American Medical Student Association

To the Class of 2013,

Congratulations on an incredible achievement; in a few short days or weeks you will be receiving your MD/DO degree and then embarking onto residency! While you undergo this transition, the field of medicine also is facing dramatic changes, both internally and externally. There has been increasing scrutiny on the objectivity of our judgement as physicians and how our relationships with industry can affect the trust relationship that is at the heart of the doctor-patient dyad.

Patients are skeptical of our relationships with industry and are concerned that they may compromise our ability to render effective and cost conscious care. In fact, studies have shown that when exposed to industry interactions such as gifts (even pens!), drug samples, free meals, and travel, doctors are more likely to prescribe costly name-brand medications and less likely to prescribe the cheaper generic alternatives. You might see this as a deviation from the evidence-based prescribing methods you learned over the past four years, while patients may see it as an erosion of trust and a higher bottom line cost for medical care in a world of skyrocketing healthcare costs.

If you can appreciate that industry interactions with medical professionals have the potential to affect the patient-doctor relationship, there here is the good news: part of the Affordable Care Act called the the Physician Payment Sunshine Act (“Sunshine Act”) requires manufacturers of drugs and medical devices to report the monetary value of gifts and payments to doctors to the Centers for Medicare and Medicaid Services, all of which will be posted on a publicly accessible website. This includes the costs of gifts, consulting fees, research activities, speaking fees, meals and travel. However, payments or other “transfers of value” to residents (you) will not be required to be reported. What will this mean for you?

• Be aware that gifts to residents are exempted from the PPSA reporting requirements that you will hear about next year
• Pledge to opt-out of drug rep access to your own prescribing data in the AMA Masterfile
• Check out your medical school’s AMSA PharmFree Scorecard, it evaluates conflict-of-interest policies and curricula at medical schools across the country. How did your alma mater do?
• National Physicians Alliance is an organization that we work with which has a physician counterpart to the PharmFree campaign: the Unbranded Doctor, get involved and join NPA’s Unbranded Doctor Campaign

Technology is in boom, especially in today’s medical world which is constantly growing and evolving to match the most up to date research and discoveries. Check out this Associated Press article, which appeared in USA Today, introducing the hottest new product on the market; your annual physical through your smart phone.

Discussed at the 2013 TEDMED conference in Washington, D.C, this up and coming technology is designed to help patients independently monitor their health outside the doctor’s office. Whether it be checking your blood pressure, listening to your heart beat, or checking out the ears, nose and throat for possible infection - all can be done from your hand held device, and on the GO! In addition, sonograms can also be performed by your ultrasound technician with your smart phone, allowing them to be performed from virtually anywhere, and at a much more affordable price.

It seems as though doctors believe these tools will be helpful to collect the patient’s data, and monitor their ongoing health conditions and concerns. With these types of applications and devices available office visits can essentially be reduced, allowing urgent and serious treatments to be readily available for patients in emergency situations. Although some products are still waiting for FDA approval, tools are available for purchase now.

Read more from http://www.smartphonephysical.org, or watch a brief educational video from the Associated Press.

Would love to hear what our nation’s next generation of physicians thinks of this trend. Do you think “iPhone physicals” are the next big thing?

AMSA invites you to watch the new PBS documentary Age of Champions for free between April 18 - 28, at ageofchampions.org/premiere. Age of Champions tells the story of five competitors who sprint, leap, and swim for gold at the National Senior Olympics. You’ll meet a 100-year-old tennis champion, 86-year-old pole vaulter, and rough-and-tumble basketball grandmothers as they triumph over the limitations of age. 

Age of Champions is a powerful resource for past and present medial students to learn more about seniors and inspire people of all ages to lead a healthier, happier and more active lifestyle.

Watch the full documentary at ageofchampions.org/premiere.

It’s hard for me to believe that I’ll have the privilege of calling myself someone’s doctor in a few short months. As a graduating medical student, I look back on my education and see that it was driven by a spark shared by all in all AMSA members: the fervent hope to help my future patients. And it’s precisely this hope that drives me to pledge to opt out of drug company access to my future prescribing information. I urge you to join me.

When I started medical school, I had no idea that pharmaceutical companies know exactly what medicines each doctor prescribes to his or her patients. I was even more surprised to learn that this capacity is enabled by the American Medical Association through the sale of a database called the “Masterfile.” All medical students and doctors are automatically enrolled in the Masterfile—regardless of whether or not we are AMA members. Each year, the AMA makes more than $40 million selling this information, which allows pharmaceutical companies to link prescribing records to doctors’ identities. The result is targeted marketing pitches, often designed to promote more expensive medicines that aren't necessarily more effective. 

