Timothy F. Kirn

SAN DIEGO—Dr. Daniel Siegel applies the zinc chloride paste developed by Dr. Frederic E. Mohs to melanomas the day before he removes them as a kind of insurance policy to reduce the risk of recurrence.

"The paste is wonderful stuff," Dr. Siegel said at a course on Mohs surgery during a meeting sponsored by the American Society for Mohs Surgery.

The paste is not commercially available, but it can be compounded by a pharmacy. Dr. Mohs himself eventually abandoned its use in favor of the fresh tissue technique in the 1950s. In addition to zinc chloride, the paste contains bloodroot (Sanguinaria canadensis) and stibnite, and a little bit lasts a long time. A single jar has lasted about 10 years, he said.

It has not been possible to get a clinical trial of the paste organized because there is no commercial interest, but there is some evidence to suggest its efficacy, said Dr. Siegel, a dermatologist practicing in Smithtown, N.Y.

Dr. Mohs reported better 5-year survival rates for melanoma than are usually reported, even better than those reported by Dr. Wallace H. Clark, originator of the Clark's levels of invasion. He reported 5-year survival of 57% for melanoma patients with a Clark's level III tumor, but Dr. Mohs reported 92%, Dr. Siegel said.

In an experiment with mice that Dr. Siegel was involved in, the investigators reported a markedly positive effect when mice were treated with the paste and then injected with melanoma cells. The mice had melanomas treated with the zinc oxide paste then removed 24 hours later. A second group of mice simply had melanomas excised. Then all the mice were injected in a second site with melanoma cells. Melanomas developed at the challenge site in 69% of the mice treated with excision only, but just 32% of the mice treated with paste (Dermatol. Surg. 1998;24:1021–5). The researchers concluded that the paste was enhancing some kind of immune response.

When Dr. Siegel uses the paste in his practice, he said he is careful to fully inform patients that the treatment is not proven. He also lets them know it is very uncomfortable, and he often uses anesthetic.

Dr. Siegel applies a 50% trichloroacetic acid solution to the lesion before applying the paste, which is painful. Patients often come in the next day complaining that they have a temperature and that their lymph nodes are sore. He then does a wide excision despite the paste, he said.

It is important to warn patients not to touch the lesion and get the paste in an eye. "You have to be very careful and fearful," he said. "Paste can be dangerous."

Despite that, it may be advantageous to use the paste for patients who may be infectious, such as those who are HIV positive, because it probably minimizes infectious agent "splatter," he added.

Most importantly, there is no reason to believe that the use of the paste may be harmful, since the tumor is being removed anyway, Dr. Siegel said.

In fact, he is not the only Mohs surgeon who uses the paste for melanoma cases.

Dr. Kenneth Gross of San Diego, one of the organizers of the Mohs course, said that he has used it for patients who are having a sentinel node procedure.

"Do I know this is helping? I absolutely do not. [But] we are killing and immobilizing cells and I don't see how that could be any problem," he said.

SAN DIEGO—Dr. Daniel Siegel applies the zinc chloride paste developed by Dr. Frederic E. Mohs to melanomas the day before he removes them as a kind of insurance policy to reduce the risk of recurrence.

"The paste is wonderful stuff," Dr. Siegel said at a course on Mohs surgery during a meeting sponsored by the American Society for Mohs Surgery.

The paste is not commercially available, but it can be compounded by a pharmacy. Dr. Mohs himself eventually abandoned its use in favor of the fresh tissue technique in the 1950s. In addition to zinc chloride, the paste contains bloodroot (Sanguinaria canadensis) and stibnite, and a little bit lasts a long time. A single jar has lasted about 10 years, he said.

It has not been possible to get a clinical trial of the paste organized because there is no commercial interest, but there is some evidence to suggest its efficacy, said Dr. Siegel, a dermatologist practicing in Smithtown, N.Y.

Dr. Mohs reported better 5-year survival rates for melanoma than are usually reported, even better than those reported by Dr. Wallace H. Clark, originator of the Clark's levels of invasion. He reported 5-year survival of 57% for melanoma patients with a Clark's level III tumor, but Dr. Mohs reported 92%, Dr. Siegel said.

