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Date: March 27, 2006.

Press Release: The American College of Physicians says yes to No Free Lunch, and just about everything else.

New York, NY—The American College of Physicians, the self described “second-largest physician group in the United States,” commences its 2006 Annual Session next week in Philadelphia, expecting almost 7,000 attendees. And unlike last year, No Free Lunch will be allowed a booth in the meeting’s exhibit hall.  The hall—over 2 football fields long—will feature, along with No Free Lunch’s 10x10 foot space, Pfizer’s 50x50 foot booth and Sepracor’s (maker of LunestaTM) 10,000 square feet of booth space, among many others. The booths will be staffed by sales reps providing “information” and distributing “approved giveaways” such as PDA organizers, USB memory sticks, and desk clocks (though money clips and manicure sets are not permitted).

The ACP maintains that there is a “bright line” between the exhibit hall and its scientific program. However, in its exhibitor prospectus, the ACP tells exhibitors “the Exhibit Hall is an extension of the learning environment of the ACP Scientific Program,” and “an important element of the meeting.” Exhibitors are told of daily raffles and complimentary lunches “to drive attendees into the exhibit hall.”  Furthermore, for $25,000, a company can sponsor a Zagat Restaurant Guide with the sponsor’s brand name or logo on the cover, which will be placed in the “official ACP tote bag.” Sponsorship of the tote bag itself, given to all attendees at registration, is available for $50,000. Companies with fewer resources can sponsor activities like the “medical student mentoring breakfast” for $4,000.

Why is any of this newsworthy? Because in 2002, The ACP—whose stated mission is to “enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine”—published guidelines on Physician-Industry Relations that include the following:

  • “The dictates of professionalism require the physician to decline any industry gift that might be perceived to bias their judgment, regardless of whether a bias actually materializes.”
  • “The potential for bias in industry-prepared information becomes especially precarious when such information is accompanied by a gift or free service.”
  •  “It is not just lavish amenities that are in question. The acceptance of even small gifts can affect clinical judgment and heighten the perception (as well as the reality) of a conflict of interest.”
  • “Ideally, physicians should not accept any promotional gifts or amenities, whatever their value or utility, if they have the ability to cloud professional judgment and compromise patient care.”

Denied a booth at last year’s meeting, No Free Lunch supporters attempted to distribute these guidelines to attendees. The ACP not only prevented them from doing so, but even distributed a memo to exhibitors assuring them that it had nothing to do with the distribution of its own guidelines. 

Of course, the ACP—which boasts almost 120,000 members—is just one example among many of a medical society that exhibits signs of “drug company dependence.” And at least it has guidelines. But the huge disconnect between the College’s words and its actions make a mockery of its mission, and threatens the health of the medical profession, as well as the public.


October 2, 2005

"There's some satisfaction in the San Francisco rain
No matter what comes down the Mission always looks the same"

Pictures at an Exhibition: The 2005 American Academy of Family Practice Annual Meeting, San Francisco, California

As you get closer to San Francisco’s Moscone Center, stepping off the Powell and Mason Street trolley with the Ambien CR ad on its side (“CR” shorthand for “going off patent soon”), you are passed by a mammoth bus with an equally mammoth ad for Z-Max along its side (azithromycin also going off patent next year), and as you approach the Center, billboard trucks advertising, Ketek, Nasocort AQ, Allegra D, and the omnipresent Ambien CR, cruise the block in perpetual motion. Above the entrance to the Center itself hangs an immense banner welcoming you to the meeting, and reminding you to visit the Crestor booth, #3611. Inside the building and down the escalators can be found a Crestor Computer Kiosk, where attendees, the official AAFP assembly Sanofi-Aventis (makers of Ambien CR) bag on their backs, can check their e-mail.

Down here you are surrounded by exhibit halls: To the Right is the massive South Hall, to the left, the smaller North Hall. The South Hall is tempting, housing as it does the booths of the Coca-Cola Company and the McDonald’s Corporation; and Ronald McDonald is said to be “in the house.” The North Hall, however, houses the No Free Lunch booth, whose application for a booth was initially rejected by the AAFP. What horrid things—worse even than a double quarter pounder with cheese (730 calories, 1330 mg sodium) and a large Coke (310 calories)—could be found here?

