Pharma salespeople have grown accustomed to seeing "No Reps Allowed" signs at the occasional physician's office or hospital. But if medical schools follow new advice from a Pew Charitable Trusts task force, those signs will be on the door of every academic medical center in the United States.
Figuratively speaking, of course, but the effect is the same: The task force advises barring reps from visiting faculty, students and trainees in academic medical centers and their affiliates. No free meals for anyone, either. Not even a ballpoint pen.
Reps looking for key opinion leaders could have trouble, too: The task force says med school faculty shouldn't accept speaking fees from industry, either. Take a look at ProPublica's database of pharma payments to doctors, and you'll see how many companies rely on medical school faculty to talk about their products to other doctors.
The Pew task force first convened last year to help teaching hospitals develop better conflict-of-interest policies. The last round of similar recommendations--from the Association of American Medical Colleges--was issued in 2008. At the time, it was pretty avant garde; the association recommended a ban on free food, gifts and travel. And at the time, conflict-of-interest policies were uncommon.
Since then, there's been more public attention on financial relationships between doctors and teaching hospitals on one side, and pharma and device companies on the other. Ghostwriting scandals, retracted journal papers, off-label marketing settlements, and a few high-profile faculty dust-ups triggered new restrictions at some schools. The state of Massachusetts even imposed a ban on pharma gifts and free meals (though that law has since been modified).
The questions about pharma's financial ties with doctors and medical schools aren't just about ethics; studies have shown that gifts and payments do sway prescribing behavior, often toward costlier drugs that are no better than cheaper rivals. Researchers also found that physician grads from schools with gift bans were less likely to prescribe expensive branded drugs that had equally effective generic alternatives. In fact, it was these studies that prompted the sales rep ban in Pew's new recommendations.
Earlier this year, the American Medical Student Association (AMSA) rated schools' conflict-of-interest policies, and the grades were better than in past years. The group's "model" policy is slightly less restrictive than the Pew task force's recommendation; speaking bureau arrangements would be allowed, if limited, and pharma reps could visit by appointment.
AMSA found that very few medical schools--four, in fact, of the 120 surveyed--had policies that blocked reps at the door. Speaking fees of course remain common. Will Pew's recommendations change that? They are published in the current issue of the Journal of the American Medical Association, so plenty of doctors and medical school faculty will see them. We'll have to wait and see how they respond.