Thursday, April 9, 2009

Johns Hopkins: Read My Lips--No More Gifts!

To a surprising amount of fanfare and press, Johns Hopkins has voted to ban free samples and to restrict some gifts from drug companies. But it is hardly a “ban” on gifts, though you wouldn’t know it from the news reports.

Here’s what has been reported, followed by what the new guidelines actually do.

1. NO MORE FREE DRUG SAMPLES. This is true. Here is the relevant excerpt:

The practice of accepting free pharmaceutical samples risks interference with one’s prescribing practices since industry representatives often provide the newest and most costly drugs. Therefore, free pharmaceutical samples and vouchers for free pharmaceutical samples may not be accepted.

2. NO MORE FREE GIFTS…er, at least no pens, mugs, and notepads, a redundant rule because these were already banned months ago under PhRMA’s updated Code on Interactions with Health Professionals
, eg., the “no tchotchkes rule.” But expensive textbooks, anatomical models, and informational posters are okay. Therefore, while a company cannot simply hand a Hopkins doctor a new i-pod nano, it can save the doctor the $100 he or she would have otherwise spent on a new textbook. Said doctor can then use these savings to buy a fourth generation i-pod nano online for $99.99.

3. NO MORE FREE FOOD…er, except at industry-supported CME events, where you can enjoy a nice meal free of charge as long as you are also getting free CME credit as well. Otherwise, NO FREE MEALS...umm, well, you can have meal if it’s part of an industry sponsored consultation gig…and, let’s see, if it is offered at a professional society meeting… and, oh yeah, if it’s part of a “research meeting”…and if the drug company gave an “unrestricted grant” to the department which decided to use that money for free food, that’s okay, as long as the company HAD NO INPUT INTO WHICH ENTRÉE WAS OFFERED. But if a drug rep invites you out to dinner in order to try to convince you to prescribe more of his drug, you must refuse the invitation…wait a minute…you CAN go out to dinner with him, but you have to pay for your own meal! (He can share an appetizer with you though) (Okay, and you can have a sip of his martini).

4. NO MORE CASH GIFTS. Johns Hopkins will no longer allow drug reps to hand doctors thick wads of money in unmarked envelopes! HOWEVER, (quoting directly from the new policy) “Gifts from industry may be used by the department to support faculty and staff education, research, and/or patient education. Distribution of the funds will be at the discretion of the department director, who will disseminate the criteria for requesting funds to all faculty members in the department.”

Okay, so let me get this straight. Companies are still allowed to give unlimited amounts of cash to academic departments, and the departments can do anything they want with the cash. Now that’s the kind of gift ban any key opinion leader on the gravy train can support!

Oh, and here’s a nice bonus. Drug companies can still give individual doctors thick wads of cash, as long as it is called a “prize” for “scientific or medical achievements.” To quote again from the policy: “For purposes of this policy, prizes and awards are not considered gifts.”

The bottom line is that Johns Hopkins has crafted a policy to generate good PR for the university, but which continues to allow a free flow of money, food, and educational gifts from the pharmaceutical industry to doctors. Let’s hope that our other academic medical centers can do better.


Med Student said...

Your usual wit and bluntness on these sham-bans is appreciated!

therapyfirst said...

Are you surprised, Dr C? I know this crew at JHH, and let me tell you, they are one of the cornerstones to the "biochemical model" crap that got rammed down the throats of us students in the late 80's-early90's.

Another passover analogy--you think they will stop worshipping the golden calf? To them, the psychiatry equivalent to the Ten Commandments is just a vague reference. First do no harm, to your wallet!!!

Sorry, harsh and critical and labeling, but how I have seen it down the road.

Board Cert Doc from another place besides JHH (thank god)

Anonymous said...

Looks like Partners is really whipping the doctors. Are the rules stringent or are they just shams? Your insightful comments will be appreciated.

Anonymous said...

Dr. Carlat,

What are your thoughts on the ACCME March 2009 Executive Summary? Do you think what they are developing will ever take hold and that a volunteer-based system could ever really work?

The ACCME has considered the feedback to its Summer 2008 Calls-for-Comment. The ACCME will not be taking any action to end the commercial support of accredited continuing medical education. Of course, the ACCME reserves the right to re-evaluate this position from time to time – but at this point no action will be taken. ....

The ACCME believes that the CME system‟s internal controls provided by the ACCME® Standards for Commercial SupportSM, and associated ACCME policies, support the development of independent continuing medical education that a) is free of commercial bias and b) does not result in an inclination by professionals to direct care that is unwarranted or unnecessary....

...The ACCME is developing an enhanced monitoring system that will be rolled out in 2009 and 2010 that will include an expanded ACCME database of CME activities and participation, as well as direct observation of CME activities by volunteer monitors. This monitoring system will provide additional information on the compliance of accredited CME with the 2006 ACCME Accreditation Criteria and the ACCME Standards for Commercial SupportSM.

Anonymous said...

In regard to free samples--in a public mental health center where many patients are unable to obtain meds because of lack of benefits or inadequate benefits, the samples help tremendously. I think of this as a tax on the drug company.