In an experiment with mice that Dr. Siegel was involved in, the investigators reported a markedly positive effect when mice were treated with the paste and then injected with melanoma cells. The mice had melanomas treated with the zinc oxide paste then removed 24 hours later. A second group of mice simply had melanomas excised. Then all the mice were injected in a second site with melanoma cells. Melanomas developed at the challenge site in 69% of the mice treated with excision only, but just 32% of the mice treated with paste (Dermatol. Surg. 1998;24:1021–5). The researchers concluded that the paste was enhancing some kind of immune response.

When Dr. Siegel uses the paste in his practice, he said he is careful to fully inform patients that the treatment is not proven. He also lets them know it is very uncomfortable, and he often uses anesthetic.

Dr. Siegel applies a 50% trichloroacetic acid solution to the lesion before applying the paste, which is painful. Patients often come in the next day complaining that they have a temperature and that their lymph nodes are sore. He then does a wide excision despite the paste, he said.

It is important to warn patients not to touch the lesion and get the paste in an eye. "You have to be very careful and fearful," he said. "Paste can be dangerous."

Despite that, it may be advantageous to use the paste for patients who may be infectious, such as those who are HIV positive, because it probably minimizes infectious agent "splatter," he added.

Most importantly, there is no reason to believe that the use of the paste may be harmful, since the tumor is being removed anyway, Dr. Siegel said.

In fact, he is not the only Mohs surgeon who uses the paste for melanoma cases.

Dr. Kenneth Gross of San Diego, one of the organizers of the Mohs course, said that he has used it for patients who are having a sentinel node procedure.

"Do I know this is helping? I absolutely do not. [But] we are killing and immobilizing cells and I don't see how that could be any problem," he said.

SAN DIEGO—Dr. Daniel Siegel applies the zinc chloride paste developed by Dr. Frederic E. Mohs to melanomas the day before he removes them as a kind of insurance policy to reduce the risk of recurrence.

"The paste is wonderful stuff," Dr. Siegel said at a course on Mohs surgery during a meeting sponsored by the American Society for Mohs Surgery.

The paste is not commercially available, but it can be compounded by a pharmacy. Dr. Mohs himself eventually abandoned its use in favor of the fresh tissue technique in the 1950s. In addition to zinc chloride, the paste contains bloodroot (Sanguinaria canadensis) and stibnite, and a little bit lasts a long time. A single jar has lasted about 10 years, he said.

It has not been possible to get a clinical trial of the paste organized because there is no commercial interest, but there is some evidence to suggest its efficacy, said Dr. Siegel, a dermatologist practicing in Smithtown, N.Y.

Dr. Mohs reported better 5-year survival rates for melanoma than are usually reported, even better than those reported by Dr. Wallace H. Clark, originator of the Clark's levels of invasion. He reported 5-year survival of 57% for melanoma patients with a Clark's level III tumor, but Dr. Mohs reported 92%, Dr. Siegel said.

In an experiment with mice that Dr. Siegel was involved in, the investigators reported a markedly positive effect when mice were treated with the paste and then injected with melanoma cells. The mice had melanomas treated with the zinc oxide paste then removed 24 hours later. A second group of mice simply had melanomas excised. Then all the mice were injected in a second site with melanoma cells. Melanomas developed at the challenge site in 69% of the mice treated with excision only, but just 32% of the mice treated with paste (Dermatol. Surg. 1998;24:1021–5). The researchers concluded that the paste was enhancing some kind of immune response.

When Dr. Siegel uses the paste in his practice, he said he is careful to fully inform patients that the treatment is not proven. He also lets them know it is very uncomfortable, and he often uses anesthetic.

Dr. Siegel applies a 50% trichloroacetic acid solution to the lesion before applying the paste, which is painful. Patients often come in the next day complaining that they have a temperature and that their lymph nodes are sore. He then does a wide excision despite the paste, he said.

It is important to warn patients not to touch the lesion and get the paste in an eye. "You have to be very careful and fearful," he said. "Paste can be dangerous."

Despite that, it may be advantageous to use the paste for patients who may be infectious, such as those who are HIV positive, because it probably minimizes infectious agent "splatter," he added.

Most importantly, there is no reason to believe that the use of the paste may be harmful, since the tumor is being removed anyway, Dr. Siegel said.

