Title:PharmedOut Turns 10

Program looks at industry influence in pharmaceutical marketing, asks the tough questions

Fueled by both a passion to tackle major public health issues, and an ever-flowing stream of espresso and homemade cookies, Adriane Fugh- Berman, MD (M’88), has a full plate. When she isn’t teaching students, organizing conferences, or gardening on the roofs and grounds of the Georgetown campus, the pharmacology and physiology professor serves as director of PharmedOut, a GUMC research and education project examining pharmaceutical industry marketing practices and supporting evidence-based, cost-effective prescribing. PharmedOut has continued to expand since Fugh-Berman launched it 10 years ago with funds from a grant created by a multiple-state claims settlement against illegal drug marketing.

“When I saw an announcement in 2006 that the attorneys general had started a grant program to educate consumers and prescribers about pharmaceutical company influence, it just felt like that had my name on it,” Fugh-Berman says.

PharmedOut grew from her interest in the forces at work that may not be visible to the public but may impact public health. Pharmaceutical and medical device companies can influence everything from what health care practitioners learn and choose for treatment, to how government regulates the industry.

In the 10 years since the project began, PharmedOut members have published dozens of articles in biomedical literature, educated health care providers through grand rounds and lunch seminars at hospitals, pioneered the first peer-reviewed papers on how industry representatives influence others (from surgeons and pharmacists to payers and people with expensive diseases), testified at FDA hearings, and inspired scientists and ethicists to take a stand against conflicts of interest.

The organization also collaborates with the D.C. Department of Health to analyze prescription drug marketing costs, and to offer non-commercial, independent continuing education free of charge to D.C. physicians and health care professionals through the D.C. Center for Rational Prescribing (DCRx). By contrast, industry-funded continuing medical education offers a prime example of potential conflict of interest.

“Lawyers and accountants and aerobics instructors pay for their own continuing education,” notes Fugh-Berman. “And yet in medicine, we think it’s perfectly okay for the people who stand to profit from

our decisions to educate us. It’s really a problem. Even well-meaning physicians who don’t see drug reps and don’t go to company-funded meetings are still getting misinformation from conventional sources, because corporate influence permeates many of the sources of information that health care providers have.”

Industry manipulation can take many forms, including a practice known as “disease mongering.” Companies may brand common human discomforts associated with menopause, overeating, shyness, or low libido as medical conditions requiring pharmaceutical remedies.

Alison O’Rourke Windels, MD (C’10, M’14), and Grace Lee (MS’15), winners of the 2017 PharmedOut conference’s student abstract competition, researched 60 online CME modules on male hypogonadism and found much of the information to be misleading. After interning with PharmedOut as a master’s student in physiology, Lee gained a critical eye for reliable and impartial sources of medical education, a perspective she took with her to medical school at UCLA.

“Part of why I’m attracted to the work of PharmedOut is that it talks about information that medical students often don’t learn about,” Lee says. “As a future physician, I’m more aware of how variable CMEs can be, and that they’re not necessarily all accurate.”

PharmedOut has trained more than 100 interns and several volunteers. In 2015, the biennial conference drew 140 registered attendees. At the 2017 conference, looking at industry influence on medical discourse, registration rose to 210.

“The conference attracts a great mix of individuals from a variety of health professions, including doctors, nurses, lawyers, pharmacists, researchers, students, and patient advocates,” says Alycia Hogenmiller, project manager and sole full-time staff person for PharmedOut. Cross-disciplinary dialogues at communal lunch tables further enrich the conference experience for attendees, she says—conversations sparked by the engaging and provocative content from presenters.

Georgetown’s emphasis on public policy draws a strong pool of studentleaders to the PharmedOut program. Fugh-Berman can recall interns who arrived as timid pre-med students, but left as future physician-advocates determined to use their medical degrees to change public policy.

“We may be giving students unrealistic expectations of how much can be accomplished by a few people with a limited budget and a limited amount of time,” says Fugh-Berman with a smile. “But it’s wonderful to see them grow into concerned and effective citizens. They are empowered to try and change things. That, to me, is our most important success.”

A sample of industry-free, web-based continuing education modules available through PharmedOut and DCRx

Drug Approval and Promotion in the United States
Medical Cannabis: An Introduction to Biochemistry & Pharmacology
Getting Patients Off of Opioids
Rational Prescribing in Older Adults
Generic Drugs: Myths & Facts