Locked Out
The new policy at Stanford prohibits physicians from accepting gifts from the pharma industry of any size, including pens, notepads and drug samples.
By on Sep 26, 2006The new policy at Stanford prohibits physicians from accepting gifts from the pharma industry of any size, including pens, notepads and drug samples. The policy, which takes effect October 1, also bans industry representatives from patient care areas and medical school facilities except for in-service training on devices and equipment.
Stanford says that although it recognizes the value of industry collaborations, which help speed the availability of vitally needed drug treatments, it aims to ensure that doctors's and scientists's interactions with industry are ethical and avoid conflicts of interest wthat would affect patients and the integrity of the school's training programs.
"We do not want industry dollars to have the potential to influence how we train people or give clinical care, and I think this document sets out ways of minimizing this potential," says Harry Greenberg, professor of medicine and chair of the 23-member School of Medicine task force that developed the policy. He says that the medical school already has a strong, long-standing policy that governs conflicts of interest in research activities and that the new policy will complement it by minimizing potential conflicts in the clinical and educational arenas.
The new policy was unanimously approved June 16 by the medical school's executive committee and was adopted in August by the medical boards at Stanford Hospital & Clinics and Lucile Packard Children's Hospital and applies to all physicians who practice at the two hospitals, including community physicians and the research faculty in the School of Medicine.
Philip Pizzo, Dean of the School of Medicine, says he has been concerned for some time about the pervasive presence of the pharmaceutical industry in the medical profession. Pizzo began a discussion in the Stanford medical school community on the issue through his "Dean's Newsletter" in the summer of 2005 and last fall asked Greenberg, who is senior associate dean for research, to convene a task force to draft a policy.
"In recent years we have witnessed an erosion of the public trust in the profession of medicine and even in the value of science," Pizzo says. "Part of that is related to the market forces that have increasingly converted medicine from a profession to a business, but a significant factor has also been the perception that physicians and scientists may be accepting gifts and gratuities from industry at the very time that the cost of drugs is skyrocketing.
"It is essential that medical professionals and scientists reclaim the moral high ground and avoid the appearances of conflict of interest that can otherwise cloud or alter the trust of the American public, he adds. It is my hope that the stance being taken by Stanford will serve as beacon of responsibility for the medical and scientific professions."
The policy specifically prohibits Stanford physicians and scientists from accepting gifts from companies, however small. Doctors are already prohibited from accepting "substantial" gifts, valued at more than $100, under guidelines developed by physician groups such as the American Medical Association and the Accreditation Council for Continuing Medical Education. But small gifts, including logo pens, pads, tote bags and drug samples, are still common accoutrements in doctors' offices, both at Stanford and elsewhere.
David Magnus, director of the Stanford Center for Biomedical Ethics and a member of the task force, says studies suggest that small gifts can have as much of an influence on physician thinking, prescribing and purchasing habits as large gifts.
"Gift giving creates a reciprocal obligation that is a powerful force, and pharmaceutical companies know this very well," he says. "So we're discouraging it from happening anywhere at the medical center."
Larry Shuer, chief of staff at Stanford Hospital and a professor of neurosurgery, says he's "certain that most medical staff would feel that they are not influenced in their medical decision-making by free pens or doughnuts from an industry representative. However, we all agree that the appearance of possible conflict is what we must try to avoid, as the public perception may be different from that of the physicians."
But Michael Shapiro, a USC law and bioethics professor, said free samples, considered gifts under the new Stanford policy, can be a boon to poor patients.
"Physicians keep free samples around particularly earmarked for patients and their families who are financially strapped," Shapiro says. "It's a way for drug redistribution. It's maybe not the best way, but it's one way."
Richard Poppemeritus professor of cardiology and a former senior associate dean of faculty affairs at the medical school, says he believes the policy is important in terms of protecting patients. "The idea is that a lot of marketing activities of the pharmaceutical industry are aimed at inducing doctors to use certain drugs and the question is: are they using a particular drug because they were seduced by the pharmaceutical industry or because it's best for the patient? The fact is you always have to do what's best for the patient."
But, he adds, balancing that imperative with the need to maintain ethical working relationships with industry can be a challenge.
"I think it's worthwhile to call attention to the subtle influence of industry, especially when it comes to the marketing of drugs, and gifts and taking people to dinner and so on. That has to stop," Popp says. "But saying industry is bad and we should not have anything to do with industry is not a good idea. There are a lot of things we could not do without the help of industry. So we have to work ethically together for the benefit of patients."
The Pharmaceutical Research and Manufacturers of America warns against limiting sales staff access to physicians, emphasizing the role pharmaceutical representatives play in educating and training doctors.
"The fact is America's pharmaceutical research companies naturally have the most comprehensive information about the medicines they research and develop," says Scott Lassman, senior assistant general counsel with PhRMA. "And their sales representatives many of whom are health care professionals themselves are well-trained technically and are prepared to answer questions about the benefits, proper use and side effects of drugs."
But it's clear this is an emerging trend among hospital and physician groups and one pharma is going to have to learn to contend with and overcome.