In fact, he is not the only Mohs surgeon who uses the paste for melanoma cases.

Dr. Kenneth Gross of San Diego, one of the organizers of the Mohs course, said that he has used it for patients who are having a sentinel node procedure.

"Do I know this is helping? I absolutely do not. [But] we are killing and immobilizing cells and I don't see how that could be any problem," he said.

PALM DESERT, CALIF.—Use of the "nested" M-plasty technique makes it possible to further shorten round wounds when closing Mohs defects, Dr. Ravi Krishnan said at the annual meeting of the American Society for Dermatologic Surgery.

The technique involves making two Ms, instead of one, in the M portion of the closure. Dr. Krishnan, director of dermatologic surgery at Indiana University, Indianapolis, said he uses a No. 11 blade to remove the Burow's triangles because that blade gives better precision.

"The M portion closes as a broken line, which, as we know, is less noticeable than a straight line," he said.

Dr. Krishnan said he uses the technique primarily when he does not want the closure excisions to extend into an adjacent cosmetic unit, or when he does not want to interrupt a structure such as the eyebrow or the nose.

Dr. Krishnan said he did not know whether his technique was unique, but it has not been described in the dermatology literature.

"It is extremely easy to execute and involves cutting out less skin," Dr. Krishnan added.

PALM DESERT, CALIF.—Use of the "nested" M-plasty technique makes it possible to further shorten round wounds when closing Mohs defects, Dr. Ravi Krishnan said at the annual meeting of the American Society for Dermatologic Surgery.

The technique involves making two Ms, instead of one, in the M portion of the closure. Dr. Krishnan, director of dermatologic surgery at Indiana University, Indianapolis, said he uses a No. 11 blade to remove the Burow's triangles because that blade gives better precision.

"The M portion closes as a broken line, which, as we know, is less noticeable than a straight line," he said.

Dr. Krishnan said he uses the technique primarily when he does not want the closure excisions to extend into an adjacent cosmetic unit, or when he does not want to interrupt a structure such as the eyebrow or the nose.

Dr. Krishnan said he did not know whether his technique was unique, but it has not been described in the dermatology literature.

"It is extremely easy to execute and involves cutting out less skin," Dr. Krishnan added.

PALM DESERT, CALIF.—Use of the "nested" M-plasty technique makes it possible to further shorten round wounds when closing Mohs defects, Dr. Ravi Krishnan said at the annual meeting of the American Society for Dermatologic Surgery.

The technique involves making two Ms, instead of one, in the M portion of the closure. Dr. Krishnan, director of dermatologic surgery at Indiana University, Indianapolis, said he uses a No. 11 blade to remove the Burow's triangles because that blade gives better precision.

"The M portion closes as a broken line, which, as we know, is less noticeable than a straight line," he said.

Dr. Krishnan said he uses the technique primarily when he does not want the closure excisions to extend into an adjacent cosmetic unit, or when he does not want to interrupt a structure such as the eyebrow or the nose.

Dr. Krishnan said he did not know whether his technique was unique, but it has not been described in the dermatology literature.

"It is extremely easy to execute and involves cutting out less skin," Dr. Krishnan added.

SAN FRANCISCO — Two head-to-head comparison trials of micafungin found that it was as effective as older antifungals in treating invasive candidiasis, according to presentations at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for treatment of esophageal candidiasis and for prophylactic treatment of patients undergoing bone marrow transplantation.

Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, said Dr. Robert Betts, a professor of medicine at the University of Rochester, New York.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, Dr. Betts said.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75%, compared with 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

In the second study, micafungin was compared with liposomal amphotericin B in 98 children with Candida infection, 91% of whom had candidemia.

Micafungin had an overall success rate of 72%, compared with 76% for liposomal amphotericin B. In patients with neutropenia, micafungin was effective in 85%, compared with 77% for amphotericin B. Neither of these differences was statistically significant, said Dr. Antonio Arrieta, an infectious disease specialist at Children's Hospital Orange County, Orange, Calif.

The majority of patients had a Candida infection other than C. albicans; the most common other species was C. parapsilosis. Micafungin treatment was successful in 80% of patients with C. parapsilosis, compared with 60% for liposomal amphotericin B, a difference that was not statistically significant.

