Policy FAQs
Gifts, Meals, and Products
Q. Why preclude meals? Do they really affect patient care decisions?
A. Research has shown that even di mimimus gifts, such as pens, engender a sense of obligation on the part of the recipient. Moreover, research has shown that in cases where a doctor has a pen or pad advertising a particular product, that product gets prescribed more often (AMA Guidelines Regarding Industry Interactions; Drug Makers Pay for Lunch as They Pitch, New York Times, July 28, 2006). Thus it has been shown that such gifts, including meals provided by Pharma, can influence the decision-making process. Our goal is to provide our patients with the best, most objective care. This is why we have chosen to eliminate such incentives.
Q. In the past, one of our pharma reps provided lunch for our meetings. Is this still allowed under the new policy? If not, how can we finance our lunches?
A. As discussed above the main thrust of our policy is to eliminate the incentives such as meals, and consequently no meals may be provided by industry anywhere at the School of Medicine, Stanford Hospital and Clinics, the Lucile Packard Children's Hospital, or the Menlo Clinic.
Under the new policy, Industry may provide funds to the department (not an individual), then the department decides how the funds are spent. For more information about this process, see Section IV of the policy and the accompanying documents on the web site. You may also wish to contact the Director for Corporate Relations & New Ventures at (650) 234-0634. Regarding funds received on behalf of LPCH and the Department of Pediatrics, you should contact the Lucile Packard Foundation for Children's Health at (650) 497-8365.
Q. Can a sales rep take a doctor out to lunch or dinner for a business purpose?
A. While our policy does not explicitly prohibit restaurant meals with industry reps, we strongly discourage them because of the implied quid pro quo that is present in such situations. We suggest, instead, that industry reps be invited to meet with Stanford faculty or medical staff in accordance with the site access provisions of this policy, which are described in the next section of these FAQs.
Q. Does the policy affect free samples for needy patients?
A. Yes and no. Free drug samples given directly to individual members of the Stanford University Medical Center are considered personal gifts under this policy and may not be accepted. However, free samples are an important source of pharmaceuticals for needy patients and they may be accepted by the SHC/LPCH pharmacies if processed in accordance with the LPCH/SHC Med Samples Policy. Questions should be directed to the SHC or LPCH Director of Pharmacy (650-723-5970).
Q. Are we allowed to accept free materials and practice models from an outside supplier for resident and student training?
A. No, because there is an implicit expectation that Stanford would purchase these materials or practice models. Such purchasing decisions need to be evaluated on objective criteria and be free of even implied obligation.
Site Access by Sales and Marketing Representatives
Q. Under the policy are sales and marketing reps allowed on the SUMC campus?
A. Industry reps are permitted in both patient-care and non-patient care areas only under very specific circumstances.
For patient care areas, under the Section II-A, medical staff, faculty or staff may request in-service training by industry reps by appointment only on devices and other equipment.
Similarly, under Section II-B, industry reps may be permitted in non-patient care areas by appointment only for such purposes as:
- In-service training of SHC or LPCH personnel for research or clinical equipment or devices already purchased.
- Evaluation of new purchases of equipment, devices, or related items.
Appointments to obtain information about new drugs in the formulary will normally be issued by the hospital pharmacy or by Pharmaceutical and Therapeutics Committees (P&T Committees) This means that faculty and medical staff should not directly make appointments with sales and marketing representatives but should work through the pharmacies or the P&T Committees (Section III-C).
Q. Is it true that sales and marketing representatives may no longer leave any written materials with employees?
A. Yes this is true. Sales and marketing materials from pharma and medical device companies may no longer be left with departments or with medical staff, faculty or staff. The reason for this is to avoid any expectation on the part of the company, and to ensure that we do not promote a company or its products to our patients. If information about a product is needed, then this information may be obtained online or through the library.
Q. Can an industry sales representative provide support in the operating room?
A. While industry reps with appropriate knowledge of a device being used may be useful in the operating room (OR), in order to provide technical support or advice, a company must first register with Materials Management (phone: 650-498-7258) and follow the hospitals' Vendor Management policy.
Industry Funding for Education
Q. I have been invited by a pharmaceutical company to give a talk to community physicians. Am I allowed to do this?
A. University policy allows faculty to consult and such talks would be considered consulting activities. However, we recommend that faculty and staff evaluate very carefully their participation in meetings and conferences that are fully or partially sponsored or run by industry because of the high potential for promotional or marketing activities such 'talks' may portray. In instances in which Stanford faculty and staff do participate in such talks, they should follow these guidelines, which are found in Section IV. E of the policy:
- Financial support by industry is fully disclosed by the meeting sponsor.
- The meeting or lecture content is determined by the speaker and not the industrial sponsor.
- The lecturer is expected to provide a fair and balanced assessment of therapeutic options and to promote objective scientific and educational activities and discourse.
- The Stanford participant is not required by an industry sponsor to accept advice or services concerning speakers, content, etc., as a condition of the sponsor's contribution of funds or services.
- The lecturer makes clear that content reflects individual views and not the views of Stanford School of Medicine, Stanford Hospital and Clinics or the Lucile Packard Children's Hospital.
- The use of the Stanford name in a non-Stanford event is limited to the identification of the individual by his or her title and affiliation.
