Prescription for Change
The UNM Hospital’s new policy puts a leash on prescription drug pushers
It's a common tactic: drug advertisements plastered on every pen, notepad, clipboard, tissue box and stapler in doctors' offices.
Members of UNM's medical student association decided they wanted to keep drug advertising out of the university's Health Sciences Center, which includes UNMH and the medical school.
After three years of negotiations between the student association and other interested parties, a conflict-of-interest policy was implemented last month. Under the policy, drug advertising will be phased out over the next three years. The new rules also put limits on the kinds of interactions the center's students, faculty and staff can have with pharmaceutical representatives.
The policy says faculty, staff and trainees can't accept any gifts from pharm reps on the health sciences campus. Pharm reps may only be in certain approved areas, and there are also stricter guidelines for accepting free drug samples for patients.
"The representatives are basically salespeople," says John Kennedy, a former co-president of the UNM chapter of the American Medical Student Association. "They present a limited side of information, they're generally not doctors and they have a specific agenda."
According to a UNM news release, drug companies spend about $705 million on academic health sciences campuses every year. Part of that money goes toward providing free lunches to staff in exchange for listening to a presentation about a company's new drugs. Under the new rules, that practice will also come to an end over the next three years. Dr. Jonas Hines, a member of the UNM medical student association, says the internal medicine department gets about $150,000 worth of free lunches every year from drug companies. "We shouldn't be relying on pharm reps to determine what's best for patients," Hines says. "There's a perception among many patients that doctors are being wined and dined by pharmaceutical companies, and that's harmful to our profession."
Lonny Hurley, a pharm rep for Pfizer, did not respond to messages requesting comment. Phone calls placed to several leading drug companies' media relations departments over the course of a week were also not returned.
"There's a perception among many patients that doctors are being wined and dined by pharmaceutical companies, and that's harmful to our profession."
Dr. Jonas Hines, member of the UNM chapter of the American Medical Student Association
UNM Professor Eve Espey, who was on the task force that created the new policy, says in the news release that studies show doctors can be susceptible to the drug advertisements in their hospital—even if they don't know it. "Most doctors will tell you they are not swayed by such items,” Dr. Espey says. "However, data suggest that even small items influence prescribing in a potentially negative way for patient care."
Kennedy says pharmaceutical companies' influence has an indirect effect on public health. It's unlikely the drugs being promoted by pharm reps are harmful to patients, Kennedy says, but the cost of the drugs can be prohibitive. "Many patients can't afford their medicine," Kennedy says. "If companies aren't buying us pens, backpacks, notepads and lunch, hopefully they'll charge less for drugs."
The regulations will help bring down the cost of medicine, he adds, by reducing doctors' reliance on what are sometimes called "me too" drugs. When a drug is first introduced into the market, Kennedy says, it has a patent life of seven to 10 years. In that time, no other company can copy the drug and sell a generic, cheaper version. After the patent expires, that same drug company will often come up with another version of the original drug, so it can retain the patent for another seven to 10 years. Kennedy says the "me too" drugs get their name because they’re chemically altered, so they're slightly different from their predecessors but have the same effects as the original drugs.
Drug companies can then continue to charge top dollar for the patented medicine, because generics won't be available. "A lot of what the reps are selling are these 'me too' drugs," Kennedy says.
Before the new UNM rules were born, it was up to individual departments to decide how they would deal with pharm reps. Kennedy says some departments had strict policies while others had very lenient ones or no regulations at all. Overall, Kennedy says he's happy with the rules, but he has a few qualms. There are no punishments laid out for people who break the rules. It's unclear how the regulations will be enforced, and while there are restrictions on free lunches and gifts on campus, it's unclear whether those regulations apply off campus.
Kennedy also says he wishes the free lunches and office items could be cut out immediately. "That would be my ideal," Kennedy says. "But I know it's economically difficult to do that." Instead, the health sciences center will decrease its dependence on pharmaceutical perks by at least 33 percent in each of the next three years.
Last month, the American Medical Student Association completed a nationwide survey of various medical schools' conflict-of-interest policies. The report noted many of Kennedy's concerns and gave UNM's Health Sciences Center a "B" grade. The mark places the health sciences center in the top 14 percent of medical schools in the country. Brian Hurley, president of the student association, says the center should be proud of its new policy. "A ‘B’ is very good," Hurley says. "It means there are a few areas that leave room for improvement, but it's well above average."