University of Toledo med school to limit drug reps

Medical student Mary LaSalvia shows an array of items handed out by pharmaceutical companies. The University of Toledo and other institutions that train physicians are taking steps to limit such gifts.

Mary LaSalvia felt uncomfortable at lectures when drug representatives served up lunches, pens, note pads, travel mugs, and other goodies alongside information about medications they were promoting.

The fourth-year medical student wondered whether a patient would question if she had a conflict of interest while writing a prescription with a pen emblazoned with the drug s name. Sometimes companies even offer prescription pads for their drugs, Ms. LaSalvia said.

At the urging last year of Ms. LaSalvia and other students, who were joined by faculty in the cause, such ethical concerns about dealing with representatives from prescription drug and medical device companies likely soon will be mitigated at the University of Toledo medical school, formerly the Medical College of Ohio.

Officials are preparing to join a growing number of institutions nationwide banning freebies from drug and device companies, restricting campus visits by representatives, and making other moves aimed at helping future doctors make objective decisions about prescriptions.

You have to constantly be considering what you re doing to make sure everything you do is always in the best interest of your patients, Ms. LaSalvia said.

She added: There s an awareness in medicine now that we really have to start addressing this [pharmaceutical] issue.

Published professional studies have shown drug reps influence doctors when they prescribe medications, causing ethical questions nationwide in the last few years especially as profits and practices of pharmaceutical companies are being closely scrutinized, doctors and students say.

Dr. Jeffrey Gold, dean of UT s College of Medicine, said he hopes to institute a policy regarding drug and device representatives on July 1, the start of the next medical school year. Such policies will become common, he said.

I predict that this will definitely be present in one way, shape, or form in every hospital and every medical school in the country it s just a question of when, said Dr. Gold, who also is UT s executive vice president and provost for health affairs.

Dr. Gold said last week he wants to talk with other UT colleges, including nursing and pharmacy, about considering similar measures. And eventually local hospitals where UT students and residents get training, including those owned by Toledo s ProMedica Health System and Mercy Health Partners, will be asked to adopt restrictions, too, he said.

A drug company association, however, contends representatives provide crucial drug information needed to treat patients. Health professionals often only have time to discuss medications over working meals, and all gifts should support medical practices, Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, said in a statement.

While drug companies are interested in learning about other ways to provide information, restricting representative access to medical schools, hospitals, and clinics is not a workable answer because it could limit or cut off vital information, he said.

Some drug companies contacted by The Blade last week either referred questions to the association or did not return calls seeking comment.

So far, a half dozen U.S. medical schools including the University of Michigan in Ann Arbor have adopted comprehensive policies restricting drug representatives, and more will follow, said Dr. David Korn, senior vice president for the Association of American Medical Colleges division of biomedical and health sciences research.

Our sense is that many, many, many other academic institutions are deliberating about these matters as we speak, Dr. Korn said. The association hopes to have its policy recommendation on the issue before June, 2008, he said.

Six other medical schools have some type of pharmaceutical policy, but only five of the 12 including UM received an A this month from the American Medical Student Association for restricting access to both campuses and hospitals. UT s medical school was among 40 colleges that did not respond to the survey by the association, which launched a PharmFree campaign five years ago, said Michael Ehlert, national president.

At UM, officials banned all gifts from drug and other companies four years ago as part of its multifaceted approach to help ensure doctors were prescribing lower-cost medications when possible, said Dr. John Billi, associate vice president for medical affairs.

Companies were spending more than $2 million a year to provide lunches at UM, and while some were worried students and residents would suffer, such freebies didn t exist 15 years ago and people survived, he said.

UM banned drug samples five years ago as the first step in its policy, Dr. Billi said. Doctors were concerned not being able to hand out free samples would cause financial problems for patients, but the university put in place a program to help them, he said.

For each rationale folks had, we were able to work out a way to answer the objection, Dr. Billi said.

He added: Now I think our students feel proud.

UT is not proposing to ban drug samples, but they are not widely used because of the rec ordkeeping required to handle them, officials said. Other facets of the policy are not as strict as other medical schools, either, but other steps could be taken, they said.

Still, not all UT medical school students are critical of drug and device company lunches and other freebies. Fourth-year medical student Chris Gabel, whose father has worked in the drug industry for 25 years, said lunches and other items are a sort of small payment for doctors time to attend lectures instead of seeing patients.

More doctors attend educational lectures with students at UT if lunch is provided, Mr. Gabel said.

The message isn t going to get heard if nobody is there, he said.

Mr. Gabel said he is in favor of other parts of the UT proposal, such as building into the curriculum more information about dealing with company representatives and assessing clinical trials.

That is an important piece for fellow student Ms. LaSalvia, too.

The most powerful weapon we have is our knowledge, she said.

The proposed policy, which will be considered by the Health Science Campus Faculty Senate next month, also calls for company representatives to get training from UT before interacting with doctors and medical students. The policy was formed from recommendations from a task force of students, including Ms. LaSalvia, and faculty chaired by Dr. Roland Skeel.

Of course, UT s Dr. Gold said, drug companies could decide to not award research grants to UT because of the policy, a small concern because they need such expertise to develop products.

So far, none of the medical schools with policies has run into such problems, although all are larger players than UT, said Dr. Korn of the medical school association.

UM s Dr. Billi said drug companies are not likely to pull research funding.

These companies aren t stupid or spiteful, he said.

Contact Julie M. McKinnon at:jmckinnon@theblade.comor 419-724-6087.