The Medical Center Enacts A Policy Separating Medicine from Industry
by David Sherman
The Stanford Medical Center recently responded to the publicÕs growing concern with workplace ethics by enacting a policy designed to limit the influence of pharmaceutical and biomedical companies in daily affairs. According to the new policy, activated October 1, 2006, physicians at the Stanford Hospital & Clinics and Lucile Packard ChildrenÕs Hospital are prohibited from accepting any giftsÑsuch as drug samples, pens, or lunchesÑfrom industrial representatives. In addition, industry representatives are banned from roaming patient care areas and medical center facilities unless they are there for authorized reasons.
Unanimously approved by the School of MedicineÕs Executive Committee in June, the policy aims to ensure all interactions between doctors and the industrial world are ethical and avoid conflicts of interest. However, the policy may have possible drawbacks, and has received mixed responses from Stanford's medical community.
Possible Drawbacks of the New Policy
Pharmaceutical companies spend $21 billion a year on marketing, and as much as 90 % goes to physicians in the form of free samples, meals, and sponsorships of educational events. With such large contributions, pharmaceuticals and biotechnology companies have helped shape the Medical CenterÕs environment and its various events.
Larry Shuer, M.D., Chief of Staff at Stanford Hospital and Associate Dean for Clinical Affairs at the Medical School, explains one possible financial drawback to the policy. ÒThe Department of Medicine thinks that they received approximately $200,000 in support to help provide food for some of their educational conferences," Shuer notes. "If they want to do that with the current restrictions, they have to look somewhere else for support.Ó The policy may also negatively affect patients who can not afford prescribed medicines. ÒSome of the [Medical School] clinics received free samples from companies to provide a service to some patientsÉ particularly for the indigent population," Shuer says. To work around this, the Medical Center established a voucher program. Under the program, the Stanford Hospital would encourage pharmaceutical companies to provide free samples to participating pharmacies. These pharmacies would distribute the drugs for free to patients with vouchers. In this manner, the Stanford Medical Center would not be directly involved in distributing the medication samples from pharmaceutical companies.
Mixed Response from Physicians
Shuer believes that the ethical and professional benefits of this new policy will outweigh the financial drawbacks. On a more immediate level, physicians may feel more comfortable walking around the patient wards without having industry representatives stop them.
However, Shuer notes there is a mixed response amongst hospital physicians. "Some people feel that this [policy] is quite important...others feel that ÔnobodyÕs going to influence me by giving me a pen,Õ" he says. "You always are going to have skeptics. The test is going to be how this is enforced, and that remains to be seen.Ó Pharmaceutical companies are concerned about the restricted access to physicians, but for the most part, there has not been much complaining. Although pharmaceutical representatives provide physicians with up-to-date information regarding some of the latest medications and biomedical technologies, physicians can find the same information on the internet.
Shuer believes that this policy will not affect patient care in the long run. ÒMost physicians are not influenced in a negative way by pharmaceutical representatives," he says. "Physicians do have the patientsÕ best interests at heart when theyÕre working here." What will change is that patients know that the Stanford Medical Center is a place free of industrial influence on doctorsÕ opinions.
The Importance of Ethics in Training Hospitals
In the academic medical community, there seems to be a growing trend to enact policies that separate medicine from industry. StanfordÕs policy is similar to policies at Yale University and the University of Pennsylvania. These universities are leaders in this endeavor, Shuer states, and people will take heed and follow. Stanford is a training institution, and Shuer believes that ethics is important: "We want our trainees to learn about whatÕs right and whatÕs wrong,Ó he says. ÒWe feel that providing an appropriate role model for the trainees is probably the best way to do that.Ó