PharmFree FAQs

Frequently Asked Questions on the PharmFree Campaign
Updated 9/25/05 by Leana S. Wen, 2005-2006 AMSA National President and Yavar Moghimi, 2005-2006 AMSA National PharmFree Coordinator

Q: Why shouldn't I take free lunches or other drug paraphernalia?

A: Basically, as future physicians, we should be practicing evidence-based medicine and promoting evidence-based prescription habits to our members and to practicing physicians. While drug companies do many great things, the advertising directed to physicians is not good for patients, or good for the profession of medicine: it increases the cost of drugs in a way that does not benefit patients, influences physician prescribing behavior, and erodes the trust that patients have in their physicians.

 

Q: Is the PharmFree campaign against drug companies?

A: It would be silly for a group of future physicians to be against drug companies. Of course we are not against drug companies-they find miracle cures and their products help improve the lives of millions. What we are against is the marketing approaches they use that are misleading and are used solely to influence prescribing habits in a way that does not improve patient care and only leads to increased cost of drugs. And it is not even the drug companies that we solely blame. The medical profession is equally at fault for accepting the gifts and promotions with open arms. We need to take back our profession and reclaim the inherent public trust.

 

Q: Drug companies say they educate doctors on the newest drugs out on the market. How else will I find out about these new drugs?

A: That's why there are clinical guidelines written by experts, and that's why we have peer-reviewed journals, and that's why we have whole classes on them. Drug companies do not provide unbiased information. In fact, their purpose is simply to sell, in the same way that your car salesman would want to sell. There are many studies that have shown that the information they provide is both biased and inaccurate. One way you can find unbiased information easily is through concise, clinically-applicable, unbiased sources of information. They are easy to use, completely unbiased, and some can be downloaded to your PDA, etc.

 

Q: If I eat drug rep's food and take their gifts without listening to them, am I really getting educated by them?

A: The problem with getting lunch from drug reps is threefold: first, the money used to buy that lunch comes from somewhere. There are 90,000 drug reps whose jobs are to "detail" physicians, and billions are spent every year to wine and dine doctors. By accepting drug company marketing to physicians we are indirectly causing drug companies to spend more on drugs, which contributes to the high cost patients must deal with.

 

Second, there is a lot of literature that shows that physicians ARE influenced by drug companies' promotional tactics, even if physicians do not think so. Gifts induce feelings of reciprocity, no matter their size, and advertising works. Otherwise, why would the most profitable industry in the world continue to advertise? Studies have shown that physicians will prescribe less desirable drugs that run counter to evidence after detailing efforts. Most physicians will not accept that detailing affects them, but will say that detailing affects their colleagues. For more information, see Does that slice of pizza REALLY matter?

 

Finally, accepting gifts from drug companies denigrates our patients, and gives us the appearance of conflict of interest. I do not want to do anything that is not in the best interest of my patients, and eating lunch provided by drug reps is not in my patient's best interest.

 

Q: What about the free samples drug reps give that can be given to indigent patients?

A: These samples may be a temporary solution for patients that could otherwise not afford the drug, but when the sample runs out the patient's management has already began on a more expensive drug that the currently cannot afford. This results in the doctor either switching them to a cheaper drug anyway or the patient buying a more expensive drug or the patient stopping to fill this drug because of the cost. Free samples may provide a temporary solution to a problem, but relying on free samples may not be the best way to manage a patient's treatment.

 

Q: What sources are good?

A: All of the sources we included are sources that have expert advisory panels composed of physicians, scientists, and pharmacists. They review the latest medical journals across all disciplines and come up with guidelines based on the best available evidence, then synthesize the evidence in guidelines that are easily readable and accessible to busy clinicians. In the digital age, this is made simple with the many formats available to us. These are sources endorsed by every independent, nonprofit organization that eschews industry influence. They receive no funding from pharmaceutical industry, and have panels of experts including physicians, pharmacists, and other health professionals to review the latest, evidence-based research to produce guidelines. And the sources are then available for your use in PDA, web, and other forms, so they are very easy to use.

 

Q: You say that we should look up all these sources, but even these take time. To look up each difference disease takes up a lot of time. I find it easier to just stick with drugs that I've seen my attending uses, or to use what the drug reps say because at least they are citing what other doctors have used. What's wrong with that?

A: Actually, each individual source takes virtually no time at all to look up. Take Infopoems. They offer a M-F email synopsis of the major drugs every day. The Medical Letter Treatment Guidelines are searchable based on classes of drugs and diseases, like drugs for migraines, and each guideline is 3-4 pages long. Every source is entirely evidence-based, which as you know is based on not just individual studies but compilations of hundreds of meta-analyses and other studies. By no means do our sources replace clinical judgment, but they are a better method of finding out about new drugs than one article offered by one drug rep, who has a clear goal of selling the drug.

 

Q: Are reprinted articles from drug reps unbiased?

A: We in AMSA recognize that drug companies serve a valuable purpose, but ultimately they are businesses beholden to their stockholders, and their reps are salespeople with a clear mission. Say many studies are done on a single drug-do you think the friendly drug rep is likely to show every article, including the ones that prove it to be less effective than its competitor? The purpose of the drug rep is not to educate, but to sell, and that's OK-that's their role. But it's important to recognize that the information we receive in return is not unbiased information; it is information used to sell a product to the doctor to convince them to prescribe one drug over another. Truly unbiased information needs to come from sources that have no industry ties.

 

Q: I don't have easy access to a computer, and I certainly don't have a PDA. Can I still get these sources?

A: Absolutely! Many of these sources are available in paper version, including the Medical Letter, Prescriber's Letter, and Consumer Union Best Buy Drugs. You can also access everything online through a local medical center or library.

 

Q: Isn't it enough to just read the latest JAMA, NEJM, and attend CME like all the other doctors?

A: That would be terrific if you read all the latest journals! Most doctors simply do not have time to do that, and drug reps rely on the line "well, doctors are too busy, so we are here to educate them" to come to their offices. We think this is a problem, because drug reps are by their nature biased-their goal is to sell and to represent an industry. Our goal is to provide doctors with resources other than industry-sponsored resources. The ones on our list are completely unbiased, put together by experts, and are really quick and easy to access and understand.

 

Q: Should health care facilities ban drug reps altogether?

A: I'm sure we all recognize that drug reps, though entertaining and attractive, may not be the most unbiased sources of information-they are salespeople paid to sell drugs, like car salesmen paid to sell their cars. They claim that they are here to "educate" doctors, and that is insulting-we as medical professionals are in charge of educating ourselves, and should take charge of that learning process. By continuing to accept biased information from drug reps we are threatening the professionalism inherent to medicine and accepting an inherent conflict of interest. As long as health care facilities allow the presence of drug reps in their halls doctors and students will be learning medicine that is not evidence-based and is not in their patient's best interest.

 

Q: Why should I be involved with the PharmFree campaign?

A:You should be involved with the PharmFree campaign because in medical school you learned that medicine should be based on evidence. By accepting pharmaceutical gifts, which has been proven to sway prescribing habits, we are deciding what drugs are best for patients based on marketing and not evidence. This isn't the professionalism that our patients expect from us and the professionalism we should expect from our colleagues.