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Hadi Farahani

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Drugs (Pharmaceuticals)

Psychiatry and Psychiatrists


Medicine and Health

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Drug Companies Get Too Close for Med School's Comfort

Published: January 20, 2004

(Page 2 of 2)

In an 2002 article, Dr. Peterson wrote: "Despite the lack of evidence of a significant difference in efficacy between older and newer agents, clinicians perceive the newer agents to be more efficacious — these findings are significant as they highlight the discrepancy between empirical evidence and clinical practices and suggest that other factors influence clinicians' medication choices in the treatment of depression."


The effect is easy to see in our department. The antidepressants fluoxetine, known popularly as Prozac, and paroxetine, known as Paxil, are now generic and cost patients and insurers pennies a day. Newer, rival drugs including sertraline (Zoloft), escitalopram (Lexapro) and Venlafaxine (Effexor) are 5 to 20 times as expensive.

In the last seven years, I have watched our residents prescribe the newest medications almost exclusively.

While doctors' prescriptions are based on more than efficacy and cost — they must also consider potential drug interactions, lethality of the drug if overdosed, the patient's prior history and patient preference — the abandonment of older medications by our residents cannot be justified given available data.

Programs that limit contact between industry and trainees do result in changes in behavior and attitudes.

In 2001, Dr. Brendan McCormick of the University of Toronto and his colleagues published a study in The Journal of the American Medical Association. The research compared internal medicine residents at McMaster University, who were prohibited from meeting with drug representatives during training, with trainees at the University of Toronto, across town, who had no such limitations.

After training, when they were free to meet with whomever they chose, the McMaster trainees had less contact with company representatives and were less likely to find such contact helpful.

In 1999, in response to growing concern in academic medicine, most pharmaceutical companies voluntarily adopted American Medical Association policies restricting lavish gift-giving to doctors. Some training programs went further, developing strict policies that limit access to medical students and residents. Policies adopted by the University of Michigan, the University of Iowa and and New York-Presbyterian Hospital, among others, have restricted pharmaceutical sponsorship of educational activities, have limited or completely eliminated their representatives' contact with trainees and have restricted gifts and where they can be displayed.

Unfortunately many programs have failed to address the issue.

In his Pulitzer Prize-winning book for 1984, "The Social Transformation of American Medicine," Dr. Paul Starr, the Princeton sociologist, argued that doctors won legitimacy during the early 20th century by aggressively taking on charlatans who offered cures and remedies. At the time, the American Medical Association argued that only doctors were objective enough to evaluate the benefits of competing medications. While there were other factors, the association leveraged physician objectivity to garner greater independence in practice, higher salaries and the legitimacy doctors have enjoyed since.

If medical schools are unwilling to separate trainees from pharmaceutical company representatives, we risk the appearance of being "bought and sold."

This is sure to lead to governmental regulation and greater erosion of independence. And it should.

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. Do Consent Forms Tell Enough? One Case From the Front Lines  (May 19, 1998)  $
. Psychiatric Researchers Under Fire  (May 19, 1998)  $
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