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Doctors refuse exhibit space to group campaigning against drug company influence

New York

Jeanne Lenzer

One of the largest doctors’ groups in the United States, the American Academy of Family Physicians, has refused to rent exhibition space to a campaigning group that says that pharmaceutical industry promotions are leading to bad patient care. But the academy has agreed to rent space at its annual scientific assembly to the fast food giant, McDonalds, alongside various pharmaceutical companies.

The academy, which will hold its annual scientific assembly in San Francisco from 28 September to 2 October, has refused to allow the non-profit making organisation No Free Lunch, based in New York, to rent exhibit space at the conference.

No Free Lunch is an organisation of doctors and other healthcare professionals who want to "encourage healthcare practitioners to provide high quality care based on unbiased evidence rather than on biased pharmaceutical promotion." The group urges doctors not to accept gifts or food from drug companies because "there is ample evidence in the literature" that such gifts "exert significant influence on provider behaviour."

According to the academy’s executive vice president, Douglas Henley, No Free Lunch was excluded because the presence of the group was "not in keeping with the purpose of the scientific assembly’s exposition, which is to promote a dialogue between the exhibitors and our attendees."

"There is an important and healthy dialogue that goes on at our meetings between the exhibitors and attendees and No Free Lunch would like to see that type of dialogue go away," he said.

He stood by the decision to allow McDonalds to exhibit: "Family physicians care for lots of patients who obviously get food at many fast food restaurants . . . To the credit of McDonalds, they have begun to promote healthier choices."

Dr Henley said that the purpose of the McDonalds’ exhibit was "to discuss with our members who attend the [exposition] these healthier choices—information they can then use to better educate and counsel their patients."

No Free Lunch’s founder, Bob Goodman, said, "This is a scientific assembly. You would expect differing points of view. Why wouldn’t they allow a small doctors’ group whose primary focus is to provide good patient care to exhibit? This is nuts."

Dr Michael Wilkes, professor of medicine and vice dean for medical education at the University of California, Davis, called the academy’s decision "ridiculous and embarrassing." He said, "As a physician I am insulted. This does not represent the interest of mainstream family physicians who are working hard to get the best information they can to care for their patients. They need to hear from people with differing opinions. The academy has gone out in right field – this is all about finances not about education. There can be no other reason for excluding a group like [No Free Lunch] than fear of offending sponsors."

Conference exhibitors and corporate supporters of the academy’s conference include the Distilled Spirits Council of the United States, Abbott Laboratories, Coca-Cola, AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Merck, and Pfizer among others.

The academy’s Advertising and Support Opportunities brochure assures exhibitors that advertising at the conference offers "proven traffic-builders that will help you achieve the greatest return on your exhibit investment and provide year-round visibility in the physician’s office" and that "over 71% of assembly attendees write more than 20 prescriptions a day—with over 32% writing 40 or more per day!"

Booth rentals are available to exhibitors for prices ranging from $2500 (£1380; €2060) to $111 375 per booth; advertisements in the academy newsletter cost between $5250 and $23 300; and providing free lunch to attendees can be purchased for $60 500 per day.

No Free Lunch was also barred by the American College of Physicians earlier this year when the college refused to rent exhibit space to the group. The college has previously acknowledged 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."

But when several medical students in No Free Lunch t shirts handed out literature at the college’s annual meeting this April, security officers, including armed police, "shadowed their every step," according to Dr Goodman. The students were handing out copies of the college’s own guidelines on interactions with industry.

See www.nofreelunch.org.