The spooky nature of being watched by Big Brother/Big Pharma might be reason enough for many to opt out of this practice. But if that weren’t sufficient enough, this type of data mining hurts also hurts patients. First, prescribing more expensive medicines increases the cost of care without necessarily improving outcomes. Drug companies spend more than $30 billion marketing to doctors each year, and these expenses are surely reflected in the high price of medicines. Notably, the tremendous amount spent by these companies on advertising dwarfs by almost two-fold the amount they invest in research and development, which is often cited as why drugs are so expensive. 

Second, this type of data mining encourages a brand of medicine that is neither evidence-based nor patient-centered. Surveys already show that 7 out of 10 patients feel that doctors’ prescribing habits are too-influenced by drug companies. Allowing drug companies to use the Masterfile for marketing purposes will further corrode the trust at the heart of the doctor-patient relationship. A new study further shows that an increasing number of patients are skimping on medicines in this tough economic climate. Why allow drug reps to leverage your own prescribing practices to promote expensive medicines through one-sided presentations?

Today, I’m pledging to opt out of drug rep access to my future prescribing practices. As AMSA President Dr. Liz Wiley has stated, “Physicians should practice evidence-based medicine using the best existing clinical evidence—not carefully-packaged advertising—and continue to uphold personal and professional integrity.” I couldn't agree more.

The AMA has made a mechanism by which residents and doctors can opt-out of drug salesperson access to prescribing information of doctors. Unfortunately, students cannot use this Prescription Data Restriction Program even though they have already been included in the AMA’s Masterfile. However, AMSA has set up a mailing list that will remind you to opt out through the PDRP when you’re able to do so. I hope that you will consider adding your name to this list and encourage your classmates to do the same.

David Tian is a fourth-year student at Harvard Medical School and the Chair of AMSA’s PharmFree Campaign.

While only four medical schools ban sales representatives from campus, the majority of U.S. medical schools have implemented strong conflict-of-interest policies this year, according to the 2013 American Medical Student Association (AMSA) PharmFree Scorecard. Released today, the Scorecard finds that 115 of 158 medical schools (73%) now receive a grade of A or B for their policies governing pharmaceutical industry interaction with medical school faculty and students, compared with 102 last year.

Find your school's grade here: www.amsascorecard.org.

Using letter grades to assess schools’ performance in eleven potential areas of conflict, the AMSA PharmFree Scorecard offers a comprehensive look at the current and changing landscape of conflict-of-interest policies across American medical education, as well as more in-depth assessment of individual policies that govern industry interaction. Now in its sixth year, the Scorecard analyzes gifts and meals from industry to doctors, paid promotional speaking for industry, acceptance of free drug samples, interaction with sales representatives and industry-funded education. The participation rate was 98% of all eligible medical institutions.

Of the 158 U.S. medical schools, 40 receive As (25%), 75 Bs (47%), 13 Cs (8%), 13 Ds (8%) and 14 Fs (9%). Four respondents received a grade of “In Process” because their policies are currently under review or revision. For the sixth consecutive year, access of sales representatives remains a challenging area. Only four schools – University of South Dakota Sanford School of Medicine, Florida State University College of Medicine, Stony Brook University School of Medicine, and the Commonwealth Medical College – completely ban sales representatives from campus, giving them a perfect score in that domain.

Highlights of the survey include:

• Only 41 schools (26%) have model policy in terms of disclosure, requiring personnel to disclose past and present financial ties with industry (e.g., consulting and speaking agreements, research grants) on a publicly-available website and disclosing these relationships to patients.
• All eight of the Texas medical schools scored at least a B. The University of Texas Medical Branch at Galveston, however, remains the lone A in the Lone Star state. All three of the Maryland medical schools scored at least a B, with both Johns Hopkins and University of Maryland Schools of Medicine receiving an A.
• More than 70 percent of medical schools now have grades of A or B (115 schools).
• Schools with model policies on speaking arrangements have grown tremendously; 44 schools ban or severely restrict participation in speaker bureaus.

Public pressure to disclose conflict of interests is highlighted by the recent finalization of regulations governing implementation of the transparency reports as part of the Physician Payment Sunshine Act under the Affordable Care Act. The legislation requires certain manufacturers of pharmaceuticals and medical devices to report to the Centers for Medicare and Medicaid Services their financial ties to physicians and teaching hospitals.