Inside the exhibit halls, one finds that the size of the gifts being offered has fortunately decreased, but the size of the booths seems to have increased proportionally. They are enormous and opulent, each housing several well-dressed and well-pressed reps, standing around chatting idly. Surprisingly, Pfizer, its booth situated at the entrance of the North Hall is giving out no gifts: A sign states that this is in accordance with California law. Because of low traffic flow to the booth, however, the sign is later removed.

For those who have spent a lot of time in exhibit halls, these booths and freebies are old news; but to a newcomer, it can come as quite a jolt. One can imagine the resident, or worse, medical student, shocked at seeing this all for the first time, but after a few more such meetings, takes it all in stride.. This is what we call “socialization.” More disturbing than the booths, however, are the many physician-attendees, scurrying about the hall like over-grown trick-or-treaters, carrying huge drug-branded vinyl bags (reminiscent of yellow IKEA bags), seizing pens and anything else they can get their hands on. Many have significant others and children in tow, who drag behind them their own bags, and who also pillage for pens and other booty. They grab pens by the fistful, with little idea of the product being promoted. The children are puzzled by the Cialis booth and the booth housing the Consortium for the Improvement of Erectile Function.

The No Free Lunch booth sits just opposite that same Consortium and next to the California Table Grape Commission. Caddie corner to our booth sits the Adams' booth, manufacturer of the expectorant Mucinex, and where stands “Mr. Mucus” a 4 ft high cuddly creature, whose fluorescent purulent green is probably not a coincidence. Despite the Academy’s reluctance to let us into the hall, and no doubt in part because of it, our booth is well trafficked. There is a good deal of support and enthusiasm for our message, and even more puzzlement and outright amazement at the AAFP’s initial decision.

The Academy maintained that the mission of No Free Lunch, which encourages doctors to refuse gifts and practice medicine on the basis of evidence rather than promotion, was not in keeping “with the character and purpose of the scientific assembly.” And looking around the exhibit hall, maybe they had a point. Like the ACP, the Academy will say that the exhibit hall is separate from the scientific assembly, but if this is so, it is curious that the most scientific session of the entire meeting—i.e., the poster session—takes place where? You guessed it, in the exhibit hall.

We are hopeful that attention focused on this meeting and the AAFP’s actions will cause the Academy to give pause and recall what its primary mission really is. Like other societies, it will no doubt claim that without all this pharmaceutical support its meetings and others like it would become prohibitively expensive. So instead of “prohibitively expensive” meetings we get prohibitively expensive prescription drugs, as the cost of all this promotion is passed on to patients. And—likewise on account of all this promotion—we get doctors who are all too eager to prescribe these very same drugs.

And no doubt those Ketek trucks will still be circling the block next week—The Infectious Disease Society is coming to town . . .


September 21, 2005

The American Academy of Family Physicians changes its mind, says yes to No Free Lunch

After further discussion and dialogue between the American Academy of Family Physicians and No Free Lunch and following thoughtful comments to the AAFP from many of its members, the application for No Free Lunch to exhibit at the Academy's upcoming annual meeting has been approved.

Press Release


Date: September 21, 2005.

The American Academy of Family Physicians changes its mind, says yes to No Free Lunch.

Following an outcry from among its members, the American Academy of Family Physicians has reversed its earlier decision to deny a booth to No Free Lunch and has invited the organization to exhibit at its meeting next week in San Francisco.

In August, The AAFP rejected No Free Lunch’s application to exhibit at its annual meeting—which will be attended by some 5,000 family physicians and slightly fewer exhibitors—stating that No Free Lunch’s position was “not within the character and purpose of the Scientific Assembly.” This despite the fact that the Coca-Cola Company, The McDonald’s Corporation, and The Distilled Spirits Council of the U.S. were all allotted space in the hall, as were countless pharmaceutical companies.

Many members were upset and even outraged that a society which they had supported for many years, and which gives industry almost unlimited access to physicians at its meetings, would not allow a small organization of health professionals to voice an opposing view. Allen Pelletier, for example, a family physician from Memphis, Tennessee, a long time AAFP member and newly elected fellow of the Academy, in an e-mail to AAFP CEO Dr. Douglas Henley, wrote “To my embarrassment, the organization that represents me as a practitioner and teacher of family medicine has shut down the possibility of open (and yes, critical) dialogue about how our practices are influenced by the pharmaceutical industry.” A family physician and AAFP member for 25 years from East Lansing, Michigan, wrote “. . . if an organization like No Free Lunch, well known for the role that it has played in encouraging awareness among physicians of the negative impact of pharmaceutical marketing, is denied the opportunity to set up a booth at the meeting, while commercial sponsors are encouraged to pay extra for more access to members and attendees, then the professional values of our specialty society have truly reached a new low.”

