Drug Pushers

The irony of visiting your doctor.

You sit in the waiting room and you see all these sharp dressed sales reps come in from different drug companies. Once you got back to the exam room, the walls are plastered with posters from drug companies, as well as pictures, little models of different parts of the anatomy and anything else you can think of. All the mugs would be from a drug company and even the office supplies would bear their names.

All the sudden I would get a prescription and it would be for the same drug that is engraved on the side of the pen the doctor was writing the script with.

When a Duluth-based operator of hospitals and clinics purged the pens, notepads, coffee mugs and other promotional trinkets drug companies had given its doctors over the years, it took 20 shopping carts to haul the loot away.

The operator, SMDC Health System, intends to ship the 18,718 items to the west African nation of Cameroon.

The purge underscored SMDC's decision to join the growing movement to ban gifts to doctors from drug companies.

SMDC scoured its four hospitals and 17 clinics across northeastern Minnesota and northwestern Wisconsin for clipboards, clocks, mouse pads, stuffed animals and other items decorated with logos for such drugs as Nexium, Vytorin and Lipitor.

Trinkets, free samples, free food and drinks, free trips and other gifts have pervaded the medical profession, but observers say that's starting to change.

"We just decided for a lot of reasons we didn't want to do that any longer," Dr. Kenneth Irons, chief of community clinics for SMDC, said Friday.

So SMDC put together a comprehensive conflict-of-interest policy that, among other things, limits access to its clinics by drug company representatives. Employees suggested the "Clean Sweep" trinket roundup, Irons said.

Ken Johnson, a spokesman for the Pharmaceutical Research and Manufacturers of America, had heard of hospitals and clinics banning promotional items before, but said SDMC's purge was unprecedented.

"I've never seen nor heard of a systematic roundup of pens and coffee mugs before," Johnson said. "It's a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst."

SDMC's effort was motivated by a desire to show patients that its 450 doctors were serious about keeping prescription drug costs down and making unbiased medical decisions, Irons said.

The backlash against the cozy relationships between doctors and drug makers gained steam from article in the Journal of the American Medical Association in 2006. It said research had shown that even cheap gifts, such as pens, can affect doctors' prescribing decisions.

The Prescription Project, funded by the Pew Charitable Trusts, was founded to promote the JAMA article's recommendations for countering aggressive marketing to physicians by the pharmaceutical and medical device industries.

Marcia Hams, assistant director of the project, said she too hadn't heard of a roundup like SDMC's, but hopes other health organizations follow its lead.

"This seems like a pretty aggressive way to kick off a policy like that," she said. "It sends an important message, I think, for how a strict policy can be implemented in an effective way."

Kaiser Permanente, the country's largest HMO, Veterans Affairs hospitals and medical centers at several universities have recently adopted strict conflict-of-interest policies, such as gift bans, Hams said.

Many of SMDC's items will be going to the health system of the Evangelical Lutheran Church of Cameroon, which has three hospitals, and several rural health centers, and no drug salesmen.