No differences in treatment were found between children less than 2 years of age and older children, but the differences observed were mainly in the adverse effects, Dr. Arrieta said. Serious adverse events occurred in 4% of the patients treated with micafungin and 9% of the patients treated with liposomal amphotericin B. “I think the safety of [micafungin] is what has changed my practice,” Dr. Arrieta said in an interview at the meeting.

Both studies were sponsored by the manufacturer of micafungin, Astellas Pharma.

SAN FRANCISCO — Two head-to-head comparison trials of micafungin found that it was as effective as older antifungals in treating invasive candidiasis, according to presentations at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for treatment of esophageal candidiasis and for prophylactic treatment of patients undergoing bone marrow transplantation.

Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, said Dr. Robert Betts, a professor of medicine at the University of Rochester, New York.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, Dr. Betts said.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75%, compared with 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

In the second study, micafungin was compared with liposomal amphotericin B in 98 children with Candida infection, 91% of whom had candidemia.

Micafungin had an overall success rate of 72%, compared with 76% for liposomal amphotericin B. In patients with neutropenia, micafungin was effective in 85%, compared with 77% for amphotericin B. Neither of these differences was statistically significant, said Dr. Antonio Arrieta, an infectious disease specialist at Children's Hospital Orange County, Orange, Calif.

The majority of patients had a Candida infection other than C. albicans; the most common other species was C. parapsilosis. Micafungin treatment was successful in 80% of patients with C. parapsilosis, compared with 60% for liposomal amphotericin B, a difference that was not statistically significant.

No differences in treatment were found between children less than 2 years of age and older children, but the differences observed were mainly in the adverse effects, Dr. Arrieta said. Serious adverse events occurred in 4% of the patients treated with micafungin and 9% of the patients treated with liposomal amphotericin B. “I think the safety of [micafungin] is what has changed my practice,” Dr. Arrieta said in an interview at the meeting.

Both studies were sponsored by the manufacturer of micafungin, Astellas Pharma.

SAN FRANCISCO — Two head-to-head comparison trials of micafungin found that it was as effective as older antifungals in treating invasive candidiasis, according to presentations at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for treatment of esophageal candidiasis and for prophylactic treatment of patients undergoing bone marrow transplantation.

Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, said Dr. Robert Betts, a professor of medicine at the University of Rochester, New York.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, Dr. Betts said.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75%, compared with 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

In the second study, micafungin was compared with liposomal amphotericin B in 98 children with Candida infection, 91% of whom had candidemia.

Micafungin had an overall success rate of 72%, compared with 76% for liposomal amphotericin B. In patients with neutropenia, micafungin was effective in 85%, compared with 77% for amphotericin B. Neither of these differences was statistically significant, said Dr. Antonio Arrieta, an infectious disease specialist at Children's Hospital Orange County, Orange, Calif.

The majority of patients had a Candida infection other than C. albicans; the most common other species was C. parapsilosis. Micafungin treatment was successful in 80% of patients with C. parapsilosis, compared with 60% for liposomal amphotericin B, a difference that was not statistically significant.

No differences in treatment were found between children less than 2 years of age and older children, but the differences observed were mainly in the adverse effects, Dr. Arrieta said. Serious adverse events occurred in 4% of the patients treated with micafungin and 9% of the patients treated with liposomal amphotericin B. “I think the safety of [micafungin] is what has changed my practice,” Dr. Arrieta said in an interview at the meeting.

Both studies were sponsored by the manufacturer of micafungin, Astellas Pharma.

SAN FRANCISCO — Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, Dr. Robert Betts reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for esophageal candidiasis and prophylactic treatment of bone marrow transplant patients.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, said Dr. Betts, a professor of medicine at the University of Rochester, New York.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75% vs. 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

The study was sponsored by Astellas Pharma, manufacturer of micafungin.

SAN FRANCISCO — Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, Dr. Robert Betts reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for esophageal candidiasis and prophylactic treatment of bone marrow transplant patients.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, said Dr. Betts, a professor of medicine at the University of Rochester, New York.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75% vs. 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

The study was sponsored by Astellas Pharma, manufacturer of micafungin.

