You won't find a Zoloft pen in Anthony Fleg's shirt pocket, or a Vitorin mug on his desk. A fourth-year medical student at UNC-Chapel Hill, Fleg testified last month before the U.S. Senate Finance Committee about drug companies' influence on doctors—$7 billion annually in free meals, tchotchkes, drug samples and advertising—and its negative impact on the practice of medicine. He asked lawmakers to support the Physician Payment Sunshine Act, which would require medical practitioners, including medical school professors, to publicly disclose their financial connections with the pharmaceutical industry.
Fleg, the American Medical Student Association's national PharmFree coordinator, plans to practice family medicine. "I have a real love for taking care of patients and a desire to protect the sacred trust physicians and patients once shared—and that can be restored."
The AMSA is also grading medical schools on their conflicts of interest involving drug companies. UNC received a C-minus; it is discussing forming a policy restricting drug reps' access to campus, but hasn't done so. Duke received a B for establishing some guidelines on access to the Academic Medical Center, but hasn't extended that practice to the medical school.
When did the backlash start? What was the catalyst?
The AMSA was the first national medical association to completely say no to any funding or scholarships from drug companies in 2002. It will take a change in medical education itself to get students to start pushing schools to address this issue.
What's the atmosphere like at UNC in terms of students' exposure to the drug lobby?
You have medical students being taught the ethics of medicine, and then we see the opposite being practiced. We're required to go against the people grading us.
I think at a minimum, we should be told when lunches are provided by drug companies. Our internal medicine department receives nice boxed lunches every day. I asked where the lunches were coming from—it wasn't disclosed—and they were sponsored by a drug company. It wasn't presented in a "decide for yourself" manner, but that "we don't think this is a big enough issue to tell students."
What's the response been to your campaign?
There's a percentage of medical students who think this is a radical idea. They don't think it's a big issue, even though the evidence shows that any gift, large or small, influences physicians. One percent of physicians surveyed said they weren't influenced by gifts from drug companies, but 40 percent said that other doctors are.
How has the drug companies' influence over doctors affected public health policy?
They're trying to get physicians to prescribe drugs, and it's not too big of a stretch to see we have an overmedication problem. Physicians prescribe antibiotics when there is no evidence that we should. We treat everything that comes in with a pill. It leads away from prevention. Patients and doctors are inundated with messages: "Ask your doctor," or "Prescribe this." It pushes aside what people should do to stay healthy.
And in a global context, in one part of the world we're overmedicated and other parts are undermedicated. We can get more than enough Viagra, but people in Zimbabwe can't get medicine for HIV.
How can you know if your doctor has an unhealthy relationship with his or her drug sales rep?
When you see a doctor, he or she doesn't come into the room and say, "Here are the 10 drug reps I've seen in last 48 hours." Patients should feel the right to directly ask their doctor whether they take money or gifts from drug companies. Or ask their surgeon, "Before I pay $50,000 for the piece of metal you're putting in me, how much did you get from the device manufacturer? Are you the person who developed it? How many people have it in them?" That's a whole other avenue where the culture of medicine will change, that we can't hide what we're doing anymore. You shouldn't be ashamed to consider choosing a doctor on this issue.