PhillyDeals: More med schools are going 'pharma free'

I did my Easter duty last week: I confessed my sins to the patient Franciscans at

St. John's

, behind what used to be

Wanamakers

. They're old and a little deaf, so they ask broad questions: "You did

what

?"

For big companies and their collaborators, penance works differently.

Johnson & Johnson, which has collected a list of federal fines and scoldings for acts of omission and commission, got nailed again April 8, when it agreed to pay the Justice Department and the Securities and Exchange Commission $70 million to settle allegations it bribed doctors and hospital and government officials in four countries to buy J&J's painkillers and breast implants, instead of someone else's.

J&J boss William C. Weldon said his company was sorry, and it won't happen again.

A proper Act of Contrition calls on sinners not just to "resolve to sin no more," but also to "avoid the near occasions of sin."

And that's what medical schools have been doing: They've been kicking drugmakers and marketers such as J&J off campus, or at least out of their clinics and practices, to keep patients, and especially young doctors, from commercial influence that would push them to pick a costly therapy over a cheaper one, or none.

There's been "a conflict of interest between pharmacy and medicine," says Dr. R. Patrick McManus, head of the residency program at Thomas Jefferson University's family medicine department. His unit has banned drug-industry paraphernalia, free meals, free samples, and other gimmes. Don't medical-school researchers still accept drug-company financial support? Yes, but "they can't choose our topics."

More than a quarter of all medical residencies are now "pharma free," up from one in ten 20 years ago, says a study published by Academic Medicine, the journal of the American Association of Medical Colleges, in May's issue. These programs refuse free drug samples, block drug-company direct gifts and meals, forbid industry-sponsored parties and events, and kept drug salespeople off the premises.

The American Medical Students Association, which rates med schools' drug-company conflict-of-interest policies, gives Penn an A grade for banning drug-company gifts and visits. Jefferson, Penn State, and Temple get B grades because their ban on free samples isn't as complete. Drexel and the University of Medicine and Dentistry of New Jersey's Stratford campus get C grades, and Philadelphia Osteopathic gets a D, for being more accommodating to pharmaceutical marketers. See the ratings at www.amsascorecard.org.

It's a switch since McManus' med-school days in the late 1980s. Drug-company-sponsored lunches "were a boon to staff," and especially to students and lower-paid admins and other support workers: a fancy break from vending-machine fare and food-cart sandwiches.

Free samples were "the last thing to go," five years ago. The giveaway pills were gratefully received by hard-pressed patients, and many doctors handed them out routinely.

But patients cut the free drugs to take in small doses, instead of buying effective prescriptions; free-sample deliveries were unreliable, making it tough to count on their use; and "patients were becoming brand-name dependent and complained this was the exact pill they needed, instead of an equally effective generic or cost-effective" substitute.

McManus says drug companies, faced with growing resistance among medical students and younger doctors, have backed off on the hard sell, in favor of direct-to-consumer advertising.

But he says he's gotten a little less worried about the direct impact of sophisticated drug sell jobs on patients than he used to be: With the avalanche of drug ads and the strengthening of warning requirements, "the novelty has worn off. Patients are more skeptical about drug ads. The lists of side effects has changed how patients view medicine."

Bribery is a crime; isolated information gets abused in lethal ways. But if fuller disclosure, demanded by conscientious doctors, really has educated members of the pill-using public, maybe drug marketers are capable of redemption.