No Free Lunch has accepted the AAFP’s invitation and plans to be present at the session which opens September 28 at the Moscone Center. Attendees are encouraged to visit The No Free Lunch booth, #1613, immediately adjacent to that of the California Table Grape Commission.

No Free Lunch (http://nofreelunch.org) is a not for profit organization whose mission is to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion. It discourages the acceptance of gifts from industry by health care providers, trainees, and students. Its goal is improved patient care. It was founded in 1999 by Bob Goodman, a general internist at Columbia University Medical Center in New York City.


Press Release

Date: September 14, 2005.

The American Academy of Family Physicians says Yes to McDonald’s, Yes to Free Lunch, No to No Free Lunch.

The American Academy of Family Physicians, one of the nation’s largest medical organizations, has denied No Free Lunch—an organization of health care providers that encourages physicians to refuse gifts from industry—the opportunity to exhibit at its upcoming annual meeting in San Francisco.

In a letter to No Free Lunch’s Director Dr. Robert Goodman, AAFP’s Manager of Sales and Services Sharon Hutinett said that No Free Lunch’s position was “not within the character and purpose of the Scientific Assembly” and therefore did not meet the AAFP’s “eligibility requirements.” This despite the fact that the Coca-Cola Company (booths # 2321 & 2323), The McDonald’s Corporation (# 2425 & 2427), and The Distilled Spirits Council of the U.S. (# 527) will all be present at the meeting, and whose missions thus presumably are within the character and purpose of the assembly.

Over 5,000 physicians are expected to attend the meeting, and exhibitors are told on the AAFP website that “seven dedicated exhibit hall hours provide you with the opportunity for one-on-one access to these high-prescribing, qualified buyers!” If this is not enough, companies are provided with an array of sponsorship opportunities. For example: $17,500 buys granola bars (“in a custom designed bag that prominently features your logo”) that are placed in the “Doctor’s Bag” that are distributed to all registrants’ hotel rooms; $150,000 buys 50 custom-made banners that will adorn the shuttle buses taking attendees to and from San Francisco’s Moscone Center. As the AAFP notes on its website: “The supporter of the shuttle bus banners will also receive complimentary private coach service for its staff from the supporter’s main hotel to and from the convention center.” And of course, there’s free lunch: $60,500 pays for the food vouchers that physician-attendees will use for lunch each day at the conference. (see http://www.aafp.org/x32809.xml)

In April of this year, The American College of Physicians also denied No Free Lunch the opportunity to exhibit at its Annual Meeting in San Francisco. The ACP further prevented No Free Lunch members and medical students from distributing literature—in some instances using armed San Francisco Police—even when this literature was the ACP’s own guidelines on acceptance of gifts from industry.

No Free Lunch (http://nofreelunch.org) is a not for profit organization whose mission is to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion. It discourages the acceptance of gifts from industry by health care providers, trainees, and students. Its goal is improved patient care. It was founded in 1999 by Bob Goodman, a general internist at Columbia University Medical Center in New York City.


Update: American College of Physicians Annual Meeting 2005

While there was no No Free Lunch booth at the Annual American College of Physicians meeting in San Francisco (see press release, below), we can at least happily report that there were no Prevacid Stomachs wandering the exhibit hall either. Nevertheless, there was plenty of cappuccino, frozen yogurt, pens, and promotion to go around, despite the ACP’s own words that “The acceptance of even small gifts can affect clinical judgment and heighten the perception (as well as the reality) of a conflict of interest.”

The ACP maintains that there is a “bright line” between the exhibit hall and the “scientific program,” but this line is hard to see: The exhibit hall is the literal centerpiece of the meeting; it is difficult to get to the meeting rooms without being assaulted by a staffer with a goodie bag at the entrance to the hall; the website advertises the exhibit hall both to the attendees as well as to the exhibitors; and though the ID tag itself is no longer sponsored, upon registration each attendee is handed an “electronic business card” with “Zetia” imprinted on it.

