Does that free sleeve of golf balls demean the profession?
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* David Square

A fierce debate about the pros and cons of allowing physicians to receive gifts from pharmaceutical companies drew 300 medical students and health professionals to a symposium in Winnipeg in February. It was held after medical students from the University of Manitoba circulated a petition to protest drug company donations of free textbooks. The petition, drafted by students Elia Abi-Jaoude and Shannon Wiebe, read: “It is important to guard the quality and integrity of our medical education from targeting by parties with a vested financial interest.”

Abi-Jaoude says the petition caused an uproar, and most students “asked that more complete information be made available on both sides of the argument.” The result was a 4-hour debate on the question: “Does the pharmaceutical industry have too much input in the education of doctors?”

Dr. Gordon Guyatt of McMaster University argued that the industry not only has too much input but also that some of the information it provides is inaccurate (*JAMA* 1995;273:1296-8). He also maintained that “there has never been a study that shows [the use of] pharmaceutical industry information results in better prescribing results.”

Murray Elston, CEO of Rx&D, the lobby group representing the brand-name drug industry, said it is probably fair to attach a presumption of bias to most drug-related information. “I suspect that some bias is associated with a product that has been in development for up to 20 years before it comes to market,” he said.

He agreed that speakers sometimes exaggerate a drug's benefits, but added: “There are people such as Dr. Guyatt who are on a bit of a crusade to get pharmaceutical companies away from providing the latest and most interesting information about their products.”

He said students can be “absolutely assured that material [provided by the pharmaceutical industry] is as scientifically based as the material in any text.”

Dr. Bob Goodman, the New York physician who founded [www.nofreelunch.org](http://www.nofreelunch.org), said accepting “free lunches” from drug companies puts medical practitioners in a conflict of interest. A study (*JAMA* 2000;283:391-3) indicated that physicians' interactions with drug company representatives began in medical school, continued at a rate of 4 per month “and were associated with requests by physicians for adding the drugs to the hospital formulary.” Goodman said it demeans the profession when doctors line up for a free sleeve of golf balls or other gifts.

But Winnipeg FP Frederick Ross said he could not keep up with developments in medicine without his “free lunch dates with pharmaceutical representatives. Revenue Canada allows me 2 CME trips per year, which I pay for myself. That just isn't enough to keep me current.”

Dr. Joel Lexchin, a critic of the relationship between doctors and the pharmaceutical industry, said drug companies spend $1.7 billion per year to promote their products to Canada's doctors.

He said doctors received 48 000 visits from sales representatives for Vioxx in 2000 and were given more than a million samples. “This encourages prescribing early on when we don't know the overall side effect of drugs.”

But Dr. George Zhanel, a professor of medical microbiology at the University of Manitoba, had a different message. “The relationship between medicine and the drug companies is absolutely inevitable,” he said. “We depend on the industry for millions of dollars each year for research.”

As the symposium ended, there was some agreement that drug companies should contribute money to a large pot that could be spent at schools' discretion.

Abi-Jaoude said a survey may be conducted to see if the debate had any influence on the medical students who felt they needed more information. — *David Square*, Winnipeg