No free lunch: Drug makers' gifts can bias students, warns University of Vermont medical student Justin Sanders. Credit: Ann Chauncey

Jake Donaldson, a third-year medical student at the University of Washington, has lately been offered a few free things: a couple of textbooks left in his mailbox, pens and lunches at the medical center—all courtesy of a pharmaceutical company.

Drug companies in 2002 adopted new guidelines to cut back on expensive meals and other lavish perks for doctors. They instead began pitching their products over modest lunches in doctors' offices and hospitals, including those where medical students learn. Whether accepting small gifts can influence behavior is a much debated matter that has thus far focused primarily on doctors.

But Donaldson and his fellow students say the gifts are a threat to students' integrity.

In May, they drew up a petition—which more than half of the first- and second-year students have since signed—calling on the university to ban representatives of pharmaceutical companies from campus, prohibit students from accepting gifts and require full financial disclosure from guest speakers.

A good medical school shouldn't expose students to doctors receiving gifts. Robert Alpern, Yale University School of Medicine

“The students really want to be sure their education isn't biased by pharmaceutical companies,” says Thomas Norris, vice dean for academic affairs. Norris says the administration is working with students to develop a policy that should be finalized later this year.

In 2005, only 10 of the 126 medical schools in the US had such policies in place, but the number is rising. In February, Yale University School of Medicine banned all gifts and on-campus meals from drug companies, followed in July by the University of Pennsylvania. The University of Vermont and the University of New Mexico are crafting guidelines.

“A good medical school shouldn't expose students to doctors receiving gifts for four years,” says Robert Alpern, dean of Yale's medical school. Otherwise, he says, “they come to accept it as the norm.”

At least one drug company, Pfizer, says promotions are aimed at doctors, not students. “When content is delivered in a medical institution such as a teaching hospital, students are exposed,” says spokesperson Alison Lehanski.

Still, students, like doctors, are susceptible to the industry's multibillion dollar marketing machine, says Frederick Sierles, a psychiatry professor at Rosalind Franklin University in Chicago. In a study of 826 third-year students at eight medical schools, Sierles found that students interact with drug companies about once a week, and tend to view gifts and activities sponsored by drug companies as valuable (JAMA 294, 1034–1042; 2005).

The American Medical Student Association's voluntary guidelines recommend that doctors, residents and students not accept promotional gifts. The association in 2002 launched the PharmFree campaign to educate students about the influence of drug companies.

“Medical students can quickly feel entitled to the perks pharmaceutical companies shower doctors and students with, and think they won't be biased,” says Justin Sanders, chair of PharmFree and a student at the University of Vermont.

Students might be more skeptical of drug companies if medical schools address the issue formally, says Sierles. But a greater challenge, he says, will be to convince the students' mentors to stop accepting gifts.

“As long as physicians accept gifts and deny it's affecting them and students see this in their role models,” he says, “we aren't going to see a radical shift.”