AMSA and Pew were also charged through a grant from the Oregon State Attorney General’s office to update the AMSA PharmFree Scorecard and expand it to 400 teaching hospitals. Alongside Dr. Joseph Ross of Yale Medical School who served as a Methodology Consultant, AMSA and Pew developed the new AMSA PharmFree Scorecard set for release in 2014. There will be two versions of the new Scorecard - one for medical schools and another for teaching hospitals. The number of domains for the Scorecard has also expanded with 16 domains common to both versions and 2 additional domains for “Samples” and “Purchasing and Formulary Committees” specific to the teaching hospital version.

In the coming year, the AMSA PharmFree Scorecard will undergo a major revision in its methodology in an effort to guarantee it remains a relevant and state-of-the art tool for evaluating conflict of interest issues at medical schools. Revisions will include a new formula for assessing academic medical centers as well as revisions in our framework for grading schools. These changes will help to ensure that the Scorecard can continue to push schools to emphasize clinical education and medical care above all other interests, particularly those that could distract from the provision of evidence-based and patient-centered care.

Tomorrow is the launch of the 2013 AMSA PharmFree Scorecard! Join us in person or via Webcast. This would be a great chapter event!

April 9, 2013: Launch of the 2013 AMSA PharmFree Scorecard 12-1pm (EST)
Join National Physicians Alliance & AMSA Online Webcast or Live In-Person
The AMSA Scorecard: The State of Medical School Conflict-of-Interest Policies and Cultivating a New Era of Effective Change

Georgetown University Medical Center, Med-Dental Building, Room SW107,
3900 Reservoir Road, NWSE408, Washington, DC 20057

Speakers:

Reshma Ramachandran, PharmFree Fellow
American Medical Student Association

Daniel Carlat, MD
Director of the Pew Prescription Project

RSVP to attend this live event in-person

On Wednesday, April 10, graduating medical students will tell the American Medical Association (AMA) that they are opting out of the AMA Physician Masterfile and that they do not want their personal and prescribing information sold to the pharmaceutical and medical device industries. National Opt Out Day, sponsored by the American Medical Student Association (AMSA), hopes to rally hundreds of fourth year medical students.

The AMA Physician Masterfile was established by the AMA in 1906 as a record keeping device supporting membership and mailing activities. The Physician Masterfile includes current and historical data for more than 1.4 million physicians, residents and medical students in the United States. Today, sales of the AMA Physician Masterfile totals more than $40 million per year and over 20 percent of their annual revenue.

“The AMA should not be selling this data to pharmaceutical and medical device companies for the purpose of tracking physicians’ prescribing habits to devise directed marketing strategies,” Reshma Ramachandran, AMSA PharmFree Fellow. “Information from the AMA Physician Masterfile should only be used for research purposes to benefit our patients.”

“We want our members – the nation’s future physicians – to understand what this information is being used for so they can make their own decision to remain in the database or opt-out,” says Dr. Elizabeth Wiley, AMSA National President. “Physicians should practice evidence-based medicine using the best existing clinical evidence—not carefully-packaged advertising—and continue to uphold personal and professional integrity.”

“As a physician, I have no knowledge or control over data about me that is sold in the AMA Masterfile," says Dr. Michael Mendoza, medical director at Highland Family Medicine in Rochester, New York and alumni of AMSA. "I am not an AMA member, and I feel that the AMA has abused my rights to privacy by selling data about me without my consent for commercial and marketing purposes."

National Opt Out Day is just one of the events scheduled during National PharmFree Week (NPFW), April 8 – 12, sponsored by AMSA. Thousands of medical students will celebrate the annual event and focus on putting patients first by addressing conflicts of interest and encouraging evidence-based rather than marketing-based education. NPFW aims to focus the attention of medical, premedical and allied health students on the importance of understanding the impact and control of financial and professional relationships with pharmaceutical and medical device companies in education, research and patient care.

Launched by the Young Professionals Chronic Disease Network and Australian design firm Local Peoples, NCDFREE (www.ncdfree.org), is a global social movement that will address NCD (non-communicable disease) inequalities and highlight young change-makers striving to make a difference locally and worldwide.

NCDs, such as heart disease, diabetes, cancer, and lung disease, kill more people than any other cause worldwide – 35 million every year. Instead of blaming individuals and painting NCDs as a disease affecting older, wealthier people, NCDFREE will change the narrative to one that shows the NCD burden resting largely in developing countries and affecting individuals in the prime of their lives.

