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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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  • Advice as graduation approaches....

    To the Class of 2013,

    Congratulations on an incredible achievement; in a few short days or weeks you will be receiving your MD/DO degree and then embarking onto residency! While you undergo this transition, the field of medicine also is facing dramatic changes, both internally and externally. There has been increasing scrutiny on the objectivity of our judgement as physicians and how our relationships with industry can affect the trust relationship that is at the heart of the doctor-patient dyad.

    Patients are skeptical of our relationships with industry and are concerned that they may compromise our ability to render effective and cost conscious care. In fact, studies have shown that when exposed to industry interactions such as gifts (even pens!), drug samples, free meals, and travel, doctors are more likely to prescribe costly name-brand medications and less likely to prescribe the cheaper generic alternatives. You might see this as a deviation from the evidence-based prescribing methods you learned over the past four years, while patients may see it as an erosion of trust and a higher bottom line cost for medical care in a world of skyrocketing healthcare costs.

    If you can appreciate that industry interactions with medical professionals have the potential to affect the patient-doctor relationship, there here is the good news: part of the Affordable Care Act called the the Physician Payment Sunshine Act (“Sunshine Act”) requires manufacturers of drugs and medical devices to report the monetary value of gifts and payments to doctors to the Centers for Medicare and Medicaid Services, all of which will be posted on a publicly accessible website. This includes the costs of gifts, consulting fees, research activities, speaking fees, meals and travel. However, payments or other “transfers of value” to residents (you) will not be required to be reported. What will this mean for you?


    Best wishes for success as you begin residency,
    The PharmFree Steering Committee

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  • Dollars for Doctors: Are Pharmaceutical Companies Paying Your Doctors?

    AMSA PharmFree Fellow Reshma Ramachandran joined a panel on American Law Journal to debate whether physicians should take money from pharmaceutical companies. They also discussed the recent GlaxoSmithKline settlement over "unsavory marketing practices" and its "unhealthy alliance with doctors," specifically Dr. Drew.

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  • Watch the PharmFree Scorecard Launch!

    On Thursday, March 8th, AMSA released the findings of the 2011-2012 PharmFree Scorecard.

    Watch the Webex now!

    And check out www.amsascorecard.org to see what your school got for a grade!

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  • 2011-2012 PharmFree Scorecard Launched at AMSA Convention

    Despite the fact that only two medical schools ban sales representatives from campus, the majority of U.S. medical schools have implemented strong conflict-of-interest policies this year, according to the 2011-2012 American Medical Student Association (AMSA) PharmFree Scorecard. Released today, the Scorecard finds that 102 of 152 medical schools (67%) now receive a grade of A or B for their policies governing pharmaceutical industry interaction with medical school faculty and students, compared with 79 last year.

    Using letter grades to assess schools’ performance in eleven potential areas of conflict, the AMSA PharmFree Scorecard (www.amsascorecard.org) offers a comprehensive look at the current and changing landscape of conflict-of-interest policies across American medical education, as well as more in-depth assessment of individual policies that govern industry interaction. Now in its fifth year, the Scorecard analyzes gifts and meals from industry to doctors, paid promotional speaking for industry, acceptance of free drug samples, interaction with sales representatives and industry-funded education. The participation rate was 98% of all eligible medical institutions.

    Of the 152 U.S. medical schools, 28 receive As (18%), 74 Bs (49%), 15 Cs (10%), 13 Ds (9%) and 9 Fs (6%). Thirteen respondents received a grade of “In Process” because their policies are currently under review or revision.
    For the fifth consecutive year, access of sales representatives remains a challenging area. Only two schools – University of South Dakota Sanford School of Medicine and Florida State University College of Medicine – completely ban sales representatives from campus, giving them a perfect score in that domain. “Industry sales representatives are employed to increase the sales of their company’s drugs. Permitting their access to medical staff is not in the interests of patients or staff,” says Lee Shapley, AMSA PharmFree Scorecard director.

    Another challenge continues to be distribution of free pharmaceutical samples. Fifty-four schools have no significant policy restricting the distribution and use of samples though it has been shown that samples lead physicians to prescribe drugs that differ from their preferred drug choice, reducing their prescribing of unadvertised drugs in favor of advertised drugs. The U.S. pharmaceutical industry distributes some $18 billion per year in drug samples.

    Only 19 schools (13%) have model policy in terms of disclosure, requiring personnel to disclose past and present financial ties with industry (e.g., consulting and speaking agreements, research grants) on a publicly-available website and disclosing these relationships to patients. “This is a particularly interesting statistic because the upcoming implementation of the Physician Payments Sunshine Act will require public disclosure by industry of all payments and gifts so the public may learn of conflicts of interest before the schools,” continues Shapley.

