I realized last night while reflecting on the annual meeting of the American Society of Clinical Oncology that concluded yesterday in Orlando that my luggage on the trip home was much lighter than in years past. 

The reason?  New pharmaceutical regulations prohibited the drug companies from giving me “anything of value,” namely pens, bags, calendars or whatever they could come up with to give to me and other attendees at the conference to gain attention for their products.

I must admit that I now feel much more pure than I have in years past, and much less conflicted since I haven’t been able to gather my supply of pens for the coming year.

But there is another side to this story; a story of unintended consequences that has not been told and that may have far reaching implications for clinical practice and even for groups like ours that work to defeat cancer.

If I seem a bit cynical about this, it’s because I am.  While I can’t get a free pen, I have colleagues out there who are paid a lot of money to speak on behalf of these same companies, “consult” for the companies, and do other activities that provide a substantial income.   But I can be swayed by a pen.  Folks, we need to get real here.

If truth be told, I never spend much time in the exhibit area at these meetings.  And, I really don’t take much of this stuff passed out by the drug companies, some of which can be very useful.  It just doesn’t interest me and I would sooner pay for my own pens anyway.  I must also admit that many of my colleagues like these things.  I particularly remember one year where the meeting rooms were filled with large bright yellow rolling bags boldly emblazoned with the name of the drug company and their highlighted product.  Sales zoomed shortly afterward, although I have no evidence that the yellow bags truly made that happen.

Here is what ASCO wrote in their daily newspaper last Saturday about these new bans on “giveaways”:

“For this year’s Annual Meeting, ASCO changed its policies for exhibitors in order to comply with the rules governing marketing practices in the 2009 Pharmaceutical Researchers and Manufacturers of America (PhRMA) Code. The changes will enhance the ASCO Annual Meeting educational experience and allow all exhibitors an equal opportunity for delivering a substantive, informative message to attendees.

“Under the new policy, all promotional items used by commercial exhibitors must be designed primarily for the education of patients or health care professionals. Items such as textbooks, informational CDs or brochures, and journal reprints all are considered acceptable for distribution. Noneducational giveaways, such as pens or mouse pads, are permitted only for patient advocacy groups and other nonprofit exhibitors. According to a press release from PhRMA, the 2009 code recognizes that, despite the minimal value of these noneducational items, they ‘may foster misperceptions that company interactions with health care professionals are not based on informing them about medical and scientific issues.’ ”

Let me be clear: I don’t blame ASCO for this.  These rules apply to—and are affecting—every medical meeting in the country.

This is a story that has received some attention in the national press.  Yesterday’s Wall Street Journal Health Blog had an article which noted that the traffic in the exhibit area at the ASCO meeting was down considerably from past years, which confirmed my own anecdotal impression.

The doctors visiting the exhibit area may have been fewer in number, but the booths (if we can call them that) the drug companies built for the conference were pretty spectacular.   And some of the companies even had separate booths, one for a doctor to speak to a representative, and another one far away (about half a city block) if there was a question about drugs currently under development and not yet approved by the Food and Drug Administration.

And the “little rooms” I wrote about last year appeared to be gone as well.  Instead, there were wide open lounges labeled “international,” right next to other lounges labeled United States.  You could get a pen or another “promotional item” in the international area, but not in the United States section.

Now the other  side to this story, the part that shows even the best intentions can have some not so good results.

In a comment on Twitter this morning, Jessica Arnold—who is the Director of Development for the National Children’s Cancer Society—wrote, “ASCO was a disappointment.  Didn’t have the exposure we did last year.  New pharma regs had larger impact than people thought—even for charities.” It appears fewer giveaways meant less traffic on the floor, which meant less chance for doctors to interact with advocacy groups and others, and perhaps fewer opportunities to learn about areas of oncology that could help their practice and their patients.

And it goes beyond ASCO.

I happen to be involved in a number of medical organizations, both state and national in focus.  The reality—for better or worse—is that pharmaceutical companies have spent considerable sums supporting these organizations and their annual meetings, even smaller statewide educational meetings here in my home state of Georgia.

In one particular situation recently, one of those groups I work with could not get pharmaceutical companies to buy booth space.  Their rationale was that since they couldn’t give anything away (and in this situation, I promise you the value of the “gifts” was very, very modest and didn’t exceed a keychain or a pen), they felt they couldn’t attract attention to their booth.  No booth, no payment to the organization, and the net result was a substantial financial loss for the meeting.

The sad reality in this circumstance was that the meeting really was educational, with great lengths taken (as currently required by the agency that grants educational credits to doctors for attending these meetings) to avoid any influence from any drug company.  Now, without funding for this multi-day educational session—which may be the one continuing educational gathering that some doctors attend for the year—there may not be the financial support necessary to continue the meeting.  It would be prohibitively expensive.

You may not think that is a problem, but for some of us well-meaning, ethical physicians, it is.   And it comes down to pens and key chains, which may itself seem ridiculous.

But it is the implication that I can be bought for a dime that really bothers me and my colleagues.  Yet when a research paper is presented at ASCO and every author (and there were many on this particular report) are either stockholders in the company, employees of the company or receive considerable compensation from the company, no one raises an eyebrow. It is simply the way business gets done.

This issue is not going to go away.  But reducing it to a promotional pen reflects how far we have come, and how far the consequences of these “regulations” have yet to take us.