12.10.2013
by David Pittman
Washington Correspondent, MedPage Today
Drug sales reps should be banned from academic medical centers, but mingling between faculty and pharma researchers is not a problem, according to a conflict-of-interest task force.
“Pharmaceutical sales representatives should not be allowed access to any faculty, students, or trainees in academic medical centers or affiliated entities,” the task force, convened by the Pew Charitable Trusts, wrote in a 30-page report released Tuesday. “However, faculty may invite pharmaceutical scientists for specific educational or scientific discussions that do not involve marketing of a specific product.”
The task force — with representatives from seven academic medical centers, various consumer organizations, the Association of American Medical Colleges (AAMC), and the American Medical Student Association — referenced a review of 29 studies that found physicians who interacted with sales reps prescribed lower-quality, higher-cost drugs compared with non-exposed doctors.
Current AAMC policy recommends that sales reps only be allowed on academic medical centers by appointment and that they be prohibited from entering patient-care areas.
Banning sales reps is one of seven recommendations the task force made, all of which would tighten current AAMC recommendations.
Pew convened the task force as the last comprehensive standards were released by the AAMC in 2008, and the group believed it was time to update recommendations now that more data on industry influence have been published.
“The guiding principle was to balance appropriate boundaries in physician-industry relationships with the need to encourage collaborations crucial for improving medical care and practice,” David Korn, MD, a former vice provost for research at Harvard Medical School, and Daniel Carlat, MD, director of Pew’s Prescription Project, wrote in a Viewpoint article published simultaneously in the Journal of the American Medical Association.
The conflict-of-interest policies should also apply to training sites such as affiliated hospitals and clinics, the task force recommended.
“Our task force decided not to address industry-funded research as a whole, because it was not as actionable,” Carlat told MedPage Today in an email. “However, several of the recommendations touch on industry–funded research. For example, we recommended allowing faculty to consult with industry regarding research, but not regarding marketing. In addition, we recommended allowing pharmaceutical representatives access to faculty to discuss scientific and research issues.”
Of the 15 recommendations made, several vary at least somewhat slightly from what the AAMC already recommends to its member schools, including:
- No gifts or meals of any value should be accepted, including gifts deemed “educational” for medical staff. However, patient educational materials are allowed.
- Drug samples are only allowed if they aren’t used for marketing purposes.
- Faculty shouldn’t accept funding for speaking engagements directed toward physicians, students, health professionals, or the public. The restriction doesn’t apply to scientific presentations made to industry employees.
- Residents and medical students may not accept industry-sponsored fellowships for clinical training.
- Members of pharmacy and therapeutics committees should be recused from discussion and voting if conflicts arise.
Continuing medical education (CME) should be limited to specialized training “such as new medical devices for which expertise may be very limited and cost of training high,” Carlat and Korn wrote. Existing industry-funded CME may continue provided that safeguards are in place.
The Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade group, said it was important for the development of new drugs and for patient safety that physicians and drug companies maintain collaborations.
“While PhRMA is still reviewing the findings of the Pew Charitable Trusts’ report, it is important to stress the importance of collaborations between biopharmaceutical research companies and physicians, including at academic medical centers,” PhRMA Executive Vice President Bill Chin, MD, told MedPage Today in a statement. “These interactions improve patient care and contribute significantly to scientific innovation.”
The AAMC, while providing guidance for the report, did not endorse it.
“We are committed to managing conflicts of interest, but at the same time, we recognize the importance of principled partnerships in advancing convergence of interest to ensure increasing the pipelines of new therapies,” Ann Bonham, PhD, AAMC’s chief scientific officer, said in a statement to MedPage Today.
The seven academic medical centers participating in the task force included the University of Michigan Medical School, Stanford University School of Medicine, Harvard Medical School, Cleveland Clinic, University of Pittsburgh School of Medicine, UMass Memorial Healthcare, and Kaiser Permanente.
Work published earlier this year in BMJ found physicians who attended a medical school with a policy that banned gifts from drug companies were less likely to prescribe two of three newly marketed psychotropic drugs once in practice.
UPDATE: This article, originally published Dec. 10, 2013, at 17:33 p.m., was updated with new material Dec. 11, 2013, at 12:25 p.m.).