM HSC campus nor can they display items bearing industry logos, such as pens, pads, hats or tee shirts on the UNM HSC campus. There are also stricter policies for accepting drug samples for patient use with the goal of encouraging physicians to select the best and most economical medications for their patients.

Estimates are that only 10-12 other academic centers nationally have policies similar to UNM’s although some 30-40 institutions are in the process of developing them. UNM medical students approached the Dean of the School of Medicine in 2005. In percentage terms, only 5.5 percent of the pharmaceutical industry’s 25 billion 2005 budget was spent marketing to faculty and medical staff at academic health centers. However, that figure translates into a startling $705 million spent annually on academic health sciences campuses.

“This has been a very thorough, thought-provoking, almost three-year process that was initiated by our students,” said Paul Roth, M.D. Executive Vice President for UNM Health Sciences. “While the increasing influence of the pharmaceutical industry on health sciences centers across the country has been a gradual one for our faculty, it is the only environment that our students know,” said Roth.

“The students were jointly in a task force with faculty to incorporate a far-reaching policy that will govern all aspects of our interactions with pharmaceutical representatives in the clinical and educational arenas. We are proud that the resulting policy puts our institution at the same level as such medical schools as Yale and Duke University,” he said.

Pharmaceutical drug representatives have interacted with physicians on campus since the 1950s, and traditionally have served an educational role in sharing information on new drugs. However, the number of drug reps in the U.S. doubled from 45,000-90,000 representatives during the 1990s. This corresponded with the explosion of what has been termed, “me too” drugs where companies developed very similar drugs for many conditions and then marketed aggressively for name-recognition and market share.

The U.S. Food and Drug Administration has judged that 76 percent of all approved new drugs in the U.S. between 1989-2000 were no more than “moderate innovations over existing treatments,” with many being modifications to an older product. Additionally, by the year 2000, the average prices of these new drugs were nearly twice the average price of existing drugs prescribed for the same conditions.

Drug companies moved to distinguish their products through aggressive marketing, from sponsoring educational seminars and luncheons to handing out free samples for patients to shipping cases of branded pens, note pads and other office supplies began streaming into medical institutions across the country.

“Most doctors will tell you that they are not swayed by such items,” said Eve Espey, M.D., professor, Associate Dean for Student Services and one of the task force members. “However, data suggest that even small items influence prescribing in a potentially negative way for patient care and there is an increasingly strong public perception that physician acceptance of gifts is not good for patient care. We believe it is important to respond to the public’s concerns.”

Among other provisions of the gift policy:

HSC faculty, staff and trainees may not accept compensation or gifts for listening to a sales pitch by an industry representative.

The long time practice of pharmaceutical company sponsored noon lectures and lunches will also come to an end over a three-year period. Beginning in January, 2011, meals funded by private health care industry (PHCI) representatives cannot be provided on the UNM HSC campus. In the transition, departments and divisions will reduce their dependence on PHCI funding by at least 33% in each of the three years.

The policy also calls for HSC health care providers to conscientiously and actively divorce clinical care decisions (including referrals, and diagnostic or therapeutic management) from any potential or actual benefits accrued.

The policy also sets out provisions for Scholarship and other training funds as well as how free drug samples will be handled.

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