The first step in defining the NCD narrative is through three short films. These films will highlight the global inequities wrapped up with NCDs by profiling the inspiring work of young change-makers in Bangladesh, Kenya, and Mongolia.

For a glimpse of the type of films that will follow, check out our short film: http://vimeo.com/62332644.

April 3, 2013

Dear Dr. Carson,

Thank you for your recent keynote address at the 2013 American Medical Student Association (AMSA) Annual Convention & Exposition. We appreciate you sharing your inspiring story and words of wisdom with our community of physicians-in-training.

On behalf of AMSA, we would like to express our concern regarding your recent public statements concerning same-sex marriage. On March 26, on Sean Hannity's Fox News program, you compared gay relationships with pedophilia and bestiality: "Well, my thoughts are that marriage is between a man and a woman. It's a well-established, fundamental pillar of society and no group, be they gays, be they NAMBLA, be they people who believe in bestiality. It doesn't matter what they are. They don't get to change the definition."

We retain the highest respect for your achievements and value your right to publicly voice your political views. Nevertheless, we feel that these expressed values are potentially harmful to patients and incongruous with the values of the American Medical Student Association.

AMSA, along with many other national organizations, believes equal access to the institution of marriage is a public health issue. The American Medical Association,# the Gay and Lesbian Medical Association,# the American Psychiatric Association,# the American Academy of Pediatrics,# the American Academy of Nursing,# the American Congress of Obstetricians and Gynecologists# and many other professional organizations all agree that discriminatory policies and social practices are likely to perpetuate stigmatisation of lesbian, gay, bisexual, transgender and intersex persons, resulting in negative health effects for individuals and their families.

While we can appreciate the power of your personal narrative to inspire physicians and physicians-in-training to believe in themselves and their vision for a life of service to people and communities, and are thankful for your recent presentation at AMSA’s Annual Convention featuring this as a central element, we are disappointed in your statements which are contrary to the evidence that has been generated regarding the experiences of LGBTQI people, their relationships, and relation to and function within the larger society. Your statement, aside from being not rooted in objective, scientifically-sound evidence, is dehumanizing by virtue of comparing mutual, consensual adult relationships with exploitative, non-mutual, non-consensual relationships between adults and children and between humans and animals, and is consistent with statements routinely made by hate groups designated by the Southern Poverty Law Center.

Your statement propagates the kind of misinformation and discrimination that is detrimental to the health and well-being of LGBTQI people.# Gay and lesbian patients are much more likely than their heterosexual counterparts to delay care or not access health care entirely because of fear of discrimination and mistreatment by their physicians.# LGBTQI physicians-in-training, many of whom are AMSA members, face patients who would actively refuse care from them just for being gay or lesbian,# and they move through their training and careers constantly worrying if living true to themselves will one day cost them a recommendation, residency position, job, or opportunity for advancement.

As a highly regarded, widely respected, world-famous physician scientist, we urge you to reconsider your statement and fully consider the weight of your words - their effect on patients, physicians-in-training and fellow colleagues. We call on you to acknowledge that your statements and statements of this type are dehumanizing expressions that are antithetical to the humanistic commitments of our profession.

Respectfully,

Elizabeth Wiley, MD, JD, MPH
AMSA National President

Nida Degesys, MD Candidate
AMSA National President-Elect

Jeff Koetje, MD
AMSA Education & Research Director

Aliye Runyan, MD
AMSA Education & Research Fellow

Deborah V. Hall, MD Candidate
AMSA National Secretary

Lexi Light, MD/MPH Candidate
AMSA Gender & Sexualtiy Chair

Carl Streed, MD Candidate
AMSA LGBT Policy Coordinator

Perry Tsai, MD/PhD Candidate
AMSA LGBT Programming Coordinator

Justin Neisler, MD Candidate
AMSA LGBT Policy Coordinator - Elect
------------------------------

# For complete footnote references, please see this link: 
http://www.amsa.org/AMSA/Libraries/Misc_Docs/LetterToBenCarson.sflb.ashx

Today, India's Supreme Court rejected an application from Novartis AG for a patent on a cancer drug. This is a landmark ruling that will ensure that poor patients worldwide will have access to lifesaving medications.

Novartis' application asked for a new patent to protect its investment in the cancer drug Glivec. India has a large generic drug industry - almost $26 billion - so this decision impacts much of the developing world.

AMSA continues to pressure pharmaceutical companies to provide affordable medicines to developing countries and lobbies to ensure that international trade regulations afford the right to do so.

Read more from the New York Times.