Also in the exhibit hall this year were several intrepid UCSF medical students in No Free Lunch T-shirts who had, it turned out, their own security detail—in some cases armed SFPD who shadowed their every step and spoken word in the hall. Furthermore, on Friday the ACP distributed a memo (see below) to exhibitors warning them of "Green Shirts" handing out—gasp!—ACP’s own guidelines on interactions with industry, and reassuring exhibitors that the ACP had nothing to do with the distribution of these guidelines.

In a press release, the ACP issued its interpretation of events, and again attributed its decision to prohibit No Free Lunch from exhibiting to events at the 2001 Meeting, even though No Free Lunch made clear as far back as January that it was not involved with these activities.

The College has, however, invited Bob Goodman, No Free Lunch’s Director, to meet with the ACP’s Ethics and Human Rights Committee, and promises that the Committee will take a good “hard look” at current practices.

ACP members are encouraged to voice their disapproval to the ACP about the denial of exhibit space to No Free Lunch, the College's heavy-handed tactics at the recent meeting, and the discrepency between its high minded guidelines and its low-minded relationship with industry. The ACP has great potential: It puts on a very good meeting (exhibit hall and sponsorship aside), publishes an excellent journal (Annals of Internal Medicine), and has produced some outstanding guidelines. It is our genuine hope that The College will bring its actions more in line with its words, and in so doing become a role model for other professional societies and a beacon for the medical profession that it should and could be.



Press Release
Date: April 5, 2005

Will there be Free Lunch at the Annual American College of Physicians Meeting?

New York, NY – The American College of Physicians (ACP), the nation’s largest medical specialty society, will convene its Annual Meeting—billed as the “most comprehensive CME event in internal medicine,”—at San Francisco’s Moscone Center on Thursday, April 14th.   In addition to its Scientific Program, the meeting will feature an exhibit hall almost 3 football fields long. The hall—which the ACP’s website calls “an extension of the learning environment of the ACP Scientific Program”—will be filled with enormous industry exhibits and countless sales reps displaying their wares and handing out trinkets to the physician-attendees.  Additionally, there will be daily industry-sponsored symposia—from a breakfast session on the treatment of overactive bladder (supported by Indevus Pharmaceuticals, manufacturer of Sanctura,TM a treatment for overactive bladder) to a dinner session on the treatment of GERD (sponsored by Astra-Zeneca, manufacturer of the ubiquitous Purple Pill, Nexium.TM), daily raffles, and of course, free lunch.  And in case all this is not enough to get the promotional message across, companies may sponsor just about every minute and inch of the program—from the morning coffee break ($6,000/day)  to the Annual Session Tote Bag ($60,000).  As the website boasts to prospective exhibitors, “The American College of Physicians Annual Session stands out from all other meetings that you attend because it offers an unparalleled opportunity to meet with physicians of power - prescribing power.”

Why is this newsworthy? Because in 2002, The ACP—whose stated mission is to “enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine”—published guidelines on Physician-Industry Relations that include the following:

  • “The dictates of professionalism require the physician to decline any industry gift that might be perceived to bias their judgment, regardless of whether a bias actually materializes.”
  • “The potential for bias in industry-prepared information becomes especially precarious when such information is accompanied by a gift or free service.”
  •  “It is not just lavish amenities that are in question. The acceptance of even small gifts can affect clinical judgment and heighten the perception (as well as the reality) of a conflict of interest.”
  • “Ideally, physicians should not accept any promotional gifts or amenities, whatever their value or utility, if they have the ability to cloud professional judgment and compromise patient care.”

No Free Lunch, an organization that encourages health care providers to decline all industry enticements, requested a booth in the exhibit hall at this year’s meeting (as do other educational and advocacy groups like Physicians for Social Responsibility and Physicians for a National Health Program), but the request was denied. In a telephone conversation, ACP’s Chief Operating Officer, Dr. John Mitas, told Bob Goodman, No Free Lunch’s Director, that No Free Lunch’s presence would inhibit “dialogue” between doctors and reps.  No Free Lunch was also accused of “secretively escorting” an undercover network news team into the exhibit hall of the ACP’s 2001 Annual Meeting in Atlanta—an accusation that Goodman, a faculty member of the Columbia University of College of Physicians and Surgeons and himself a practicing internist, flatly denies.  Though, he points out, it does make one wonder what exactly it is that the ACP is trying to hide. To quote further from the ACP’s own guidelines:  “How would I feel if the relationship was [sic] disclosed through the media?”

Free Lunch? We think not.

   

 

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