After today, physicians may find a new group of people competing with drug-company detailers for precious moments of their spare time: medical students.
At locations around the country today, the American Medical Student Association will be sponsoring events marking its second annual PharmFree Day at which medical students and residents will be encouraged to show their professionalism by refraining from accepting gifts and free meals from pharmaceutical company sales representatives.
In addition to hearing inspirational words from speakers such as former New England Journal of Medicine editor and Harvard University professor emeritus of medicine Arnold Relman, M.D., who is appearing at Drexel University College of Medicine in Philadelphia, attendees will also participate in "counterdetailing teach-ins."
These sessions are designed to instruct students on how to help practicing physicians find the latest unbiased sources of scientific literature on pharmaceutical products.
"It's not simply stirring the pot and saying more about the same things," said AMSA National President Leana Wen, who said the organization has been working on the counterdetailing campaign since April.
Wen herself was the first medical student to take part in counterdetailing in Virginia, and she said she's been met with enthusiasm by the physicians she's spoken to.
Wen, who's taking a year off between her third and fourth year of medical school to focus on her duties as AMSA president, said much of the time in these encounters is spent showing doctors how to access information from the U.S. Agency for Healthcare Research and Quality's National Guideline Clearinghouse, the Medical Letter and the Consumers Union Best Buy Drugs databases on the Internet, personal digital assistants or in paper form.
The AMSA Web site contains a suggested script for students to use and notes that there should be no direct mention that doctors are behaving unethically by accepting drug company gifts. It also notes that the goal is not to make doctors feel uncomfortable and that "Every effort is made to let them save face and 'educate' the student in return."
The AMSA, a 55-year-old organization with nearly 60,000 members, launched its PharmFree campaign in 2002 as a way to revitalize medical professionalism.
Wen said she believes drug industry marketing and gifts shape physician prescribing habits, create a culture of entitlement among healthcare professionals, increase the cost of medicine and degrade the medical profession.
"It degrades professionalism when students see physicians line up to get the latest gifts," she said, adding that studies have shown that more patients than doctors think accepting drug company gifts is unprofessional.
Wen said the AMSA must not only counter how students and residents rationalize why it's OK for them to accept gifts and meals, but also find strategies to eliminate the "You-but-not-me syndrome."
"That's where they say 'You are influenced, but I'm not influenced' -- even though evidence contradicts what they say," Wen explained. "Students may also be able to justify accepting meals by saying 'I don't prescribe that drug anyway.'"
Nevertheless, she thinks the campaign has had an impact.
Wen recalled how at a program she attended in 2002, a speaker's presentation on not accepting drug company lunches was met with "stony silence" and only one student signed the PharmFree pledge. But, since then, "thousands" have signed the pledge not to accept gifts or meals.
"I've seen a shift in how students feel about the PharmFree campaign," Wen said.
It may not be directly related to the campaign, but she also noted that the AMSA's membership has almost doubled over the past four years.
"Almost all of our members have been exposed to this issue in some way," Wen said. "Our message is reaching students all over the country."
That message has not necessarily been universally applauded, however, as the drug industry trade group the Pharmaceutical Research and Manufacturers of America, or PhRMA, continues to defend its members' marketing techniques.
"Many sales representatives are nurses and pharmacists by background and training, and are well-prepared to talk to physicians about when and how to use new drugs properly and about any potential side effects," PhRMA spokesman Jeff Trewhitt said. "If a sales representative is not well-trained, or if a person is ill-informed, the credibility of the company is harmed and it makes it difficult for them to make it through the door next time."
Code of conduct
He also said that PhRMA has a code of conduct that mandates that any gifts to physicians be worth less than $100 and should support the medical practice.
Trewhitt added that entertaining doctors is not permitted under the code, but meals considered moderate by prevailing local standards are acceptable as an "acknowledgement that a sales representative has taken a chunk of time out of a doctor's busy schedule."
Wen disagreed, and noted how the AMSA's own code goes further than either PhRMA's or the American Medical Association's in that the organization says that absolutely no drug company gifts, meals, advertising or sponsorships are allowed.
"Pharmaceutical reps say 'We're educating physicians,' but what they're really doing is advertising," she said.
Read more about PharmFree Day at: http://www.amsa.org/prof/pharmfreeday.cfm.