Taking on Big Pharma

Where Corporate Excess Meets Medical Ethics

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IN MOST DEVELOPED COUNTRIES, prescription drugs and health care are considered entitlements and are often heavily subsidized or covered outright by the government. In the United States, health costs are borne by individuals, employers and sometimes the government and they continue to rise at unsustainable rates. Increasingly the cost of staying healthy is becoming a burden, even for the middle class.

Pfefferkorn was first sensitized to issues of access and affordability when he began working as a pharmacy technician. It was a part-time job he took while a student at Susquehanna, where he majored in biology. “I saw people talking about splitting medications with spouses and not taking medications, or coming up to the counter with three prescriptions and deciding to fill only one of them.”

In his first year of medical school, Pfefferkorn found himself influenced not only by his experiences at the prescription counter, but also by the bombardment of freebies from pharmaceutical companies trying to curry favor with him, his classmates and his instructors. Sometimes the gifts were small and sometimes they were significant. Early on, he remembers receiving an eye chart printed on a card that prominently displayed the names of a prescription eye drop and its manufacturer. When he asked his instructor if it was necessary to distribute what Pfefferkorn regarded as advertisements, the instructor became annoyed. “This is an educational tool and it helps us provide basic care—that was the way it was rationalized,” Pfefferkorn recalls.

Later in his training, he worked at a rural medical clinic in Wisconsin. Every day at lunchtime a catering truck would pull up to the clinic, and the driver would unload provisions for a buffet. The staff and 15 family physicians who worked at the clinic and at the nearby 40-bed hospital would help themselves to the meals, all sponsored by pharmaceutical manufacturers.

At another rotation in Milwaukee, Pfefferkorn says the clinical staff would participate every Thursday in continuing education luncheons. These, too, were sponsored by Big Pharma. One day his clerkship director, the person in charge of educating students at the site, specifically invited him to the lunch. “I said, ‘That’s OK, I brought my own lunch.’ She just let it pass, but occasionally people would say, ‘So you don’t take drug lunches?’”

Pfefferkorn says these encounters sometimes create uncomfortable moments for students who question the status quo. And the encounters become even more pronounced once students enter practice. The Pew Charitable Trusts says the pharmaceutical industry spends about $30 billion a year on marketing, the majority of which is spent on direct marketing to physicians in the form of free gifts ranging from pens and meals to continuing education classes and lucrative speaking engagements. Published studies also show that the industry distributes $18 billion a year in free drug samples, and a substantial portion of these are used by physicians, their families and staff.

The marketing costs for these freebies are passed on to consumers, the ones Pfefferkorn witnessed splitting medications or declining to buy them because they were unaffordable. When he put two and two together, he looked for a way to make a difference. He joined the American Medical School Association (AMSA), a 50-year-old professional association with 68,000 members, and got hooked into a project called PharmFree. That first step ultimately led him to work that won him national recognition this year from the American Public Health Association (APHA) for “challenging traditional public health policy or practice in a creative and positive way.”


IN 2002, AMSA CREATED the PharmFree campaign to prevent the pharmaceutical industry from unduly influencing medical education and clinical practice. Charging that pharmas were partially responsible for driving up medical costs, it cited this research finding: Since 1985, only 2 percent of drugs approved for market use were found to provide an important therapeutic innovation, compared with the more than 90 percent that did not appear to offer any real benefit over already available drugs. In its literature, AMSA said, “Physicians should not seek education from industry marketing efforts, whether they are in the form of advertisements, sales pitches from representatives or sponsored lectures by paid physicians.” AMSA’s other PharmFree campaign goal was to promote increased patient access to medicines in the developing world.

To begin creating professional space between pharmas and medical schools, AMSA banned pharmaceutical advertising and sponsorships at regional and national conferences, in its magazine and on its Web site. It published newsletters, fact sheets and ethics primers, all with the goal of helping medical students make well-informed decisions on evidence-based medicine. And it staged high-impact demonstrations. In 2005, it sponsored a “pen drop” and dumped thousands of pharma-branded pens and paraphernalia outside of the headquarters of a major pharmaceutical firm.

Soon, “PharmFree Liberated” stickers began appearing on medical campuses. Pfefferkorn became active on his medical school campus at the University of Wisconsin. He breathed life into a dormant AMSA chapter and helped assemble brownbag luncheons and speaker panels. “In my first year it was just an interest, but it became more and more of a passion,” he says. “I started getting e-mails from other students, and people began stopping me in the hall for what I began to call ethical consults. They would say, ‘I encountered this situation; what do you think?’ I didn’t know quite how to deal with many of these issues myself; it wasn’t something I had read about or understood.”

Without the ethical foundation one would expect a professional school to provide, Pfefferkorn says he and his colleagues struggled to make sense of a welter of issues, including the correctness of attending dinners sponsored by Big Pharma. “From day one in medical school you are told how important you are, how smart you are and what a great job you are doing. And you get to the point where you say, 'Well, I deserve a dinner, I’m working hard. Why shouldn’t I go and learn something, relax and have a bottle of wine?'”

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