Medical students fight marketing influence	March 2008

Med Ad News spoke with Michael Ehlert, M.D., president of the American Medical Student Association, the largest independent medical student organization in the United States. AMSA has been a prominent advocate for stricter limitations against pharmaceutical marketing at medical schools; the organization is leading the PharmFree campaign, an educational effort about pharmaceutical marketing tactics that target medical students and physicians.

Med Ad News: What were and are the motivations behind the PharmFree campaign? What are the campaign’s short- and long-term goals?

Dr. Michael Ehlert: AMSA’s PharmFree campaign was started to bring awareness and change to the current pharmaceutical advertising policies that influence medical education, prescribing habits, and the cost of medications. With an increasing proportion of medical education, continuing education, and prescribing information being provided by the makers of therapeutics, physicians are being taught from biased sources. Further, the torrent of free medical equipment, drug samples, nick-knacks, speaker fees, and other giveaways are designed to influence the prescribing behavior of doctors. As a profession with a social contract to act on behalf of patients, you cannot defend any benefit of these influences if they change how a physician would otherwise treat their patients. Physicians have a duty to maintain the integrity of their profession, and corporate sponsorships and branding of stethoscopes, penlights, clipboards, and generally everything in and around doctors is a slow selling out of our profession. These marketing practices cost billions and add to the rapidly increasing cost of medication and push newer, more expensive, and rarely more effective medications over cheap, safe, and proven generics.

The goals of AMSA’s PharmFree Campaign are to raise awareness among medical students, physicians, and the public about the influence these companies have on the practice of medicine, and to change student and physician behavior to refuse these giveaways and learn about pharmaceuticals from non-biased, non-industry sources of information. AMSA specifically has a partnership with The Medical Letter where we provide free of charge, print, on-line, and PDA versions of TML to our third year AMSA members and have discounted subscriptions for all other members. We are also active in supporting legislation that discloses the payments to physicians and decision makers in an act of transparency, although our long-term goal is to remove the presence of physician detailers and biased information from the practice of medicine.

Med Ad News: What positive effects do you feel the campaign has had? Have there been any unintended effects?

Dr. Michael Ehlert: AMSA has been effective in raising the awareness at medical schools and academic medical centers about the hazards of biased sources of information and the influence these companies have on medicine. We have collected pledges from our members who choose not to eat drug company sponsored lunches or take gifts. Further, there is a broader public discourse about the cost of medicines and the marketing practices of these companies that is going on and medical students are a large part of the discussion. As the future leaders in medicine it is important to educate a generation of doctors about this and work to remove the influence from their practice of medicine. Patients will also benefit in that physicians can rebuild the public trust if they are seen as fighting outside influence and standing up for the independence of their decisions and treating patients according to sound medical evidence. Several unintended consequences include a large drop in resources for the association. As the only major medical organization refusing sponsorship and advertising from drug companies we have much less money for our members and programming. Pharmaceutical companies are the largest sponsors of organized medicine. It also strains our relationships with other medical organizations, as they all know we do not support drug company influence while their business model depends on it.

Med Ad News: What about the more restrictive policies that have been put in place recently by prominent medical schools (i.e., Stanford, Penn, Michigan, etc.)? Do you feel that these policies have gone far enough? Have they had beneficial effects? Unintended consequences?

Dr. Michael Ehlert: AMSA supports these policies and encourages more schools to adopt them. Removing drug reps, samples, and educational sponsorship does a great deal to remove the influence on the practice of medicine. There are still loop-holes with off-campus events and a general lack of enforcement. Follow-up studies are needed to determine if these policies are enforced or if they decrease the unnecessary use of expensive name-brand drugs instead of equivalent generics. AMSA is looking for students to press their own schools to adopt policies which remove these paid advertisers and their gifts from the legitimate education of medical students and residents.

Med Ad News: What sort of relationship between medical students and representatives of the pharmaceutical industry do you feel is acceptable/appropriate? Should pharma marketing and/or pharma industry-generated materials be completely removed from any medical school environment, or is there some level of relationship that would be appropriate? Why?

Dr. Michael Ehlert: Pharmaceutical companies play a critical role in the health of our patients and in the advancement of health care. It would be unreasonable to think that no relationship is acceptable, when in fact they are a great resource and have a duty to work with physicians and institutions to educate and research pharmaceuticals. However, so much of their budgets are spent on marketing, which uses information not selected and reviewed by independent peers, but rather those looking to represent the drug in the most positive light. If there is scientific merit to a treatment then it should be rewarded and used widely. They choose, however, to market drugs with broad usage potential in chronic lifestyle diseases and have been caught advertising them for uses not supported by science to patients they were not approved on (children are a big case). There have also been cases where they only sponsor research that is virtually guaranteed to show beneficial outcomes with their drug, and they have NO obligation to disclose trials, which have negative outcomes. All pharma material is biased and created for the sole purpose of marketing and selling a drug – not education as some would claim. This is a selling-out of our profession and should be removed from our offices. In cases where the companies want to support education or research, they need to allow independent researchers and educators to provide those materials and determine the content. It is okay if a company supports an event, but having anything to do with the content is a clear violation of our professional obligation to base decisions on science and evidence, not marketing fodder.

Med Ad News: Should students be educated in medical school about ways to manage relationships with representatives of the pharmaceutical industry in their future professional careers? If so, how should this be done, and what should be taught?

Dr. Michael Ehlert: Physicians begin to develop habits early on in their careers and if something is unacceptable in school, then it will be unacceptable in practice. There is no formal education required on these conflicts of interest, which is where AMSA has played a unique and important role. Students need to understand WHY this leads to worse patient care and increased costs to our patients. Further, they are asked to participate very early on in journal clubs, lunch talks and dinners sponsored by drug companies. Pens are virtually ubiquitous and are in the pockets and hands of so many students, which is the beginning of a ‘grooming’ by the companies for decades of a cozy relationship. Students need to be taught about the facts and figures of what is put into marketing and how they actively try to change the way you practice medicine to increase profits for their stockholders. Basic principals of professionalism and conflicts of interest should also be taught, as should appropriate sources of non-biased prescribing information (like The Medical Letter).