Toward a PharmFree Medical Profession

With future physicians like Yavar Moghimi in the pipeline, pharma manufacturers and their sales representatives will have a hard time conducting business as usual. Moghimi is a third-year medical student at George Washington University in Washington, D.C., and this year's coordinator for PharmFree.

PharmFree is a nationwide project of the American Medical Student Association (AMSA). It was launched in 2002 by medical students who believe that drug company sales representatives, through gifts and other favors that influence medical education, were causing doctors and students to make biased decisions when prescribing drugs. It now has about 60,000 members.

AMSA is not against prescribing drugs, just against hype. It has developed a PharmFree Pledge for interested students to sign. It reads: "I am committed to the practice of medicine in the best interests of patients and to the pursuit of an education that is based on the best available evidence, rather than on advertising or promotion.

"I, therefore, pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my medical education and practice."

Moghimi vows to treat future patients with pharmaceuticals supported by the best existing clinical evidence, "not carefully packaged advertising," he says.

Students are exposed to a lot of marketing, Moghimi says. He estimates that medical students have at least one interaction per week with a pharma salesperson. "In our clinical years," he says, "we're just as likely to have interactions as the doctors or residents." He says that reps are frequently giving out pens and information about drugs "while grabbing your attention in between patients."

Moghimi finds the encounters troubling but not as insidious as some of the influence that pharma companies have on captive audiences and on professional continuing medical education courses. "It's pretty easy to avoid the invitations to expensive dinners," which he says are held at "very nice restaurants" in the evening outside of the clinical setting. But noon conferences are mandatory as part of medical students' education, and drug reps influence the content of these required events because they are working closely with the doctors and consultants who make presentations at these events.

"There is some self-regulation now," he says. "You don't see as many trips to the Caribbean or golf courses for the weekend," he says. Many drug company marketing efforts are, he believes, in the area of continuing medical education where, he says, it's harder to define the line between hard science and marketing as it is with, say, a pen or a notepad.

PharmFree supports continuing medical education that either is not industry supported or, if it is industry supported, is clear and open about the sources of funding, he says. Transparency is vital so that students can assess the different biases of the expert panelists.

"I don't want to sound like I'm blaming the industry for all the problems that are happening," Moghimi says. "In a lot of ways, it's the medical societies and the medical establishment that need to be defining these boundaries more than the industry. Industry's main obligation is to its stockholders. It's up to physicians to decide what the boundaries should be. AMSA has taken a firmer stance on this than any other medical society because it believes that any interaction, any gifts, will influence the doctors whether they believe it or not."