The American Association of Medical Colleges recently released a long-awaited report recommending that pharmaceutical companies and medical device manufacturers knock off their efforts to bribe medical students and faculty. The Association said in no uncertain terms: No more freebies. That means no more doling out free lunches, tickets, trips, pens, binders, flashdrives, bookbags, free samples and other trinkets in classrooms, offices, exam rooms and reception areas of medical schools.
What led the leaders of the schools that train American doctors to pull the plug on the free flow of chachkes, baubles and doughnuts to medical students and their teachers? The report says that the steady marketing of drugs using freebies raises questions about the “objectivity and integrity of academic teaching, learning and practice.” In other words, if you let young, well-coifed drug company representatives run around your school in short skirts or snazzy suits doling out gifts, it conveys a very bad image — that a school is an appropriate place to do marketing.
Worse still, making your medical school a drug company free-fire zone conveys the impression that the faculty believe there is a lot to learn from slanted drug company sales pitches. And worst of all, when the welcome mat is out for drug reps bearing small gifts, this says that the faculty believe the best way to educate the next generation of doctors about drug safety and efficacy is to make sure students remember a drug’s name by having it thrown in their faces 10 times a day on every pen, notepad, vase, clock, key ring, calculator and coffee mug that a pharmaceutical company’s marketing department can have their legions of salespeople lug into the hospital.
I think a ban makes good ethical sense. I am proud to say that my medical school and its teaching hospitals were the first in the country to boot the drug reps and freebie peddlers off campus.
But the policy of banning marketing in medical schools has drawn some predictable criticism.
Some physicians are incredulous that anyone would think they could be “bought” for the price of a pen or a box of doughnuts. A few argue that the best way to keep up with the latest developments regarding new drugs and devices is from drug and device company salespeople. Others bemoan the fact that now their department will have to pick up the costs of feeding students to get them to appear at grand rounds or to lure their alums into continuing education events. And some just disagree that allowing marketing in a medical school is an ethical problem. The critics are wrong.
The whole point of the free pens, notepads and coffee mugs is that this form of low level but pervasive marketing works. Study after study shows that prescription practices are influenced by small gifts. In a study that I did with two of my colleagues here at Penn five years ago we found that a particularly effective gift in terms of influencing behavior is food brought in regularly. In fact, small trinkets and gifts are effective precisely because most doctors, along with the rest of us, do not believe that they are susceptible to the blandishments of a free bookbag or a sandwich proffered by a smiling salesperson.
But we are. The strongest proof that doctors can be bought in this way is that pharmaceutical companies spend a fortune on this kind of marketing. Does anyone think the cornucopia of presents would continue year after year if it did not have an effect? Does it make any sense to believe that the costly horde of drug reps employed by Pfizer, Lilly, Merck, Glaxo, Amgen, Genentech, Schering Plough and so on simply want to hang out at baseball games with medical residents or breakfast with the 7 a.m. crowd at surgery grand rounds just because they enjoy the company?
No one, including doctors, is immune from advertising. The marketing done by pharmaceutical companies and medical device manufacturers is among the most sophisticated in the entire business world. This sort of marketing does not belong in academic medical centers where the next generation of health care professionals is being taught.
You would not tolerate it if a well-dressed, slick sales representative from Texaco or Lukoil showed up everyday at your kid’s high school dolling out free gifts for the students and free coffee for the teachers right in the middle of their homeroom, biology or environmental science classroom. Nor would you like it if your kid's college threw open their classroom doors so that every nutrition class began with free samples and gifts from a heavily accessorized and perfumed sales rep from Hershey’s, Nestle or McDonalds, or if every physics and chemistry class came with a nice meal along with a high-powered sales pitch from Toyota, Peabody Energy or Siemens.
That is why schools charge tuition and government gives subsidies — to avoid the need to rely on advertising to pay for teaching and thus keep the lecture hall a relatively commerce-free environment.
Business has no business selling or promoting in the middle of classrooms or other academic settings. Academic medical centers, if they want to teach their students how best to think about the medicines they prescribe and to retain the trust of the American people about evaluating them objectively, should do everything they can to keep the marketing, sales pitches, promotions and bribes — large and small — away from campus.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.