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  • GSK Takes a Stand on Payments to Physicians…Who’s Next?

    GlaxoSmithKline (GSK) announced that it will make big changes in its marketing practices by no longer paying physicians to promote its products. It is the first (and hopefully not the last) major pharmaceutical company to address some questionable, and unfortunately popular, marketing techniques that have the potential to create conflicts of interest for physicians. Under its new policy, GSK will no longer pay physicians to speak on its behalf to medical professionals at conferences and other events. Its compensation model for pharmaceutical sales representatives will also move away from one focused on physicians’ prescribing habits.

    Though this policy change is significant, it is part of a growing trend to improve transparency of financial relationships between physicians and pharmaceutical and medical device companies. This movement is evident in federal policy--the Physician Payment Sunshine Act’s Open Payments website will publicly disclose industry payments made to physicians and teaching hospitals starting in September 2014--and in the policies being adopted at medical schools and teaching hospitals. Just last week our partner at The Pew Charitable Trusts released best practices in conflict-of-interest policies.

    GSK’s announcement will send ripples through the entire pharmaceutical industry, and we hope that other major companies will also end the practice of paying doctors to be glorified drug reps.

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  • Moving COI Policies Up A Notch: New Recommendations from an Expert Task Force

    It’s no secret that medical device and pharmaceutical companies have had long-standing relationships with medical schools and teaching hospitals. And although fruitful collaborations with these companies, primarily for research and collaboration, should continue, some of these relationships have gone too far. Although many schools have significantly strengthened their conflict-of-interest policies that govern these relationships, industry still brings biased information into our nation’s medical education training grounds—places that should be steeped in evidence-based learning. One recent survey of medical schools, for example, found that up to half of medical students and residents reported receiving personal gifts from pharmaceutical companies, even in schools graded highly on the AMSA Scorecard.
     
    Conflict-of-interest policies, guidelines for how industry can (or cannot) interact with an institution, are key to preventing this industry overreach. There is evidence demonstrating that COI policies at medical schools can, in fact, impact prescribing behavior. One study showed that graduates from schools with strong COI policies prescribed antidepressants more rationally than graduates with weaker or no COI policies. 
     
    Today, The Pew Charitable Trusts, in partnership with an expert task force of leaders from academic medicine and other partners, including AMSA, released a set of 15 best practices for medical schools and teaching hospitals to use in developing conflict-of-interest policies
     
    These experts have set a high standard for schools and teaching hospitals, with recommendations that COI policies should include banning pharmaceutical representatives from any interaction with students to ensuring that affiliate hospitals and clinics are following the same policies. 

    We believe that, though these recommendations are strong, they can be attained and are important for our education. 

    Want to learn more?
    Join AMSA’s PharmFree Campaign to get involved in building a strong conflict-of-interest policy at your school and other upcoming activities.

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  • Why I'm Opting Out of the AMA Masterfile

    It’s hard for me to believe that I’ll have the privilege of calling myself someone’s doctor in a few short months. As a graduating medical student, I look back on my education and see that it was driven by a spark shared by all in all AMSA members: the fervent hope to help my future patients. And it’s precisely this hope that drives me to pledge to opt out of drug company access to my future prescribing information. I urge you to join me.

    When I started medical school, I had no idea that pharmaceutical companies know exactly what medicines each doctor prescribes to his or her patients. I was even more surprised to learn that this capacity is enabled by the American Medical Association through the sale of a database called the “Masterfile.” All medical students and doctors are automatically enrolled in the Masterfile—regardless of whether or not we are AMA members. Each year, the AMA makes more than $40 million selling this information, which allows pharmaceutical companies to link prescribing records to doctors’ identities. The result is targeted marketing pitches, often designed to promote more expensive medicines that aren't necessarily more effective. 

    The spooky nature of being watched by Big Brother/Big Pharma might be reason enough for many to opt out of this practice. But if that weren’t sufficient enough, this type of data mining hurts also hurts patients. First, prescribing more expensive medicines increases the cost of care without necessarily improving outcomes. Drug companies spend more than $30 billion marketing to doctors each year, and these expenses are surely reflected in the high price of medicines. Notably, the tremendous amount spent by these companies on advertising dwarfs by almost two-fold the amount they invest in research and development, which is often cited as why drugs are so expensive. 

    Second, this type of data mining encourages a brand of medicine that is neither evidence-based nor patient-centered. Surveys already show that 7 out of 10 patients feel that doctors’ prescribing habits are too-influenced by drug companies. Allowing drug companies to use the Masterfile for marketing purposes will further corrode the trust at the heart of the doctor-patient relationship. A new study further shows that an increasing number of patients are skimping on medicines in this tough economic climate. Why allow drug reps to leverage your own prescribing practices to promote expensive medicines through one-sided presentations?

    Today, I’m pledging to opt out of drug rep access to my future prescribing practices. As AMSA President Dr. Liz Wiley has stated, “Physicians should practice evidence-based medicine using the best existing clinical evidence—not carefully-packaged advertising—and continue to uphold personal and professional integrity.” I couldn't agree more.

    The AMA has made a mechanism by which residents and doctors can opt-out of drug salesperson access to prescribing information of doctors. Unfortunately, students cannot use this Prescription Data Restriction Program even though they have already been included in the AMA’s Masterfile. However, AMSA has set up a mailing list that will remind you to opt out through the PDRP when you’re able to do so. I hope that you will consider adding your name to this list and encourage your classmates to do the same.

    David Tian is a fourth-year student at Harvard Medical School and the Chair of AMSA’s PharmFree Campaign.

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  • Release of AMSA PharmFree Scorecard!

    Tomorrow is the launch of the 2013 AMSA PharmFree Scorecard! Join us in person or via Webcast. This would be a great chapter event!

