SMDC facilities bid drug company freebies farewell

Dr. Kenneth Irons remembers it was less than three years ago at the Duluth Clinic-Lakeside, where he practices, when drug company representatives were providing lunch for the staff "probably four, if not five, days a week."

Often, several pharmaceutical salespeople were in the clinic at the same time, and the distraction became substantial enough that the clinic banned drug reps. So did the Duluth Clinic-Ely. "Our reason was that we would get better information from unbiased sources," he said.

Just a year ago SMDC Health System, the parent of the Duluth Clinic, decided to write new policies covering interactions with the pharmaceutical industry. They went into effect Jan. 1.

They go so far as to prohibit drug or pharmaceutical company logos in any SMDC office and exam rooms.

To kick off the new policies, employees at all SMDC facilities began hunting down everything with a pharmaceutical or medical device logo to get rid of them.

The result: Almost 20,000 items collected, from pens to plastic models of organs -- enough to fill about 20 shopping carts. Most will be donated to a hospital in Cameroon, Africa.

The new policies are to reassure patients that SMDC's 7,000 employees aren't influenced by free gifts, lunches or other incentives. It is one of the toughest in the nation, according to a health system statement.

The new policies don't include drug samples, because rules for them were adopted several years ago.

The new policies' highlights include:

* Drug companies can't have displays at SMDC facilities, its conferences or learning activities.

* Drug reps can't provide food or beverages at any SMDC facility. Employees -- including the system's 450 physicians -- are discouraged from accepting dinners paid for by drug companies off the SMDC property.

* Items and supplies with drug logos can't be used or displayed.

* No one employed at the health system can receive direct payment from drug companies for any service, including speaking or consulting. The companies must pay SMDC and SMDC will pay the employee.

* SMDC will, however, accept unrestricted grants from drug companies for education, but they are to be accepted and distributed according to SMDC rules.

"I really commend them for this," said Marlene Hart, a former nurse who is a patient of physicians at both SMDC and St. Luke's in Duluth. "I think some doctors rely on [drug] reps to give them information about drugs, and they aren't necessarily told the whole truth."

She recalled several years ago being prescribed a new, name-brand drug for her rheumatoid arthritis. "It was kind of pushed on me -- 'Here, try this. It'll help you'," she recalled her doctor saying. The cost was $1,500 to $3,000 a month, Hart said. She said she believes the doctor prescribed it because a drug company representative was pushing it. "I'm just assuming that, but I'd almost bet on it," she said.

When she lost her insurance and the drug manufacturer wouldn't give her a price break, she stopped taking it. She received help with other drugs from the Minnesota Citizens Coalition Northeast. She is now president of the group because she wanted to give back to the organization that helped her afford her drugs.

Pharmaceuticals are a huge and profitable business. Drug companies on Fortune magazine's Global 500 list returned a total of more than $79 billion in annual profits in 2006, according to the publication's July 23, 2007, issue.

The federal government, the state of Minnesota, drug manufacturers and physician groups have made rules about doctors' interactions with drug companies and their representatives. But many people believe it's not enough.

"More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts," an article in JAMA, the Journal of the American Medical Association, said in the Jan. 25, 2006, issue.

A number of other health systems are considering or have adopted many of the same policies SMDC has put in place, including the Mayo Clinic, HealthPartners and Allina, according to the SMDC policies statement.

St. Luke's in Duluth has had a policy for pharmaceutical companies and vendors in place for about five years, said Sandy Barkley, vice president of clinics. Unlike SMDC, St. Luke's hasn't banned small giveaways. "It wasn't felt that small things like sticky notepads or a pen would be a problem," she said.

Some St. Luke's clinics prohibit drug reps, but others allow them, Barkley said. St. Luke's does prohibit employees from accepting personal gifts, favors or compensation from any vendors, including drug companies, that are "seeking a business relationship with St. Luke's," a summary of policies provided to the News Tribune said. Only St. Luke's Education Department pays for educational events.

Some other examples of St. Luke's policies include a requirement for drug reps to make appointments in advance at clinics and to discuss products away from patients.

Research shows that even small gifts can leave physicians feeling beholden to drug companies, said Irons, who heads SMDC's community clinics and helped write the new policies. Instead, doctors should get their information about drugs from unbiased sources, he said.

One of the rationales for the new SMDC policies states that, "New drugs seldom offer significant clinical benefit over older, less or nonmarketed drugs and some have caused increased significant incremental harm ..."

Probably 75 percent of the Duluth Clinic patient sites ban drug reps, said Irons, a family practice specialist.

Several local drug company representatives and three major pharmaceutical manufacturers -- GlaxoSmithKline, Procter & Gamble and Merck -- did not respond to News Tribune requests for comment on SMDC's new policies.

Ken Johnson, senior vice president with Pharmaceutical Research and Manufacturers of America (PhRMA), an industry group, told the Associated Press that he had heard of other health-care facilities banning promotional items -- but SMDC's action was new to him.

"I've never seen nor heard of a systematic roundup of pens and coffee mugs before," Johnson said. "It's a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst."

Johnson also issued a prepared statement to the News Tribune. "Meetings with technically trained pharmaceutical research company representatives -- some of whom are health-care professionals themselves -- are one of several important ways for physicians to receive the scientific and educational information they need to make sure medicines are used properly and patients are safely and effectively treated," Johnson said in the statement.

The pharmaceutical industry, however, does have its own set of rules. "The PhRMA marketing code says all forms of entertainment, including competitive sporting events and games of golf, are inappropriate. The guidelines also say that only modest meals should be allowed and gifts should not exceed $100 in value and should be only those items that support a medical practice, such as a stethoscope or a medical dictionary," Johnson said.

Before the new policies went into effect, Irons and several other SMDC representatives met with drug reps to present the new rules. "Most of them were as understanding as they could be when their livelihoods are threatened," he said.

It's too early to say what the effects on prescription-writing will be, but Irons said he expects SMDC physicians will think differently about them and maybe prescribe more generic drugs, which often cost less.