Monday, May 12, 2008

AAMC’s proposed ban on drug company gifts draws controversy

MSNBC ran a point counterpoint on the Association of American Medical Colleges proposed ban on drug company freebies for medical students. Dr. Edward V. Craig, Professor of Clinical Orthopedic Surgery at Cornell Medical School, writing in opposition to the ban, said:

Unfortunately, this proposal ignores all subtlety, is dismissive of the many benefits of industry relationships with medicine, and considers individuals and medical organizations rudderless in their efforts to be steered by a personal and professional moral compass.

If your medical school is being over run by drug reps or if they are creating a distraction in the learning environment, you as an administrator or faculty member should take action. But the AAMC proposal is simplistic and extreme.

The larger problem in medical education is the need to teach students to think critically. Although that would address not only the slanted information in drug company promotions but also the woo students are exposed to it’s not being done effectively. Instead, students are being asked to check their brains at the door to the classroom. If you have doubts on whether med students are embracing pseudoscience on a large scale check out the complementary and alternative medicine pages of the American Medical Student Association web site.

Via Kevin M.D.


Paige Hatcher said...
This comment has been removed by the author.
Paige Hatcher said...

As someone that advocates for evidence-based practice, it's interesting that you would ignore the overwhelming data that shows that gifts influencing medical prescribing. There is no "pseudoscience" there, but only cold hard facts. If you had actually read the report, which is obvious you didn't as it's the AAMC not the AAMS, you could easily find many of the important citations there. Interestingly, there has also been a correlation between the amount of money accepted and the degree of disbelief that gifting effects prescribing habits. I'm curious to know who pays for your lunch. You should probably offer a disclosure statement.

R. W. Donnell said...

Thanks for pointing out the typo in my title. Of course I knew it was the AAMC, which was apparent in the body of my post. I've fixed it.

R. W. Donnell said...

By the way, before I respond to your questions (which would be best addressed in a blog post) maybe you should define the terms and conditions. It seems we agreed a while back not to debate each other on our blogs.

Paige Hatcher said...

I asked you not to personally attack me on your blog, but I thought you would appreciate that this report really does have a lot of evidence behind it. Not a debate...

R. W. Donnell said...

At the risk of violating the "terms and conditions" (I'm still not sure I understand what they are):

1) If we Q&A each other on something we disagree on, that's a debate. Debates can be collegial, of course.

2) I try to attack positions and assumptions, but not people. That said, I have no control over what commenters might say. Although deletion of some comments may be appropriate I err on the side of open commentary.

3) I had read accounts of the AAMC report, not the report itself. I acknowledged this fact in a follow up post. Subsequently I read the report in the original and found it to be not nearly as bad as the NYT and blog posts said, although I still don't fully agree. Unless the AAMC does something about the promotion of quackery in many medical schools I can only conclude, to put it nicely, that they suffer selective outrage.

4) As for the citations---I was already quite familiar with this literature. I've read most or all of those articles before and many more like them. They provide evidence that doctors are influenced by industry promotions. No question about that. But it's a big leap to go from there and claim that the influence harms patients. We have no outcome based data.

5) I personally choose not to accept gifts (occasional exception noted below)or read or listen to industry promotional material, as I have better sources of information. However, I need convincing outcome based data showing net harm to patients before I'm willing to point the finger at others who accept gifts, etc.

6) Disclosure: I estimate I've attended 4 modest drug company lunches in the past year. Otherwise I quit taking even small gifts some time ago. I have no drug company stock and receive no honoraria.