Who is Going to Feed Us Now?
John Biebelhausen, M’11 (MD/MBA)
You have heard it before: “There is no such thing as a free lunch.” Now, more than ever, this rings true throughout the halls of the nation’s medical schools and teaching hospitals. If there was any doubt of the recent shift away from hand-holding between industry and academic medical institutions, then the recent Association of American Medical Colleges (AAMC) report on industry funding of medical education sets things straight like an over-protective father on prom night.
The report, the product of a two-year investigation by the Task Force on Industry Funding of Medical Education (from hereon referred to as the Task Force), strongly “urges all academic medical centers to accelerate their adoption of policies that better manage, and when necessary, prohibit, academic-industry interactions that can inherently create conflicts of interest and undermine standards of professionalism.” Clearly, the days of pharmaceutical-sponsored luncheons and logo-emblazoned pens are rapidly fading. (A complete review of the Task Force’s recommendations is provided at the end of this article.)
The basic principle at hand is the inherent conflict of interest that arises when pharmaceutical companies and other health care companies participate in “practices that compromise professionalism as well as public trust,” such as gift giving and financial incentives. The same tenet applies in elementary schools where giving an apple to Mrs. Smith is one thing, but offering $100 gift cards is simply outlandish. When it comes time to give out grades, who is the teacher going to remember? Whether it’s giving out grades or writing scripts, the contention is the same: where does one draw the line with gift-giving in the professional setting? While grades and prescribing habits are two different things, the effect of gifts on (sub)conscious behavior is one and the same and cannot be ignored.
To discuss the matter, I spoke with Tufts University School of Medicine Dean, Dr. Michael Rosenblatt, who revealed that he feels strongly that “gifts or other things of value for a prescriber ought to be proscribed.” Physicians are charged with providing the utmost care to their patients, part of which often involves making drug prescription decisions or selecting the use of a particular medical device. Many have argued the impact of industry gifts on prescriber habits and behavior, but undoubtedly there is an underlying effect of such offerings on medical professionals. Dr. Rosenblatt rightly points out that it is “very important to get conflict of interest out of the doctor-patient intersect.”
While the Dean supports the general principles and ideology backed by the Task Force, he did raise concern that such regulations might extend into the realm of scientific collaboration between academe and industry. He noted that industry funding can be beneficial across the board—from providing funding research at academic institutions to translating bench work to bedside treatment. Industry support of academic medical research is an entirely different arena with its own set of regulations. Separating industry funding of education from funding of research is critical to avoiding the pitfalls of the former and maintaining the benefits of the later.
As doctors-in-training, it is critical to our professional development that we understand the complex industry within which we work. I think that I could receive a free lunch or pack of Post-its from a company without it overtly affecting my medical care habits. Then again, I am aware of my brain’s neural reward circuitry working below the radar to remind me that the next time I prescribe an anti-hypertensive, I should go with the familiar drug, whether or not evidence-based medicine supports it.
So, in keeping with the Task Force’s recommendations, just remember a few basic rules when dealing with industry: know your tendencies, appreciate your limits and accept your vulnerabilities. It will make you a better person, a more effective doctor, and bring you one-step closer to being super-human—you know you want to be, you’re a med student!
The following recommendations were made by the Task Force, including:
- Bans on all gifts, including food and travel, to doctors, faculty, staff, and students (on-site and off-site)
- Establishment of a system for the central management and distribution of pharmaceutical samples within the hospital, so as to avoid distribution through an individual physician
- Limits on access by pharmaceutical representatives to non-patient care and non-public areas, with such interactions by physician appointment or invitation only. The interactions should be educational in nature and carried out in group settings to maintain supervision and critical review, and representatives should have an advanced scientific degree.
- Limits on access of device manufacturer representatives to patient care areas, only by credentialed individuals by appointment or invitation only, with no access during patient care unless prior patient consent has been obtained. Such interactions should be limited to in-service training or for assistance on devices and equipment.
- Establishment of a central office to manage industry funds and developing auditing mechanisms for Continued Medical Education (CME) programs to assure compliance with standards of the Accreditation Council for Continuing Medical Education (ACCME)
- Strong discouragement of physician/faculty participation in industry-sponsored speaker bureaus
- Oversight of the receipt and distribution of all industry-sponsored scholarships and educational funds through the administration, with no industry involvement in award-recipient selection
- Prohibitions on any form of ghostwriting of reports and presentations
- Prohibitions on any individuals with financial interest in industry companies from assisting with purchasing decisions