SAN FRANCISCO — Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, Dr. Robert Betts reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for esophageal candidiasis and prophylactic treatment of bone marrow transplant patients.

The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.

There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, said Dr. Betts, a professor of medicine at the University of Rochester, New York.

The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75% vs. 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.

Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.

“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.

The study was sponsored by Astellas Pharma, manufacturer of micafungin.

SEATTLE — Obesity costs the United States $49 billion for each group of 4 million children born, according to findings presented by Dr. Matthew M. Davis at the annual research meeting of AcademyHealth.

That $49 billion figure reflects the present rate of obesity, not the expanding rate actually occurring, said Dr. Davis, of the department of pediatrics and internal medicine at the University of Michigan, Ann Arbor.

Dr. Davis' research involved constructing a model that calculated the longitudinal costs of being obese—from ages 3 to 65—for the percentage of individuals who are obese at every age. Currently, the average number of children born annually is 4 million.

The model suggests that the percentage of individuals who are overweight or obese does not really change much before age 16, because some individuals gain and lose weight as they grow and cycle from being overweight to normal weight. But that percentage begins to climb at age 16 years, as the likelihood of being overweight or becoming overweight at that age and then returning to a normal weight declines. The rate begins its steepest climb when individuals are about 25–35 years of age.

Significant differences in health care costs for persons who are obese do not begin to occur before age 40 years, Dr. Davis said. But then they continue to increase so that by age 50 each individual incurs excess costs averaging $2,000 a year.

The $49 billion extra spent for obese individuals between the ages of 3 and 65 is composed of $44 billion in direct health care costs and $5 billion in days of lost work.

Dr. Davis also attempted to predict what impact various proven obesity interventions would have if they were implemented nationwide. However, he found he could not, because none of the studies about those interventions had any longitudinal information on the individuals once the intervention was stopped.

He said there are five public health interventions that most experts agree have been shown to work to reduce obesity rates. All five of those public health interventions involve targeting children, mostly those between 9 and 12 years of age. The public health intervention shown to have the biggest impact on reducing obesity rates is eliminating the sale of soda in schools, Dr. Davis said.

In his study, Dr. Davis had to assume the effect of the interventions stopped when the intervention ceased; in such a scenario, the interventions had minimal impact. Getting soft drinks out of schools would save only about $650 million. All of the other four interventions combined would result in savings of another $300 million.

Dr. Davis commented that the effective interventions are all programs that were implemented in schools. This is a problem, he pointed out, because the people needing the most intervention are in the 20- to 30-year age range.

Data for Dr. Davis' study were culled from a variety of sources, including the National Longitudinal Survey of Youth and the Medical Expenditure Panel Survey.

SEATTLE — Obesity costs the United States $49 billion for each group of 4 million children born, according to findings presented by Dr. Matthew M. Davis at the annual research meeting of AcademyHealth.

That $49 billion figure reflects the present rate of obesity, not the expanding rate actually occurring, said Dr. Davis, of the department of pediatrics and internal medicine at the University of Michigan, Ann Arbor.

Dr. Davis' research involved constructing a model that calculated the longitudinal costs of being obese—from ages 3 to 65—for the percentage of individuals who are obese at every age. Currently, the average number of children born annually is 4 million.

The model suggests that the percentage of individuals who are overweight or obese does not really change much before age 16, because some individuals gain and lose weight as they grow and cycle from being overweight to normal weight. But that percentage begins to climb at age 16 years, as the likelihood of being overweight or becoming overweight at that age and then returning to a normal weight declines. The rate begins its steepest climb when individuals are about 25–35 years of age.

Significant differences in health care costs for persons who are obese do not begin to occur before age 40 years, Dr. Davis said. But then they continue to increase so that by age 50 each individual incurs excess costs averaging $2,000 a year.

The $49 billion extra spent for obese individuals between the ages of 3 and 65 is composed of $44 billion in direct health care costs and $5 billion in days of lost work.

Dr. Davis also attempted to predict what impact various proven obesity interventions would have if they were implemented nationwide. However, he found he could not, because none of the studies about those interventions had any longitudinal information on the individuals once the intervention was stopped.

