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Healthy Skepticism Library item: 12359

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: news

Crowe D.
Inked Out
Los Angeles Business Journal 2007 Dec 17

Full text:

It’s the type of event commonly associated with illegal hand guns and used drug syringes – but that was the point.

UCLA’s giant medical center recently asked its doctors, medical students and employees to turn in any pens and promotional items imprinted with corporate logos or products made by drug and other health care companies.

Though not unprecedented, The Great Pen Exchange conducted Nov. 29 is believed to be the first such action taken by a big, influential academic medical center targeting how drug companies try to sway medical care.

It’s estimated by organizers that some 75 pounds worth of promotional marketing materials distributed by drug companies and other vendors were turned in and exchanged for Starbucks gift certificates and health system pens supplied by the medical center.

“We got a lot of muttering about, ‘Do you really think I can be bought for a slice of pizza?’” said Dr. Andrew Leuchter, who headed a faculty committee that recommended UCLA do more to stem the influence of drug and other companies. “Well, no. But there are many studies that show that the small gifts can be even more effective, over time, in guiding prescription practices.”

Though the exchange was voluntary, it
follows a decision by the university to impose
guidelines July 1 intended to discourage faculty, staff and students from receiving even modest gifts. Employees and students also are not allowed to participate in company-sponsored entertainment, with very few exceptions, such as in conjunction with a professional association event.

The action also comes amid a growing nationwide controversy over drug company influence on physicians’ medical care decisions. Drug company sales reps, known as detailers, have been known to shower physicians with expensive dinners and trips to vacation spots connected with educational seminars that generally heavily promote a company’s latest product.

A PricewaterhouseCoopers survey earlier this year noted that 94 percent of physicians, hospital executives and other health care professionals believed drug companies spend too much money promoting their products.

Medical schools around the country began shoring up their vendor policies around two years ago following pressure from groups like American Medical Student Association, which has added pharmaceutical promotion policies to the criteria by which they rank medical schools.

“It’s really one of the hottest topics in the profession right now,” said Professor Lisa Bero at UC San Francisco’s School of Pharmacy, who has published studies on the influence of pharmaceutical marketing on physician practices.

Bero was impressed by UCLA’s inventive take on gun and needle exchanges. “You know we just had a gun exchange like that in San Francisco; they were giving gift certificates to Macys.”

Billions spent

The pens and other marketing materials distributed represent only a drop in the bucket of the $19 billion that some experts estimate drug companies alone spend annually on marketing to physicians and medical school students. That kind of spending makes the UCLA Health System far from alone in its concern over pharmaceutical industry marketing practices.

UC Davis Medical Center, for example, bans the use of samples of the hottest, and often most expensive, drugs. Johns Hopkins University Medical School has largely banned drug company sales representatives from its campus. And the District of Columbia Council last week gave initial approval to a potentially landmark measure requiring drug company sales reps to be licensed.

UCLA isn’t going that far – yet. So far the administration’s approach has been to impose the new guidelines and educate faculty, staff and student as to how even the most modest gift can affect care decisions.

Physicians in the private sector also are taking note of the rumblings in academia. Dr. Robert Margolis, chief executive of HealthCare Partners, Southern California’s largest physician group, said his company several years ago instituted strict vendor relationship guidelines and has continued to update them over the years.

The guidelines don’t prohibit staff members from accepting pens, mugs or other marketing materials but do prohibit accepting gifts totaling more than $50 over the course of a year.

“We’re not trying to be holier-than-thou, but just trying to be moral and ethical in how we practice health care,” said Margolis, a nationally-recognized leader in the health care quality movement. “Of course we do have the advantage of being large enough to put resources into this. It can be harder for smaller practices.”

Industry and pharmaceutical company representatives declined to comment directly on UCLA’s pen exchange but said that their industry by and large has cleaned up its act in recent years and abides by the guidelines of its largest trade group, the Pharmaceutical Research and Manufacturers of America.

The guidelines don’t prohibit pharmaceutical companies from distributing pens and other marketing materials to doctors and other health care workers. But they do urge members to drop physician entertainment such as steak dinners and instead emphasize educational brochures for patient waiting rooms, as well as straightforward informational papers that doctors can peruse in their spare time.

“They are voluntary guidelines but we believe that our members abide them,” said Jeff Trewhitt, a spokesman for the trade group. “Sales reps perform a valuable service to doctors. Who better to educate a doctor on how a drug works than the company that’s spent 10 to 15 years studying it themselves?”

Mary Klem, a spokeswoman at Amgen Inc., said the giant Thousand Oaks biotech requires company sales representatives to follow whatever guidelines are in place at hospitals and other health care facilities visited.

“Our focus is on ensuring medical staffs have the timely information they need to administer our medicines appropriately,” Klem said. “Amgen sales representatives are strictly expected to respect and follow all compliance guidelines with absolute consistency.”

Gifts and more

Leuchter, a psychology professor at UCLA, said he realized how pervasive industry marketing efforts were around two years ago when he began cataloging how many promotional items he had accumulated over the years.

When he later asked his 15-person research lab to round up all their gifts, the group managed to fill several boxes with data storage flash drives, laser pointers, and, of course, dozens of pens.

“If a drug company can put a name on it, they will,” said Leuchter. “When you’ve been in the medical profession a couple of decades as I have, you become desensitized to this. But as I began work on the committee and researching the topic, I came to realize that having this stuff around has an effect.”

Leuchter said the revised UCLA vendor guidelines should largely eliminate many of the problems, but administrators likely will have to work out compromises as more complex situations arise. That might include whether the hospital’s nursery should continue allowing companies to give product gifts to new moms.

In the meantime, UCLA administrators are trying to figure out what to do with all the material that was collected in the pen exchange. Leuchter said it likely would not be thrown out.

“We’ve already approached the art department,” he said. “We have some sort of interpretive art exhibit in mind.”


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