Q. Is it still allowable for our department to receive grants from industry for scholarships or other educational funds for students and trainees?
A. Yes, and in fact departments are encouraged to seek such funding, so long as it is compliant with Section III of the policy. Such support must be specifically for the purpose of education, and should be free of any actual or perceived conflict of interest. In order to be compliant with the policy it must meet the following conditions:
- The School of Medicine department, program or division selects the student or trainee.
- The funds are provided to the department, program, or division and not directly to student or trainee.
- The department, program or division has determined that the funded conference or program has educational merit.
- The recipient is not subject to any implicit or explicit expectation of providing something in return for the support, i.e., a "quid pro quo."
To ensure compliance with this policy, all gifts and non-government grants received on behalf of the School of Medicine and SHC should be directed to the Director for Corporate Relations & New Ventures, Office of Medical Development at (650) 234-0634.
All gifts and non-government grants received on behalf of LPCH and the Department of Pediatrics should be sent to the Lucile Packard Foundation for Children's Health, 770 Welch Road, Suite 350, Palo Alto, CA 94303, Attention: Gift Processing.
Q. I understand that we no longer allow pharmaceutical sponsors to purchase meals on campus, but what about using gift funds that are derived from unrestricted gifts for research and education?
A. Good question. We do not allow Industry to buy meals for Stanford events. However, the policy does allow pharmaceutical, device, and biotech companies to make gifts to departments or divisions or the CME office (although not to individual faculty members) in support of their educational activities and programs. Both the receipt of such gifts and their use will be governed by the Accrediting Council on Continuing Medical Education's Standards for Commercial Support (ACCME). This will mean, among other things, that the faculty will determine the topics and the choice of speakers for the events funded by industry support. In addition, whereas pharmaceutical sales and marketing representatives may have been present at such activities as grand rounds in the past -- in their roles as company sponsors of the event -- they will no longer be able to be present in that role. (They may, of course, attend public meetings as members of the public, just like anyone else).
The department receiving such unrestricted gifts may choose to use these funds in order to purchase food for educational events. Just be sure that when you use educational grants from the relevant industries to complete the Checklist for Commercial Support of Non-CME Educational Activities found on the policy web site and submit to your department's DFA or other designated individual in your department or division. The completed checklist will serve as the record of your compliance with this policy.
Q. Isn't there a big loophole in the policy if a company can make an education gift to a department and the department can turn around and use that money for the same purpose?
A. It may seem that way, but no there is no loophole. Let's look at the difference. Prior to implementing this policy industry reps provided meals for talks, may have directed the subject of the talk and the speaker, and were at the event with promotional materials. They may have discussed their products with participants. This essentially makes it a company event or rather a "COMPANY X" event. Now when educational events take place they are free of company intervention or direction. If food is provided it is provided by the department. And while the department may have received gift funds from a company that has products in that area, these funds are mixed with all other support and spent according to the department's choosing. Most importantly, no one will feel any obligation to any company. With or without industry support and with or without food incentives educational events will continue at Stanford.
Q. Is it all right for us to request industry sponsors to provide funding for grand rounds we are holding quarterly. These are CME events, and will be held off campus. No sales reps will be present, and we are planning on putting all money collected from these sponsors into one account so we can't say any event is sponsored by a single particular company.
A. We commend your efforts to follow our policy. However, CME events are subject to their own set of rules. If you are organizing a CME event you should work directly with the Office for Continuing Medical Education (http://cme.stanford.edu) so that you comply with their rules for soliciting industry support.
Q. In the past our student group has received Industry support for our fund-raising event. Is this still allowable under the Stanford Industry Interactions Policy?
A. It is fine for to solicit corporate sponsorships for your event. We would just ask two things:
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Please do not have company promotional materials at your event.
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Please touch base with the Director of Corporate Relations in our Office of Medical Development (650-234-0634), about the documentation of the sponsorship. He will make sure that whatever gift letters you use comply with the policy.
Q. A SUMC employee attends a yearly educational conference. Can their travel and hotel costs be paid for by Industry?
A. The policy allows costs to be defrayed if the individual is speaking or actively participating or presenting at the event as long as the costs are reasonable, but not if the employee is simply attending the conference
Q. In the past, our pharma reps paid for and attended our Journal Club meetings, which are held at a restaurant in downtown Palo Alto. Since these are off-site, can this practice continue?
A. No, the practice cannot continue. This is because the Journal Club is a Stanford-sponsored event and so must abide by the Standards for Commercial Support of the Accrediting Council on Continuing Medical Education (ACCME). Section IV of the policy explains how make industry support for educational events compliant with these Standards. For instance, commercial support must be obtained as an unrestricted educational grant to the division or department. The past practice of having pharma reps pay directly for these events is no longer allowable. Furthermore, unless it is a public event, and the industry rep comes as a member of the public, they are no longer allowed to attend.
Q. Can Industry pay for educational brochures to be provided to patients?
A. Understandably such materials may be valuable to patients, but they could also be perceived as promotional, or create a sense of obligation for the department, so, no, it would not be allowed. However most foundations provide educational materials at no cost so these could replace industry brochures. Or a company could make an educational gift to a department, which the department then may decide to use to cover the printing costs of such materials.
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