He said there are five public health interventions that most experts agree have been shown to work to reduce obesity rates. All five of those public health interventions involve targeting children, mostly those between 9 and 12 years of age. The public health intervention shown to have the biggest impact on reducing obesity rates is eliminating the sale of soda in schools, Dr. Davis said.

In his study, Dr. Davis had to assume the effect of the interventions stopped when the intervention ceased; in such a scenario, the interventions had minimal impact. Getting soft drinks out of schools would save only about $650 million. All of the other four interventions combined would result in savings of another $300 million.

Dr. Davis commented that the effective interventions are all programs that were implemented in schools. This is a problem, he pointed out, because the people needing the most intervention are in the 20- to 30-year age range.

Data for Dr. Davis' study were culled from a variety of sources, including the National Longitudinal Survey of Youth and the Medical Expenditure Panel Survey.

SEATTLE — Obesity costs the United States $49 billion for each group of 4 million children born, according to findings presented by Dr. Matthew M. Davis at the annual research meeting of AcademyHealth.

That $49 billion figure reflects the present rate of obesity, not the expanding rate actually occurring, said Dr. Davis, of the department of pediatrics and internal medicine at the University of Michigan, Ann Arbor.

Dr. Davis' research involved constructing a model that calculated the longitudinal costs of being obese—from ages 3 to 65—for the percentage of individuals who are obese at every age. Currently, the average number of children born annually is 4 million.

The model suggests that the percentage of individuals who are overweight or obese does not really change much before age 16, because some individuals gain and lose weight as they grow and cycle from being overweight to normal weight. But that percentage begins to climb at age 16 years, as the likelihood of being overweight or becoming overweight at that age and then returning to a normal weight declines. The rate begins its steepest climb when individuals are about 25–35 years of age.

Significant differences in health care costs for persons who are obese do not begin to occur before age 40 years, Dr. Davis said. But then they continue to increase so that by age 50 each individual incurs excess costs averaging $2,000 a year.

The $49 billion extra spent for obese individuals between the ages of 3 and 65 is composed of $44 billion in direct health care costs and $5 billion in days of lost work.

Dr. Davis also attempted to predict what impact various proven obesity interventions would have if they were implemented nationwide. However, he found he could not, because none of the studies about those interventions had any longitudinal information on the individuals once the intervention was stopped.

He said there are five public health interventions that most experts agree have been shown to work to reduce obesity rates. All five of those public health interventions involve targeting children, mostly those between 9 and 12 years of age. The public health intervention shown to have the biggest impact on reducing obesity rates is eliminating the sale of soda in schools, Dr. Davis said.

In his study, Dr. Davis had to assume the effect of the interventions stopped when the intervention ceased; in such a scenario, the interventions had minimal impact. Getting soft drinks out of schools would save only about $650 million. All of the other four interventions combined would result in savings of another $300 million.

Dr. Davis commented that the effective interventions are all programs that were implemented in schools. This is a problem, he pointed out, because the people needing the most intervention are in the 20- to 30-year age range.

Data for Dr. Davis' study were culled from a variety of sources, including the National Longitudinal Survey of Youth and the Medical Expenditure Panel Survey.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said. “We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement.”

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said. “We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement.”

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said. “We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement.”

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item. At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item. At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item. At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

At UC Davis and some of the other institutions, efforts are being made to help patients who previously might have benefitted from receiving free drug samples or devices; these items have been very helpful, especially for lower-income patients, Dr. Albertson noted. The university is going to try to purchase some of the equipment that has been donated in the past, such as training inhalers for asthma patients and supplies for those with diabetes. “We're going to make every effort to buy them” for use by lower-income patients, he added.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late 2006 to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins institutions such as Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July.

The new policy “picks off the low-lying fruit” in an attempt to create a greater distance between clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “I think the academic medical centers needed a little nudge.”

At the academic medical centers, free meals appear to be the big issue impeding acceptance of the policies. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late 2006 to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins institutions such as Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July.

The new policy “picks off the low-lying fruit” in an attempt to create a greater distance between clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “I think the academic medical centers needed a little nudge.”

At the academic medical centers, free meals appear to be the big issue impeding acceptance of the policies. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late 2006 to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins institutions such as Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July.

The new policy “picks off the low-lying fruit” in an attempt to create a greater distance between clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295:429–33).

