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Penn Bans Gifts From Drug Reps: Doctors' Decisions Should Not Be Influenced, an Official Said

Posted on: Wednesday, 3 May 2006, 15:00 CDT

By Dawn Fallik, The Philadelphia Inquirer

May 3--There will be no more free lunches at the Hospital of the University of Pennsylvania. No more notepads promoting a heartburn drug or pens pushing arthritis pills. And medical students, no more Friday pharma buffet for you, either.

Less than five months after a major medical journal chastised doctors for accepting gifts and meals from the pharmaceutical industry, HUP announced a crackdown, requiring sales reps to make appointments to see doctors and forbidding even the smallest gifts -- during office hours.

"I don't think we're entitled to be fed every day," said Patrick J. Brennan, chief medical officer at Penn, who helped create the program, one of the most stringent in the country. "I don't think our doctors' decisions should be influenced by that."

Motivated in part by internal pressure and public perception, doctors nationwide are reconsidering their relationship with the pharma industry. The challenge, they say, is figuring out how to distance themselves without alienating the industry that pays for a good part of their research and most of their continuing education.

Many hospitals and schools have open-door policies, allowing the practice of "trolling," in which reps simply walk the halls, looking for someone to approach.

Lectures on new drugs come with catered meals for an entire office, and everything from stethoscopes to pet food is provided for students.

The lobbying is particularly intense in Philadelphia, where as many as 20 percent of the nation's doctors receive medical training, and many of the world's largest pharmaceutical companies are based.

Lunches and lectures

"We had lectures every day for three months, and every single day the lunch was sponsored by a pharma company," said Rajan Agarwal, 29, a radiology resident at Penn. Most residents received dinner offers every couple of weeks, he said.

In January, the Journal of the American Medical Association published an article written by the Association of American Medical Colleges and the Philadelphia-based American Board of Internal Medicine, among others. It called on doctors, particularly at academic institutions, to refuse even small gifts.

The article pointed to repeated studies showing that doctors who accept small gifts or free samples tend to prescribe those drugs, even if the drug is not the best choice for treating the disease. Research has also found that doctors insist that they themselves are not influenced, but that a majority of their peers are.

Penn banned free samples several years ago, offering vouchers instead. In 2004, officials started discussing "remodeling" the hospital's relationship with the industry. It was announced yesterday and begins July 1. Although the program is based at HUP, the goal is to expand it through the university health system.

Grants allowed

The new program allows companies to give an "unrestricted grant" to chairs or department chiefs, who will decide how to spend the money. Brennan said most of it would be spent for educational purposes.

The health system has also created the Center for Evidence-Based Practice, which will serve as the main contact for the industry. Representatives would contact the center to come and give lectures about new medications.

At Drexel University School of Medicine, reps are also required to make appointments, said school spokeswoman Rachel Sparrow. However, "modest" meals and gifts are allowed if given in an educational setting.

Penn's announcement seemed to take representatives from the pharmaceutical industry by surprise. More than 100 attended the meeting.

Dee Mahoney, senior vice president of sales for Pfizer Inc., said that the industry and the hospital shared the same goal: to help the patient.

"Quite frankly, we'd be happy not to have to bring in pizza," she said. "But we found that the only way we could get in to see the doctor was to bring in pizza."

Drug reps concerned

Pharmaceutical reps voiced concerns about being completely shut out from doctors and residents, particularly because they would not be allowed on ground rounds, a weekly lecture given each department.

They worried that doctors would not make time for them, and Penn officials would make no promises.

"It'll be interesting to see if that happens," said Richard Demers, assistant hospital director.

However, the school will not prohibit doctors and other staff from dining out with pharmaceutical industry reps. But the practice will be discouraged, Brennan said.

"We can't control what doctors do in their off hours," he said.

And while Brennan said that doctors would be discouraged from going to those lavish meals, it was clear the offers would keep coming.

As Brennan spoke, a drug rep from MGI Pharma Inc. was e-mailing doctors at Thomas Jefferson University Hospital from her laptop, inviting them to a dinner program in two weeks.

A spokesman from MGI would not comment, other than to say the company would abide by Penn's restrictions.

Contact staff writer Dawn Fallik at 215-854-2795 or dfallik@phillynews.com.

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Source: The Philadelphia Inquirer

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