« June 2012 Issue
In Medicine, There's No Such Thing as a (Conflict) Free Lunch
A few years ago it wasn't uncommon to see drug reps armed with lunch platters or pizzas roaming hospital hallways or lingering in physician offices. While drug companies still employ this tactic to market brand-name drugs - along with fancy dinners, gifts, drug samples, consulting contracts, and subsidized continuing medical education and conferences - today these practices are increasingly being challenged and limited.
In 2006, Community Catalyst founded the Prescription Project amid growing concerns and mounting evidence about the inappropriate influence of pharmaceutical marketing on prescribing decisions and its impact on the cost and quality of patient care and the integrity of medical education. Funded by the Pew Charitable Trusts, the project sought to address conflicts of interest created by pharmaceutical industry marketing to physicians and to promote increased reliance by prescribers on independent evidence of drug effectiveness. For instance, multi-faceted campaigns by companies to promote drugs to doctors may result in the prescribing of new, more expensive drugs of little value. Examples include drugs like Vioxx, the pain pill that was no more effective than cheap over-the-counter drugs and was prescribed for millions of patients before being pulled from the market after causing tens of thousands of heart attacks.
The Prescription Project was highly successful: numerous U.S. academic medical institutions adopted or strengthened conflict-of-interest policies to police these practices in their hospitals and medical school campuses. It also helped drive policy change at the state and federal levels. States such as Massachusetts and Vermont enacted gift ban and disclosure laws. Congress followed suit by including "sunshine" provisions in the Affordable Care Act that, beginning in 2013, require pharmaceutical and medical device companies to disclose their gifts and payments to physicians on a publicly searchable website.
Now a new initiative, the Partnership to Advance Conflict-Free Medical Education (PACME), is underway. PACME builds on the work of the Prescription Project by expanding the movement to create a conflict-free environment at medical schools and academic medical centers nationwide. PACME is a collaborative effort of Pew Charitable Trusts, Community Catalyst, the American Medical Student Association (AMSA) and the National Physician Alliance (NPA), and is funded by the State Attorney General Consumer and Provider Grant Program, which was financed by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.
"There has been great progress over the last four years at medical schools in the U.S., as measured by our partner, AMSA, in its PharmFree Scorecard," said Marcia Hams, director of Community Catalyst's Prescription Access & Quality project. "More than two-thirds of medical schools now have grades of A or B on their conflict-of-interest policies, reflecting bans on drug maker gifts, meals and scholarships. But we still have a long way to go, and we don't know yet what the policies are at most teaching hospitals."
Community Catalyst will draw on its expertise in working directly with academic medical centers and medical schools to facilitate adoption or improvement in policies. The team, led by Hams and joined by physician consultant Dr. Stephen Smith, has already convened institutions in New England to share best practices in conflict-of-interest policies, problem-solve and overcome barriers to improvement. To extend our reach, we are developing another such "learning community" in Pennsylvania in collaboration with leaders there.
Community Catalyst will also develop a toolkit of best practices and recruit an outstanding workgroup of institutional compliance leaders to collaborate in creating a robust evaluation instrument to assess implementation and compliance with written conflict-of-interest policies. Our PACME partner, Pew, has convened a national expert panel to spur the next generation of policy development and is working with AMSA to update and expand the scorecard. AMSA will also organize students into its PharmFree campaign, and the National Physician's Alliance has begun offering educational programs to physicians, residents and students.
"Our goal is to engage academic medical center leaders, physicians and medical students to expand the number of institutions that adopt and implement strong and comprehensive conflict-of-interest policies that ban practices that undermine good patient care and medical education, while managing other physician-industry relationships in areas such as research that may be in the public's interest," Hams added. "We know from our past experience that policies are strongest when a broad array of stakeholders are engaged and invested in their development and implementation."