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BMJ. Jan 13, 2001; 322(7278): 69.
PMCID: PMC1119380

Pen “amnesty” for doctors who shun drug companies

No Free Lunch, a group of US healthcare providers who “believe that pharma- ceutical promotion should not guide clinical practice” (www.nofreelunch.org), is to publicise a list of practitioners who have pledged to be “drug company free.”

Doctors who sign up to the “drug free practitioners list” must pledge to be “free of company money and influence in their clinical practice, teaching, and research.” They must also promise to practise medicine on the basis of the best available scientific evidence and in the best interest of their patients, rather than on the basis of advertising or promotion.

The idea for the list came from a group of patients in New York who had been given free drug samples by their doctors. These patients began to question why they were given samples, believing that it was part of a marketing strategy by the pharmaceutical industry.

In one recent study, doctors stated that they used free samples as a way of avoiding cost to patients who were uninsured (Journal of General Internal Medicine 2000;15:478-83). The availability of drug samples, however, led doctors to dispense and subsequently to prescribe drugs that differed from their preferred drug choice. The pharmaceutical industry gave $7.2bn (£4.8bn) worth of samples to US doctors in 1999, and No Free Lunch believes that this was a deliberate marketing ploy.

In addition to publishing the list, No Free Lunch offers a “pen amnesty” programme—doctors hand in their drug company pens and receive a No Free Lunch pen in return.

Doctors can also check their own “drug company dependence” by answering a special CAGE questionnaire (www.nofreelunch.org/cage.html), a parody of the screening tool commonly used for alcohol dependence. “Have you ever prescribed Celebrex? Do you get Annoyed by people who complain about drug lunches and free gifts? Is there a medication loGo on the pen you're using right now? Do you drink your morning Eye-opener out of a Lipitor coffee mug?”

Bob Goodman, the director of No Free Lunch, hopes that the group will help to change a medical culture that sees taking gifts from drug representatives as “an entitlement.”

Figure
No Free Lunch”s logo (above) will appear on their pens

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