Healthy Skepticism Library item: 14473

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Publication type: news

Moore J.
U Medical School plan: Ban all gifts to doctors
Star Tribune (Minneapolis - St Paul, Minnesota) 2008 Oct 21
http://www.startribune.com/lifestyle/health/31435329.html?page=1&c=y

Full text:

The University of Minnesota Medical School is considering a new conflict-of-interest policy so strict that doctors wouldn’t even be able to accept Post-it Notes bearing a drug company’s logo.

The far-reaching policy, which if enacted would be among the toughest in the nation, comes as congressional investigators and the U.S. Justice Department are probing ties between doctors and drug companies and medical device manufacturers — probes that have raised some difficult questions for the university.

The Medical School’s proposed policy digs deep and reaches far into the entrenched relationship between the drug and medical device industries and the university’s doctors, researchers and students, as well as the institution itself. If adopted, the policy would profoundly alter the relationship between industry and the state’s largest medical school.

All personal gifts from industry would be banned. Free drug samples would be limited. Industry support for doctors’ continuing medical education would be phased out. Doctors’ consulting relationships would be disclosed to both patients and the public. Those financial ties would be monitored far more closely.

“It’s really putting policies in place that would, as best as possible, ensure the patient’s best interest,’‘ said Dr. Leo Furcht, co-chairman of the task force recommending the rules and chairman of the U’s Department of Laboratory Medicine and Pathology.

A draft of the proposed policy was presented to Medical School Dean Deborah Powell last month and subsequently distributed to the school’s faculty for comment. That process will likely wrap up by the end of the semester. It’s unclear whether approval by the university’s Board of Regents will be required. Either way, Furcht said the reaction so far has been mixed.

“Many people have said, ‘This is something we have to do,’ there are some who feel [the policy] has gone a little too far, and some who feel it isn’t enough,’‘ he said.

Medical research component

Medical technology companies argue that doctor input is critical to making their products safe and effective. They also say physicians must be trained — preferably by other doctors — on the proper use of new devices. In addition, as government research funding languishes, industry often pays for the clinical studies for new drugs and devices. Without that support, many cutting-edge technologies might not be available for patients.

The university’s effort comes at a time when similar ethics policies are under consideration at several other universities, including the University of Pittsburgh, Stanford University and the University of Pennsylvania.

Critics have long maintained that financial relationships between doctors and companies that make drugs and medical devices subtly, but effectively, sway medical decisions. A recent Star Tribune series documented those ties and raised questions about the way they could influence physicians.

“Even small gifts can influence behavior,’‘ said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania’s School of Medicine and a former faculty member at the U of M.

“The doctors who say, ‘I can’t be bought for a piece of pizza or a free box of doughnuts,’ aren’t paying attention to what empirical science shows influences people,’‘ he said. “It isn’t just a drug company giving out $25,000 to give a talk and go on a nice vacation — that would certainly influence you. But even if [a drug rep] shows up with a free lunch every week for 50 weeks, it tends to build a sense of reciprocity on the part of the people who get the free gift.”

A question of money, ethics

The pharmaceutical industry spends as much as $57.5 billion a year promoting its products, according to a recent Canadian study, although only some of that goes for gifts and payments to physicians. It’s not known how much medical device companies spend, but estimates run into the hundreds of millions.

The yearlong work of the university’s task force comes at a time when these ties are being probed nationally by Congress and the Justice Department. A bill cosponsored by Sen. Amy Klobuchar, D-Minn, and supported by Sen. Norm Coleman, R-Minn., would require drug and device companies to publicly disclose payments to doctors.