January 23, 2009
U of I to bar free drug samples, gifts
By Erin Jordan | DesMoines Register | Link to article
Iowa City, Ia. - A new University of Iowa policy would prohibit physicians from giving free drug samples to patients, a long-standing practice that hospital leaders and consumer advocates say contributes to the ballooning cost of health care.
Other changes include barring U of I Health Care employees from accepting gifts and meals from private companies and requiring all doctors who do industry consulting to report who they work for and how much they are paid.
The restrictions, to be implemented by June, come after a U of I-requested audit showed U of I Health Care needed more specific conflict-of-interest policies and better ways of monitoring potential conflicts.
The audit was released in May and revealed some U of I doctors were paid for private consulting while they were on the clock for the university and others purchased equipment directly from companies with which they had financial ties. Nine doctors out of more than 800 did not file required reports in 2006 disclosing their potential conflicts of interest, according to the audit done by the Iowa Board of Regents audit committee.
Vice President for Medical Affairs Jean Robillard sent faculty and staff an e-mail Thursday outlining the new eight-page policy he approved for doctors, nurses, pharmacists and medical students who work at the 680-bed hospital and accessory clinics in Iowa City. A central database of conflict-of-interest reports and new management strategy will be implemented by June, he said.
"Will I get a lot of tomatoes and rotten eggs? Yes," Robillard said. "But this is absolutely the right thing to do. We have a responsibility to our patients."
Stressing care over profits
The changes are part of a national trend toward limiting the influence of the corporate world to ensure that patient care - not personal profit - comes first. The shift is spurred, in part, by high-profile reports of doctors having financial ties with private industry.
Last year, three U of I orthopedic surgeons were included on a list of doctors across the country who accepted money from the manufacturers of artificial hips and knees.
Dr. John Callaghan, a U of I surgeon, received $2.6 million in 2007 from DePuy Orthopaedics, a Johnson & Johnson company that makes replacement joints. Callaghan said the payments were above-board royalties for other doctors' use of joint replacement devices he helped develop. The U of I knew of the financial ties, but did not know how much Callaghan made in royalties because the university-wide conflict-of-interest policy does not require employees to report payment amounts.
The U of I's new conflict-of-interest policy will require all doctors doing consulting with private companies to provide details about specific tasks and payment amounts.
"Patients will have access to this information," Robillard said.
Iowa Sen. Charles Grassley is pushing for federal legislation that would require drug companies and device manufacturers to report payments over $25 made to doctors and hospitals. These lists would be posted online.
The U of I's new policy forbids doctors and other employees from giving free drug samples to patients, a controversial practice. Consumer advocates say distributing free samples of new, name-brand drugs means patients get used to these medications and are less likely to seek cheaper generics.
Name brands add to prescription costs
"It's important for a physician to look at what are the most effective drugs, not ones that are handy and free," said Lisa McGiffert, senior policy analyst for Consumers Union, which publishes Consumer Reports.
Name-brand prescriptions add to the costs for patients and for the health care system, Robillard said. "You and I pay," he said.
But some doctors and pharmaceutical companies defend the use of free samples, which allow patients to try a new drug for a short time before paying for a full course of medicine. "Sometimes, samples can be helpful," said Dr. Victoria Sharp, an associate professor of urology and former U of I Faculty Senate president.
The Pharmaceutical Research and Manufacturers of America, or PhRMA, recently adopted a voluntary code for sales representatives interacting with health care professionals that prohibits giving gifts and taking doctors out for meals at restaurants.
"We do believe the interactions with pharmaceutical reps and physicians should be professional and focused on education," said Diane Bieri, executive vice president and general counsel for PhRMA.
The organization disagrees with drug sample bans and hospital policies that prohibit drug sales reps from hospital premises, she said.
U of I is riding a national trend
At least 25 public and private academic medical centers now have "strong" conflict-of-interest policies, according to a Sept. 3 commentary in JAMA, the Journal of the American Medical Association, by David Rothman and Susan Chimonas of the Institute on Medicine as a Profession at Columbia University.
The institute's searchable database for conflict-of-interest policies at medical centers and university hospitals, at www.imapny.org/coi_database, shows the U of I's proposed restrictions are stricter than some, but not the most severe.
Florida State University's College of Medicine, for example, prohibits representatives from drug and device manufacturers or other vendors from entering "all campuses except to discuss/provide unrestricted educational grants." U of I Health Care's policy would ban reps from patient-care areas.
While gifts are banned under the U of I code, the University of Minnesota Medical School only discourages gifts. The University of Missouri Columbia School of Medicine permits gifts limited to $5 each or $75 annually, according to the IMAP Web site.
Robillard is not worried that U of I doctors will leave because of the policy. "You will hear that," he said. "A doctor told me he is leaving for Emory, but they just adopted a new conflict-of-interest policy. Ours is probably middle of the road."
U of I Faculty Senate President Michael O'Hara, a psychology professor, supports the changes. "We're absolutely heading in the right direction," he said.
The Iowa Medical Society declined to comment on the policy.