My Brush with Physician-Directed Marketing Last updated November 7, 2004 home > Physicians and Pharmaceutical Marketing > My Brush with Physician-Directed Marketing

When I was a fourth year medical student, I was selected by the neurology and psychiatry faculty at University of Rochester School of Medicine and Dentistry to attend The National Medical Student Conference on Psychiatry and Neuroscience at Columbia University College of Physicians and Surgeons. Among the distinguished speakers was Nobel Laureate Eric Kandel. Unfortunately, the conference was funded by a grant from Forest Laboratories, Inc. The grant covered costs for lodging at the Plaza Hotel in New York City, group meals, and a Broadway show for 126 fourth-year medical students and a partner of their choice. The grant also covered the transportation costs of the 126 students.

The faculty and advisory deans at University of Rochester were divided about whether or not to nominate a student for this pharm-sponsored conference. They scheduled a discussion of the topic at Ethics Grand Rounds. Many students and faculty attended, and at the end of the conference, the facilitator asked for a hand-count from students only: 40 voted in favor of nominating a student and only about 8 voted against.

Even after the conference, the faculty remained divided. They eventually agreed to nominate a student. Unbeknownst to me, the few faculty who were opposed sending a student stipulated that if the nominated student were to refuse on ethical grounds, then the faculty would not nominate another student to take his/her place.

When I received the phone call announcing my nomination, I felt sick. I worried that faculty and students alike would view a refusal to attend as a form of "holier-than-thou" snobbery. I asked for time to think. Over the weekend, I decided that attending this conference would not be in the long-term best interests of my patients. The funds from Forest Laboratories, Inc. ultimately come from patients themselves, who buy Forest drugs at high cost. Moreover, accepting the gifts of transportation, lodging, education, and entertainment from Forest would place me in a position of indebtedness. My ability to make unbiased pharmaceutical recommendations to my patients could be compromised by this feeling of indebtedness.

I drafted letters to the faculty at University of Rochester, to the conference's educational director, and to Forest Laboratories, explaining my reasoning. To my surprise, my refusal was met with respect, not the censorship I had feared.

After this experience, a group of students and faculty from the University of Rochester formed an interest group called De-Fib, Demanding Evidence, Forgoing Industry Bias. Our goal is to provide resources to the Rochester medical community to encourage productive debate of the ethics associated with pharmaceutical industry interactions.

Since I'm no longer living in Rochester, I'm using Nimble Turtle to post articles and resources relevant to the interactions of physicians with the pharmaceutical industry.

I believe peer-support is one of the key elements of reversing the influence of pharmaceutical marketing on physician prescribing behaviors. "Everyone" is not accepting drug handouts. Please feel free to email me.

Shelley Schoepflin Sanders, MD, MTS