Anthony Fleg, MD, MPH – Medical Reformer and Community Activist

Dr. Anthony Fleg is a Family Practice Resident at the University of New Mexico in Albuquerque, New Mexico. In addition to his work with the Native Health Initiative, he is committed to reforming the influence that the pharmaceutical companies wield in the nation’s healthcare. We recently met with Dr. Fleg to get his thoughts. 

In 2008, as part of your advocacy against undue influence by the drug companies, you were called as a witness to testify before Congress . Were you nervous? What didn’t you say that you wished you had said?

Aside from the Native Health Initiative, one of the most exciting opportunities that has come my way was the chance to lead the American Medical Student Association’s (AMSA) PharmFree campaign, a movement to address and eliminate the conflicts of interest in medicine that arise when industry influences too much of the science and decision making.

As part of this, I submitted written testimony to U.S. Congress, and also spoke at a Congressional briefing, taking a stand for patient-centered, conflict-free, evidence-based medicine.

I think the most important lesson I took away from these moments in Capitol Hill is the tremendous opportunity and responsibility physicians have to work for larger level changes for the good of our patients and communities.

How did you get involved with the PharmFree program at the AMSA? Are you still involved and if so what is your role?

I got involved in the PharmFree campaign because I saw the influence of pharmaceutical companies in every clinic at my medical school.

I saw an immediate conflict between this presence of advertising in our clinics, lunchrooms, and hospitals with the Hippocratic ethics of our profession, ones that require us to do only that which is in the best interest of our patients.

As I would counsel students, when an issue becomes important to you and you see a group out there doing something about it, join them and think about taking leadership in the effort.

Moreover, in my year of leading PharmFree (2007-8) we took a proactive approach, refraining from attacks on industry, medical education, etc.

Instead we went about the work with a simple mission – to reclaim the ethics of medicine by removing conflicts of interest and rest0ring the sanctity of the patient-physician relationship.

 What concrete difference did PharmFree progam make in changing the prescribing or practice patterns in America?

One of the things PharmFree has done most effectively was to create the PharmFree Scorecard (www.amsascorecard.org), grading each U.S. medical school (M.D. and D.O.) on their conflicts of interest policies.

When deans of medical schools began calling their local AMSA leaders into their offices, demanding to know why their school received an “F” on the Scorecard, we knew that we had truly struck a chord.

In the last three years, we have seen an explosion of schools adopting strict conflicts of interests policies, and have even seen the accrediting bodies of medical education take the issue more seriously.

 

It seems that our “No Academic Medical Center Left Behind” motto has quickly become a reality,  with schools racing to develop policies. I would safely say that some of this momentous change in culture around conflicts of interest was due to the efforts of the PharmFree campaign.

 One other recent event that medical students might be interested in occured in the summer of 2009, again showing how important our voices are as physicians in training.

 U.S. Senator Chuck Grassley, a strong proponent of tighter ethical standards in health care, heard that a certain number of schools had not responded to the AMSA PharmFree Scorecard.

He promptly sent personal letters to the 23 schools in this category, requesting that they disclose their school’s position and action steps toward eliminating conflicts of interest.

How do you respond to critics who claim that Pharma is a legal, licensed, for profit industry trying their best to sell their wares and they have a right to try to influence the market to their advantage? Much like, say, trial attorneys, the defense industry or for that matter the Federal Reserve.

I agree that companies, hospitals, and clinicians all have the right to profit off of healthcare.

However, with PharmFree the focus was not on attacking drug companies, but rather on changing the culture within medicine and medical education.

After all, patients put their trust in doctors to do what is best for them; they do not entrust drug companies with their lives and bodies, and therefore it is those of us in medicine who need to take seriously the commitment we have to refrain from the bribes the industry throws at us – all of which is advertising to help increase their profits, much of which is done under the guise of “education”.

It would be hypocritical to point fingers at the industry while a majority of physicians still think it is ethical to be wined and dined by healthcare industries.

Have you ever accepted or used a complimentary product from a drug company or rep – including a coffe mug or pen that was imprinted with a logo?

 Yes and yes. Before I became PharmFree, in my early years of medical school, I took lunches and all of the trinkets offered to me.

At one point, I remember saying, “You know, my default should be that I won’t take another gift until I do my homework, and can assure myself that taking these gifts will not influence me,” – as opposed to the default of “Everyone else, including my mentors, are doing it, so why shouldn’t I do the same?”.

The rest is history, as the literature is unequivocal in terms of supporting what all of the companies and advertising gurus know – doctors, like the rest of folks, can be bought and influenced by drug samples, gifts, lunches, conferences and all of the other means of advertising used by the drug industry.

 And I do occasionally still use drug pens and other items, but only if I have affixed the item with a nifty “PharmFree – Liberated” sticker that is used to cover up the industry logo, turning the item into a liberated, conflict-free item.

 Do you favor a public option for healthcare insurance?

I favor a nationalized health care system, one similar to the systems found in every other country in the industrialized world.

I think that the incredible amount our country spends on health care, combined with the abysmal results we get for the trillions of dollars we are spending, elucidates the problem with a system where profit interests are too powerful, where rationing happens in an irrational and erratic manner, and where we have no true unified system of healthcare for our country.

I think a public option might be the most politically palatable first step toward this, and if done right – which is a big if given that industry interests are sure to do their best to weaken it to the point of being ineffective, as we have seen in Maine, it will lead us to see that running health care on a capitalist, free-market principles is simply not in the best of interest of our country.