Third in a series
PRESCRIPTION drug companies develop, manufacture, and sell powerful medicines. Academic medical centers treat patients and train physicians. Both the drug industry and the teaching hospitals play essential roles in modern medicine, but their functions need to be kept separate, as they will be under a policy recently unveiled by UMass Memorial Medical Center in Worcester.
Health insurance companies and state governments have encouraged physicians to prescribe generic products, and the rate of prescription drug inflation has diminished significantly. But keeping inflation down is a constant battle in healthcare. Academic medical centers, as shapers of physician opinion, ought to lead the way in protecting physician education from marketing by drug companies and their companion industry, the manufacturers of medical devices.
The UMass Memorial policy, up for final approval Wednesday, would prohibit hospital physicians from receiving gifts or meals from drug companies. Doctors wouldn't be able to accept drug samples, which would instead be distributed by the central pharmacy. Donations to physicians for educational programs would be banned. Companies could contribute to a hospital fund for education or direct money to a department, but administrators would determine the content of the program.
This policy goes against a tradition of drug company largesse, but hospitals around the country are realizing that they can no longer serve as marketing adjuncts. In Massachusetts, a nonprofit coalition under the umbrella of the Prescription Project is shaping opinion to a strict standard. Last summer, Boston Medical Center adopted a policy similar to UMass's, although physicians can partake of free food off campus if they "use discretion."
Elsewhere in Boston, Tufts-New England Medical Center bans gifts, and, assisted by the Prescription Project, is working on a comprehensive policy. The Partners network imposes restrictions, but many can be waived by a department chief. Drug companies can offer informational meetings, with a meal if the food costs less than $20 per person and the chief approves. Samples can be accepted, if the program or department allows them, as can gifts worth less than $100. At Beth Israel Deaconess, a company can pay for food at seminars as long as the department approves. Doctors can get samples (for poor patients), and gifts, too, up to an annual $300 limit.
Partners, at least, is working on a tougher policy. Dr. Daniel Podolsky, its chief academic officer, cautioned, "We want doctors to know what is the best state-of-the-art care." Drug and devices companies spend billions of dollars on marketing, and they'll get their message out one way or the other. Hospitals need to make sure the information is not tainted by even a tiny bit of physician self-interest.