Fighting the Freebies

Medical student Leana Wen knows becoming a doctor means that she will soon get lots of nice gift offers--catered lunches, dinners at fine restaurants and endless office supplies, to name a few--from drugmakers that hope she will readily prescribe their products. Yet rather than relish these traditional perks, Wen and the 60,000-member American Medical Students Association (AMSA) have launched a campaign to offset the influence of drug-industry representatives. Students at 150 medical schools intend to fan out this year across the country, calling on 40,000 doctors, urging them to stop depending on salespeople bearing gifts. "Accepting gifts from drug companies influences prescribing habits in a way that is not in the best interest of patients," says Wen, president of AMSA. "If we can reach the current generation of students [with new ethical standards], we can change the culture of medicine as well."

A kerfuffle at a meeting of the American Academy of Family Physicians (AAFP) in September highlighted a growing perception of conflict of interest between doctors and the corporate world. The activist organization No Free Lunch, which urges physicians to refuse all gift offers, was initially barred from an exhibit hall where corporate sponsors, including consumer-product companies and drugmakers, would be offering giveaways galore. After a deluge of calls from angry AAFP members, the academy eventually allowed No Free Lunch to set up a booth as well.

In response to criticism, drugmakers have been tightening their gift-giving code. Since the early 1990s, they have prohibited such perks as lavish trips for top prescribers, and in 2004 they stopped paying for doctors to attend conferences or spouses to attend industry-sponsored dinners at restaurants. The American Medical Association limits gift value to around $100 per gift and stipulates that all gifts, such as informational dinners and free drug samples, should benefit patients. Dr. Bob Goodman, a New York City internist who founded No Free Lunch in 1999 to combat the practice of accepting gifts, says doctors should push back harder. "Gifts are gifts. Whether they benefit patients or not, they're just freeing physicians' other income" in a way that creates indebtedness, he says.

For decades, taking gifts from drugmakers has been business as usual for doctors. The pharmaceutical industry spent $22 billion on marketing to physicians (including free samples) in 2003, up from $12.1 billion in 1999, according to data from Pharmaceutical Research and Manufacturers of America (PhRMA). The industry is on track to spend almost $3 billion in 2005 solely on meetings and events for physicians, according to Verispan, a health-care market-research firm in Pennsylvania. The drug industry argues, with reason, that gift giving evolved as a necessary tool for sharing information about new drugs with busy physicians who needed incentives to stop and listen. Says PhRMA's chief medical officer, Dr. Paul T. Antony: "Any physician can decline a gift at any time."