    Highlights of the survey include:

    • Harvard Medical School received an ‘A’ this year. In 2008, Harvard had no policies and received an ‘F’ on the Scorecard. Due in large part to student activism over the past four years, the school now has one of the strongest policies in the country that includes a ban on speaker bureaus in addition to a strong gift, disclosure and samples policy.
    • Four schools significantly improved their scores from ‘F’s to ‘B’s. These schools are: University of Texas Health Science Center at Houston, University of South Carolina, Howard University and Morehouse School of Medicine.
    • All eight of the Texas medical schools scored at least a B. The University of Texas Medical Branch at Galveston, however, remains the lone A in the Lone Star state.
    • Approximately one quarter of U.S. medical schools improved their conflict-of-interest policies since the release of the 2010 PharmFree Scorecard.
    • More than two-thirds of medical schools now have grades of A or B (102 schools).
    • Schools with model policies on speaking arrangements have grown tremendously; 17 schools ban or severely restricting participation in speaker bureaus.

    Check out your school's grade at http://www.amsascorecard.org/.

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  • Students Across the Country Call on Medical Schools to Address

    American Medical Student Association Celebrates National PharmFree Week, November 14-18

    AMSA National PharmFree Week (NPFW) is back stronger than ever!

    Launched in 2002, AMSA’s PharmFree Campaign encourages medical schools and academic medical centers to develop policies that encourage evidence-based prescribing and industry partnership for research innovation while reducing the impact of marketing, gifting and conflicts of interest.

    The 2011 NPFW features:

    • Microgrant support for students in Texas, Arizona, Tennessee, Ohio, Massachusetts, Rhode Island, Maryland and New York to host local projects throughout the week
    • 3 day Pharmaceutical Policy Leadership in Medicine Institute in January to train student leaders on conflict of interest issues
    • Second Slide Campaign to encourage students to advocate for disclosure of conflicts of interest by faculty during their training
    • FDA’s Bad Ad Campaign to encourage healthcare professionals to recognize and report potentially dishonest or misleading drug promotion.
    • PharmFree Scorecard, a first-of-its-kind ranking which evaluates conflict-of-interest policies at medical colleges nationwide (go to www.amsascorecard.org)

    Remember:

    "Our goal is to change the culture of medicine from relying on the convenience of marketing and the luxury of free gifts to a culture which puts patients first by prioritizing evidence-based medicine."

    Tim Anderson

    AMSA PharmFree Campaign Chair
    Fourth year medical student at Case Western Reserve University

    What will YOU be doing for NPFW? Go to http://www.amsa.org/AMSA/Homepage/Events/NPFW.aspx for more info!

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  • Supreme Court hears arguments over prescription drug data

    By Elizabeth Wiley, JD, MPH
    AMSA Vice President for Internal Affairs 
    AMSA Legislative Director
    This morning the U.S. Supreme Court is hearing oral arguments in Sorrell v. IMS, a case with significant potential implications for physicians and pharmaceutical companies.

    At issue in the case is Vermont’s Prescription Confidentiality Law. This law, passed by the Vermont State Legislature in 2007, provides physicians the right to consent to the use (and sale) of their prescribing data. These prescribing data are very valuable to pharmaceutical companies who then use this information to craft marketing strategies (a practice often referred to as “data-mining”). Notably, the American Medical Association (AMA) plays a pivotal role in data-mining through the sale of its Physician Masterfile to data-mining companies. 

    IMS Health, a data-mining company, challenged the Vermont law as a violation of commercial free speech under the First Amendment and won in a lower court. As a result, the case is now before the Supreme Court. Several other states have either passed or are considering similar legislation, so the Court’s decision may have implications across the country.

    While these marketing strategies may boost drug company profits, the unfortunate consequence of this practice for patients is higher prescription drug costs, less access, and, arguably, fewer evidence-based prescriptions and compromised doctor-patient confidentiality. For payers such as states and the federal government, data-mining and similar pharmaceutical marketing tactics raise the cost of health care at a time when budgets are tight.

    So what do physicians (and future physicians) think about data-mining? There is some evidence suggesting that few physicians are aware that their data is mined. A study conducted by Kaiser revealed that 74% of physicians disapprove of the practice. A similar study by the AMA found 66% do not support data-mining.

    The American Medical Student Association joined an amici brief in support of the Vermont law with the New England Journal of Medicine, the Massachusetts Medical Society and the National Physicians Alliance.

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  • National PharmFree Week: Much to Celebrate!

    By Chris Manz
    Chair, PharmFree Steering Committee


    This past year has seen a number of notable advances in medical center conflict of industry policies. Two years ago, PharmFree students at Harvard School of Medicine demanded that their school develop a rigorous policy for regulating relationships between industry and physicians at its hospitals. Their efforts bore fruit a few months ago when Harvard announced its new conflict of interest policy that, among other things, makes Harvard one of the few medical schools to bar faculty from participating on speakers bureaus.