The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “I think the academic medical centers needed a little nudge.”

At the academic medical centers, free meals appear to be the big issue impeding acceptance of the policies. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295: 429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295: 429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.

SACRAMENTO — Another medical school has joined what could be a growing movement to ban faculty and residents from accepting any gifts whatsoever from drug company representatives.

The University of California, Davis, Health System decided in late November to forbid its medical staff to accept any gifts from drug salesmen, including drug samples, pens, mugs, and meals, however small they might be. Earlier, the school had banned drug company representatives from walking into the clinical areas on a preceptorship.

By taking this action, the school joins a cadre of institutions that includes Yale University, which implemented its policy in 2005, the University of Pennsylvania, which did so in July 2006, and Stanford University, which implemented its policy in October 2006. At UC Davis, the policy goes into effect in July 2007.

The new prohibition “picks off the low-lying fruit” in an attempt by the institution to create a greater distance between its clinical practice and the pharmaceutical industry, said Dr. Timothy E. Albertson, the university system's executive director of clinical care.

The school has plans to look at the issue of conflict of interest in further detail, particularly in regard to relationships with and practices of other vendors, he said.

“We're certainly not trying to change capitalism, but we are trying to redefine the ethics of this type of involvement,” he said.

The efforts at UC Davis and the other academic medical centers were spurred in part by an article in the Journal of the American Medical Association (2006;295: 429–33). The article noted that many authoritative bodies, including the Pharmaceutical Research and Manufacturers of America and government agencies, have made attempts to curtail practices that constitute a conflict of interest for physicians. But the article also said those actions have largely failed to change the current climate. Thus, the 11 authors of the paper urged academic medical centers to take the lead by, among other things, banning the acceptance of gifts, samples, and payment for time spent at meetings.

Academic medical centers need to adopt such policies because the medical profession looks to them for leadership, and because academic medical centers shape the ethics of the profession, the proposal said.

The article notes that 90% of the marketing dollars spent by the pharmaceutical industry were directed at doctors, despite the increase in money spent on direct-to-consumer marketing in recent years.

According to IMS Health, a pharmaceutical information and consulting company, drug companies spent $27 billion on product promotion in 2004, of which $16 billion was for free drug samples and $7.3 billion, including gifts and meals, went to sales representative contacts.

The pharmaceutical industry, which adopted strict guidelines on gift giving in 2002, says that limiting the practices and access of their sales representatives will deprive physicians of the best expertise on their medicines.

But gifts, however insignificant, establish an unspoken quid pro quo between physicians and pharmaceutical companies. If gifts did not serve this purpose, companies would not give them, the JAMA authors say. They note that the research bears this out.

According to a 2003 survey of more than 1,000 third-year medical students, an average third-year student receives one gift or attends one company-sponsored activity a week (JAMA 2005;294:1034–42). That is precisely the point of the no-gift policies proposed by the JAMA article, said one of its authors, Dr. Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine.

“These meals and gifts give residents and trainees the idea that pharmaceutical largesse is all right and the way things work, but it taints the profession,” Dr. Kassirer said in an interview. “They wouldn't pass out these gifts if it didn't matter.

“I think the academic medical centers needed a little nudge,” he added, noting the impact the article appears to be having. “It's a beginning.”

At the academic medical centers, free meals appear to be the biggest issue impeding acceptance of the policies among staff. The free meals allow physicians to attend midday meetings they otherwise would not have time to attend, and they are a big ticket item.

At the UC Davis Cancer Center alone, it is estimated that companies spend about $70,000 on free lunches a year. The center will now pick up those costs, and other departments may have to do the same.

At the University of Pennsylvania Health System, the adoption of its policy caused some grumbling at first, along with the loss of some legitimate educational programs that were sponsored. For the most part, however, physicians and other staff members have adjusted, said Dr. Patrick J. Brennan, the chief medical officer of the university health system.

He said there is “much less evidence” of sales representatives around the clinics and school. At one suburban clinic run by the university, sales reps turned in their identification badges in protest; but, he believes, the sales force may have adjusted. He has lately seen an increasing number of medical education programs offered to faculty and staff sponsored by a third party hired by a drug company.