    April 9, 2013: Launch of the 2013 AMSA PharmFree Scorecard 12-1pm (EST)
    Join National Physicians Alliance & AMSA Online Webcast or Live In-Person
    The AMSA Scorecard: The State of Medical School Conflict-of-Interest Policies and Cultivating a New Era of Effective Change

    Georgetown University Medical Center, Med-Dental Building, Room SW107,
    3900 Reservoir Road, NWSE408, Washington, DC 20057

    Speakers:

    Reshma Ramachandran, PharmFree Fellow
    American Medical Student Association

    Daniel Carlat, MD
    Director of the Pew Prescription Project

    RSVP to attend this live event in-person

    or
    Register to participate in this live online webcast

    This event offered as part of the Partnership to Advance Conflict-free Medical Education. This partnership and related materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin. Learn more at www.npalliance.org/conflict-free.

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  • Graduating Medical Students Tell the AMA, “I’m Opting Out”

    On Wednesday, April 10, graduating medical students will tell the American Medical Association (AMA) that they are opting out of the AMA Physician Masterfile and that they do not want their personal and prescribing information sold to the pharmaceutical and medical device industries. National Opt Out Day, sponsored by the American Medical Student Association (AMSA), hopes to rally hundreds of fourth year medical students.

    The AMA Physician Masterfile was established by the AMA in 1906 as a record keeping device supporting membership and mailing activities. The Physician Masterfile includes current and historical data for more than 1.4 million physicians, residents and medical students in the United States. Today, sales of the AMA Physician Masterfile totals more than $40 million per year and over 20 percent of their annual revenue.

    “The AMA should not be selling this data to pharmaceutical and medical device companies for the purpose of tracking physicians’ prescribing habits to devise directed marketing strategies,” Reshma Ramachandran, AMSA PharmFree Fellow. “Information from the AMA Physician Masterfile should only be used for research purposes to benefit our patients.”

    “We want our members – the nation’s future physicians – to understand what this information is being used for so they can make their own decision to remain in the database or opt-out,” says Dr. Elizabeth Wiley, AMSA National President. “Physicians should practice evidence-based medicine using the best existing clinical evidence—not carefully-packaged advertising—and continue to uphold personal and professional integrity.”

    “As a physician, I have no knowledge or control over data about me that is sold in the AMA Masterfile," says Dr. Michael Mendoza, medical director at Highland Family Medicine in Rochester, New York and alumni of AMSA. "I am not an AMA member, and I feel that the AMA has abused my rights to privacy by selling data about me without my consent for commercial and marketing purposes."

    National Opt Out Day is just one of the events scheduled during National PharmFree Week (NPFW), April 8 – 12, sponsored by AMSA. Thousands of medical students will celebrate the annual event and focus on putting patients first by addressing conflicts of interest and encouraging evidence-based rather than marketing-based education. NPFW aims to focus the attention of medical, premedical and allied health students on the importance of understanding the impact and control of financial and professional relationships with pharmaceutical and medical device companies in education, research and patient care.

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  • Implement the Sunshine Act Now!

    AMSA, along with the National Physician's Alliance (NPA), is pushing the Obama administration to fully implement the Physician Payments Sunshine Act which is aimed at transparency. 

    The legislation, part of the Affordable Care Act, requires drug, medical device, biologic, and medical equipment manufacturers to collect data on financial relationships with doctors and hospitals, and to report that data to the Centers for Medicare and Medicaid Services. 

    The two groups sent a letter to the White House stating:

    The NPA and AMSA have supported the PPSA since its passage and are deeply discouraged that HHS has not yet released final regulations, even though the statute called for regulations to be issued by October 1, 2011. We are now 15 months past the statutory deadline. 

    We are joined in our support by a diverse array of stakeholders, including drug and device companies which have already invested a great deal of money to comply with the Sunshine Provisions. 

    As physicians and medical students, we understand that payments from industry can set the stage for significant conflicts of interest that can lead to the prescription of costly treatment, even when equally effective, safe, and less expensive treatments are readily available. Such conflicts pose a grave threat to the intent of the Affordable Care Act, which is to deliver quality and affordable care to all Americans. Transparency about industry payments is an important step toward restoring trust and integrity in medicine. 

    There is no call for further delay. We request that final regulations be released no later than January of this year, so that manufacturers can quickly implement procedures to begin collecting payment information.

    Want to help??

    The Physician Payment Sunshine Act regulations have yet to come out - we need to put pressure on the White House to get them out! If you're on Twitter please retweet one or more of the below:

    T: @matthewherper physicians are "disappointed" that the sunshine provisions remain unimplemented <link>

    Link: Prominent Doctors Call For Action On Transparency Law – January 16, 2013

    T: @ChuckGrassley called delayed rules on Physician Payments Sunshine Act “unacceptable” @pharmalot <link>

    Link: Frustration Rises Over The Missing Sunshine Rules – January 17, 2013

    T: RT @FiercePharma AARP, AFL-CIO and prominent docs to White House: Get us the sunshine rules <link>

    Link: AARP, AFL-CIO and prominent docs to White House: Get us the sunshine rules, stat, Fierce Pharma – January 18, 2013

    Not on Twitter? Post the following to Facebook and tag AMSA National!

    Prominent doctors, medical students, Eli Lilly, Medtronic, AARP, AFL-CIO, Pew urging the White House to adopt without further delay the "Sunshine rule," which requires pharmaceutical and medical device companies to disclose their financial relationships with doctors and teaching hospitals. Like and share if you agree that patients should know and that the government should act, Read here: http://www.pharmalot.com/2013/01/frustration-rises-over-the-missing-sunshine-rules/.

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