Tuesday, June 03, 2008

Are Doctors for Sale? Can a Drug Company Influence a Doc with a Free Lunch and Free Notepads?

Suppose that you are a new Economics PHD and at your first job you are asked to teach economics 101. You must pick a textbook for this course. Many superstars have written such books and just to name a few names that you might pick there are books by; Krugman, Mankiw, Stiglitz, Phelps, Nordhaus, Samuelson, Case & Fair and others who I can't remember. But suppose that a startup publisher called "Kahn's slimebags" sends you a comic book and claims that it is a econ 101 textbook. Suppose that I send an attractive person to talk to you about adopting my book and suppose that I throw a great conference in Las Vegas where I pay for your trip and hotel and for 2 hours during your 3 day stay you must listen to me praise my "textbook" (i.e the comic book). Will you adopt my book?

This New York Times article claims that doctors have gotten themselves all riled up over the pernicious effects of "free gifts". The article hints at a counter-factual; doctors are making bad choices (i.e prescribing the wrong drug or a drug that is unlikely to be cost-effective) because they have been captured by the drug companies. To pre-empt this behavioral response, doctors are now expected to refuse all gifts.

This raises several issues related to behavioral economics. As a Chicago Economist, you could shower me with free stuff and I will take it. I like a free lunch but I will feel no guilt when I don't adopt your product because I was on to you and your little scheme.

This logic raises the issue of why doctors (who are supposed to be our most ethical people?) are trapped in this trap? I was happy to see that UCLA gets an A for not taking free stuff but I wonder what psychological model of people explains why a fraction of doctors feel the need to reward those who have been nice to them by adopting their products. A theory of fairness should argue that doctors should be focused on taking care of the patient not their relationship with the drug rep.

Now you may counter that the drug rep's sales pitch has convinced the doctor to update his subjective probability of the effectiveness of the new drug but a sophisticated bayesian would recognize that the drug company has an incentive to over-state its new product's effectiveness. A serious doctor should wait for a 3rd party verification that is published in a leading peer review journal before switching to an unproven medication.

June 3, 2008
Survey of Medical Schools Is Critical of Perks

Most medical schools in the United States fail to police adequately the money, gifts and free drug samples that pharmaceutical companies routinely shower on doctors and trainees, according to a ranking by the American Medical Student Association.

Only 7 of the 150 medical schools included in the rankings received a grade of A while 14 were given a B. Sixty got a failing grade, and the student association found that 28 schools, or nearly one in five, were in the midst of revising their conflict-of-interest policies.

“These policies are incredibly important to protect the educational experience students have at school and the quality of the education they’re getting,” said Dr. Brian Hurley, president of the student association. Schools that shield students from marketing messages will produce doctors who provide better care to patients, Dr. Hurley said.

The student association will routinely update the grades it gives medical schools, which are listed on a school-by-school basis at amsascorecard.org. The grades will be officially released Tuesday.

Mount Sinai School of Medicine in New York, the University of Pittsburgh Medical Center and University of California schools at Los Angeles, Davis and San Francisco were among those receiving top grades.

The role played by pharmaceutical and device makers in the education of doctors has become an increasingly controversial topic, with some top medical schools placing a growing number of restrictions on the longtime practice of providing free food, gifts and educational seminars to trainees.

The Association of American Medical Colleges advocated in April that schools ban many of these perks. The proposal was the result of a two-year study of the issue by the association.

Dr. Sidney Wolfe, director of the health research group at Public Citizen, a consumer advocacy organization, said the medical college association’s proposal “would be relatively meaningless without this critical surveillance system” created by the students.

“Most of the medical school bureaucracies are getting too much money and other forms of largess from the drug industry to initiate these healthy, long overdue policies on their own,” Dr. Wolfe said.

The student association, which represents more than 67,000 medical students, residents and practicing physicians, began its ranking in November when it requested conflict-of-interest polices from all of the nation’s medical colleges. The association made at least four attempts to receive the policies from every school in the country, but 16 schools declined to submit a policy and 29 did not respond at all. These schools, along with 15 that did submit policies, were given failing grades.

Two graders who were unaware of the identity of the schools did the scoring.

Gabriel Silverman, a medical student at the University of Pittsburgh School of Medicine who oversaw the grading, said medical students were increasingly put off by school policies that allowed drug companies to market their products to doctors and faculty members.

“We see all these pharma sales reps in clinics with free lunches and marketing paraphernalia giving us the hard sell,” Mr. Silverman said.

Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, said the student survey was important because students were significantly affected by the rules that applied to their faculty.

“In the same way that faculty pay attention to how they’re rated by students in their teaching,” Dr. Blumenthal said, “it seems to me that schools should pay attention to how students evaluate policies in fields that are of substantial importance to the future of the students.”