    University of Michigan also upped the bar this year by establishing a policy that bars industry funding of continuing medical education. These developments belie a groundswell in new policies at schools across the country which we look forward to documenting when the 2010 AMSA PharmFree Scorecard is released next month.

    Earlier this year, we saw the passage of the Physicians Payment Sunshine Act, a bill long championed by PharmFree that makes transparent payments that industry makes to physicians. But while the law does not take affect for a few years, a recent ProPublica report used currently available industry payment databases from just a handful of companies, documenting $250 million in payments to 17,000 physicians across the country. The stunning magnitude of these payments underscore that there is much work to be done. But PharmFree is on it.

    In addition to advocacy for robust conflict of interest policies, medical students are using National PharmFree Week as an opportunity to call on their representatives in Congress and ask them to ban Pay for Delay deals. These collusive deals, where a brand name pharmaceutical company pays a generic company to keep generic competition from entering the market and lowering prices, delay access to affected drugs by an average of 17 months, costing American patients an estimated $35 billion over the next decade. Want to help? Take 2 minutes to write your Congressman right now! Just click here.

    As our tagline says, PharmFree promotes evidence-based prescribing, pharmaceutical innovation and access to medicines. This week, we highlight the PharmFree students that continue to push their institutions to implement conflict of interest policies that restore the integrity of the medical practice and students calling on Congress to put patients first and ensure affordable access to medicines.

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  • Attending the Critical Prescribing Skills Conference

    Posted by Jack Rusley

    “Maybe it’s time for us to think: WWID,” Dr. Jerry Avorn said. “What would industry do?” After many years of arguing with classmates and others that the pharmaceutical and device industries should do more to provide access to essential medicines and less to influence physicians to use their products with flashy marketing and shotty research, I was taken aback by this question at first. As I settled into my seat, I realized that Dr. Avorn – a well known internist, geriatrician, and drug epidemiologist at Harvard – was pushing us to consider the most cost-efficient and effective methods for educating prescribers and changing their prescribing behavior…toward safer, more cost-effective drugs.

    In recognition of AMSA’s extensive work on industry interaction and conflict of interest issues, the organization was invited to select 15 students to join more than 100 physicians, lawyers, policy makers, and allied health professionals at the University of Illinois at Chicago for a two day conference titled “Critical Prescribing Skills: Advances from the Attorney General Consumer and Prescriber Education Grant Program.” The grants and the conference were made possible by a $2.3 billion settlement between Pfizer and the state Attorneys General over the marketing of Neurontin (gabapentin) for off-label uses.

    We heard from more than 20 grantees—a nurse practitioner who contributes to the Consumers Union Best Buy Drugs program, a PhD from UCSF who sits on World Health Organization committees on drug research and development, the AMA’s Vice President for Ethics, and many more—but the common goal was helping prescribers make better decisions and use the most efficacious, evidence-based, and cost-effective treatments available. Ah, if only this was as easy as it sounds! Most groups developed online modules that physicians, pharmacists, nurse practitioners, and other targeted prescribers can complete, ideally raising their awareness of marketing influence and conflicts of interest and leading them to make better prescribing choices. Almost all the groups struggled to get a large number of prescribers to participate, and when they did, had trouble quantifying any changes in behavior—both common issues in medical education research.

    Thomas Abrams, head of the Food and Drug Administration department that regulates industry marketing was the other keynote speaker, and gave us a fascinating overview of how the agency works, what they can do (i.e. require black box warnings, which they do occasionally; call for a drug recall, which they do rarely), and what they can’t do (i.e. pull TV ads). He made it clear that the FDA does its best to work with drug companies instead of trying to impose it’s will, and that for the most part, industry cooperates and pushes the envelope at the same time.

    AMSA and student activists received many acknowledgements throughout the conference, especially around their force for policy changes at their academic medical centers (AMCs). Outgoing Chair of AMSA’s PharmFree Campaign, Nitin Roper, spoke on a panel about AMSA’s work on the Physician Payment Sunshine Act (now law), the PharmFree Scorecard (now in its 4th year), and numerous AMC policy changes spurred by student activism.

    As I flew home to Providence after two days of conference fun (minus the Disneyland rides), I was heartened by three things:

    • the amazing students I met and reconnected with are not only extremely well-informed, passionate, and articulate, but are also clearly the future leaders on industry interaction issues,
    • there is a small but growing group of physicians, nurses, pharmacists, policy makers, and lawyers who have committed a large part of their careers and lives to these issues (translation: we are not alone, and you will have somewhere to go after graduation), and
    • government is on our side, from the FDA to Attorneys General to Senator Grassley, there is a strong sentiment that access to safe, affordable medicines is a public good and a human right.

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