UPMC draws up severe code on freebies
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The University of Pittsburgh Medical Center has drafted a get-tough policy that would prohibit its physicians and other employees from accepting almost all freebies -- from sample medications to pens and notepads -- from drug and medical device companies.
Industry influence can result in "unacceptable conflicts of interest," the draft says, adding that financial support or gifts, even in modest amounts, "can exert a subtle but measurable impact on recipients' behavior."
While he understands why officials want to curtail use of samples, Dr. Jonathan Han, medical director of the UPMC New Kensington Family Health Center, said the proposed policy could have "pretty serious unintended consequences."
He noted that some uninsured or underinsured patients need hundreds of dollars in medications each month that they cannot afford. Physicians often help out by giving them samples provided by drug companies.
The proposed policy is similar to those adopted by other academic medical centers. It would apply to about 50,000 people -- faculty, staff and students of the university's Schools of the Health Sciences and other professionals and staff employed or contracted by UPMC's U.S. operations.
Those who don't comply could face sanctions including written reprimands, fines or loss of hospital privileges. Industry representatives could receive written warnings or be banned from medical system property.
The draft proposal calls for establishing a database of manufacturer assistance programs and investigating the feasibility of a voucher program that would allow patients to obtain medication at no cost to them. Providers unable to find drugs for patients through those means could make special requests for manufacturers' samples.
But that approach could mean greater delays in getting patients needed medications, Dr. Han said. Vouchers might not be accepted at all neighborhood pharmacies, and while manufacturers' assistance programs can be helpful, months can lapse before the drugs are provided, he said.
Meeting the needs of the uninsured and underinsured is one reason why the Henry Ford Health System in Michigan still permits doctors to provide samples, though with some restrictions to ensure proper control of inventory, said Dr. Kathleen Yaremchuk, vice president of clinical practice performance at Henry Ford Hospital.
Henry Ford, however, does require vendors to be certified through a health system-sponsored class, bans vendor-supplied food or promotional materials, and requires vendors in clinical procedure areas to wear black scrubs -- a less common color that helps make those representatives more easily identified, Dr. Yaremchuk said.
Since the new policy took effect, the number of representatives in operating room areas has dropped from 30 to 35 per day to about five or 10, she said.
The Hospital of the University of Pennsylvania implemented a ban on samples about five years ago, and officials last year implemented other provisions similar to Pitt's proposal in University of Pennsylvania health system facilities, said Dr. Patrick Brennan, the system's chief medical officer. While a voucher system was instituted to help indigent patients obtain drugs, some medical practices have found it cumbersome, he said, and an effort to provide free generic medications also has encountered problems.
The University of Michigan implemented a ban on sample medications in 2002, and imposed other restrictions on industry representatives the following year.
Efforts were made to switch patients in financial need to lower-cost medications or to help them qualify for assistance programs to obtain more expensive drugs. Vouchers also have been used on a limited basis, said Dr. Steven J. Bernstein, an associate professor of internal medicine.
In general, the approach has worked better than the former system of distributing samples, he said.
Dr. Robert Branch, director of Pitt's center for clinical pharmacology, defended the proposed policy for Pitt and UPMC, including the ban on sample medications. He said samples encourage use of newer, more expensive medications when lower-cost drugs may be just as effective.
While some physicians seem to feel they are immune to the effects of marketing by industry, Dr. Branch said it's unlikely companies "would make this massive investment if it wasn't successful."
Many other academic medical centers have developed similar policies or are considering them, said Dr. David Korn, a senior vice president for the Association of American Medical Colleges.
Widespread attention to the matter was prompted in part, he said, by an article published early last year in the Journal of the American Medical Association. That article proposed that academic medical centers "take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry."
Relationships between industry representatives and physicians are common. A study published earlier this year in the New England Journal of Medicine found that four out of five doctors surveyed in six specialties accepted food or drink from drug or medical device companies. Nearly as many reported accepting drug samples.
Thirty-five percent of respondents said they received reimbursement for costs associated with professional meetings or continuing medical education.
In May, the American Medical Student Association released a scorecard assessing medical schools' policies concerning relationships with the pharmaceutical industry.
Schools receiving an "A" grade for having comprehensive policies restricting access by industry sales representatives were Stanford University; the University of California, Davis; the University of Pennsylvania; the University of Michigan; the University of Vermont and Yale University.
Pitt was among a group that received a "B" for having more limited policies. Many other schools received lower grades.
A final decision on the UPMC policy will be made by President Jeffrey Romoff and Dr. Arthur Levine, Pitt's medical school dean and senior vice chancellor for the health sciences, said Dr. Barbara Barnes, associate dean for continuing medical education at the medical school. Both have endorsed principles contained in the draft, she said.
Officials hope to finalize the policy this fall and implement it by early next year, she said.
First Published July 1, 2007 10:59 pm