Training Directors Guide Residents Through Morass of Drug Marketing
In their quest for knowledge, residents are exposed to information from many sources, including the pharmaceutical industry. To help provide some guidance on determining the usefulness and reliability of that information, a group of training directors, faculty members, and residents gathered in March to discuss the fine line between education and marketing.
Chris Varley, M.D.: “Residents in training may be subject to marketing forces that may not be appropriate for their education.”
Varley explained that task force members have been working to acknowledge “that residents in training may be subject to marketing forces that may not be appropriate for their education.” An increase in industry-supported medical education has coincided with a decline in federal and private support for medical education, Varley said. Residents are thus more likely to be exposed to marketing influences during training.
To determine whether training programs maintain policies about or provide training on resident interaction with the pharmaceutical industry, Varley surveyed about 425 AADPRT members and received responses from 150. The results of the survey are being analyzed and may be published later.
One of the goals of the task force is to encourage training programs to develop guidelines for residents to follow when they interact with drug representatives.
For example, from the training director’s point of view, is it acceptable for residents to meet on an individual basis with a drug representative to discuss a certain product or for drug representatives to provide lunch to residents during an educational presentation?
It depends on whom you ask, Varley and McCarthy discovered. Through their own experience, they have found that, in general, training programs have a wide range of written and unwritten policies on how their residents should interact with drug representatives, while others have no policy at all.
McCarthy, who is the associate training director of the Harvard Longwood Psychiatry Residency Program at Brigham and Women’s Hospital in Boston, discussed some of these policies. After calling a few psychiatry training programs in the Boston area, she learned that in some programs drug representatives are not permitted to meet directly with residents to discuss drug information, but must go through the residency training director or the director of psychopharmacology first. Other programs maintain policies that forbid direct marketing to residents if there is no educational benefit.
Some psychiatry departments and training programs model their policies on the AMA’s policy, which was developed by its Council on Ethical and Judicial Affairs in 1990 and published in the June 23/30, 1991, issue of the Journal of the American Medical Association.
Since that time, the AMA has updated and clarified these guidelines a number of times. The most current version of the guidelines, from June 1998, can be found on the AMA’s Web site at www.ama-assn.org/ama/pub/category/5689.html.
The guidelines, titled “Gifts to Physicians From Industry,” specify in part that gifts accepted by physicians from the pharmaceutical industry should benefit patients and “should not be of a substantial value,” defined in the updated version of the guidelines as no more than $100.
Gifts should also relate to a physician’s work and should not be accepted by physicians if there are strings attached, for example, if they are accepted by a physician with a promise on his or her part to prescribe a certain advertised drug.
Cash payments should never be accepted, but funds that permit medical students or residents to attend “carefully selected” educational conferences are permissible under the AMA guidelines.
But even with the AMA’s guidance, many residents still need direction when it comes to choosing a conference that presents balanced, accurate information to attend, for instance.
Varley informed attendees that some psychiatry training programs are teaching residents to use their own judgment when following the guidelines (see Original article: page 24).
Much of the AADPRT session, attended by both training directors and residents, was reserved for discussion about how the participants felt about events sponsored by pharmaceutical companies.
“I’m constantly tempted by drug-sponsored dinners at the fanciest restaurants in town,” said one resident. “These dinners are held at places I could never imagine affording.”
Others believed that when residents attend such dinners and the benefits of a certain drug are discussed, they are in violation of the AMA’s guideline specifying that meals should be “modest.” The AMA defines a modest meal as being “similar to what a physician would routinely eat when dining at his or her own expense.” The guidelines also specify that when physicians meet with a drug representative in an office or hospital setting, it is permissible to accept a sandwich or snack from that representative.
As director of residency education at the Virginia Commonwealth University Medical School (formerly the Medical College of Virginia), John Urbach, M.D., said that he wants to ensure that his residents get a fair and balanced view of all psychiatric treatment options, but this isn’t always easy, he acknowledged.
“Revenue from sources that have traditionally funded education programs and awards, such as university departments or the federal and state governments, are becoming more scarce just as the pharmaceutical industry is reporting record profits,” he said.
Urbach added another dimension to a previous discussion about how contact with drug representatives can bias residents toward one medication over another. Urbach said that other forces could influence how residents treat their patients, such as the tendency for pharmaceutical companies to market newer drugs more heavily than older ones. “There are certainly situations in which older drugs that aren’t heavily marketed may be adequate or may even offer advantages over newer drugs,” he said.
The other issue for residents to consider, he said, is that “there aren’t psychotherapy corporations that sell shares on the New York Stock Exchange, and there is no one marketing psychotherapy intervention.” Urbach said that residents will get the message that because drugs are marketed and therapy is not, “all the glitz, glamour, and effectiveness” lie with psychopharmacology.
“Psychotherapy may be viewed as slow and ineffective, and I don’t think this is true,” he said.
He relayed the story of a colleague who had a number of mugs and pens printed up with the logo “psychotherapy” and passed them out to residents as a tongue-in-cheek reminder that there are many ways to treat a patient.
In the end, Varley said, residents should understand that they must give careful consideration to all interactions with the pharmaceutical industry beforehand. With instruction, he said, residents can better develop a clear perspective on how their industry contacts can influence patient care. ▪
