"They're going to be cutting themselves off from a lot of useful information," he said, referring to bans on meals with sales representatives.
"I can tell you that the sales reps would just as soon not bring in the pizza and the meals," Lassman said. "But often the physicians are extremely busy, and the only time they can get access is over a working lunch or dinner. We thought it was appropriate to pay for that."
In 2002, the industry group and the American Medical Assn. responded to rising criticism by issuing voluntary ethics guidelines. Such lavish gifts as fishing trips, expensive football tickets and greens fees at swanky golf resorts were out. Gifts had to be relatively small -- pens, pads, stethoscopes -- and related to patient care. Drug reps, all 90,000 of them, were urged to deliver educational programs over modestly priced lunches or dinners.
Last month, the International Federation of Pharmaceutical Manufacturers & Assns., which represents drug companies worldwide, issued similar rules.
Doctors in private practice have been courted by "drug reps" for years and, with the exception of Kaiser Permanente, the California-based managed-care group, few private hospitals or physician groups have enacted restrictions. Many doctors, for instance, have drug samples to give to patients.
But academic institutions need to set an example, according to the AMA magazine's article last year. "Academic medical centers, which include medical schools and their affiliated hospitals, should provide leadership for medicine in the United States," said the article, signed by doctors from Harvard Medical School, Columbia University and other schools, including two UC campuses. "Research reveals that the habits learned or acquired during training persist into practice."
The article called on academic centers to ban every free offering, even inexpensive note pads.
The article was notable, given the prominence of the magazine, but it was just the latest in a string of journal articles decrying drug marketing's influence on medicine.
For years, many doctors shrugged off such studies. Some were insulted that anyone would think a few free doodads and dinners could affect their judgment. Others defended interactions with sales reps as a way to stay up to date on the latest drugs or as a source of free samples for low-income patients.
