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MINNEAPOLIS (AP) ― When the SMDC Health System in Duluth purged almost all the pens, notepads, coffee mugs and other promotional trinkets drug companies had given its doctors over the years, it took 20 shopping carts to haul everything away.
  
The 18,718 items touting pills such as Nexium, Vytorin and Lipitor will soon be shipped off to Cameroon. SMDC Health System joined the growing movement to ban gifts to doctors from drug companies -- with a bang.
  
It scoured its four hospitals and 17 clinics across northeastern Minnesota and northwestern Wisconsin for clipboards, clocks, mouse pads, stuffed animals and other items with drug logos.
  
Trinkets, free samples, free food and drinks, free trips and other gifts used to be pervasive throughout the medical profession, but observers say that's starting to change.
  
"We just decided for a lot of reasons we didn't want to do that any longer," Dr. Kenneth Irons, chief of community clinics for SMDC, said Friday.
  
So SMDC put together a comprehensive conflict-of-interest policy that, among other things limits access to its clinics by drug company representatives. Employees suggested the "Clean Sweep" trinket roundup as a way to get the attention of staff throughout the system to show that it was serious, Irons said.
  
Ken Johnson, a spokesman for the Pharmaceutical Research and Manufacturers of America, had heard of hospitals and clinics banning promotional items before, but SDMC's purge was a new one for him.
  
"I've never seen nor heard of a systematic roundup of pens and coffee mugs before," Johnson said. "It's a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst."
  
SDMC's effort was homegrown, Irons said, motivated by a desire to show patients that SDMC's 450 doctors were serious about keeping prescription drug costs down and making unbiased medical decisions.
  
The backlash against the conflicts of interest that can arise from cozy relationships between doctors and drug makers gained steam from article in the Journal of the American Medical Association in 2006. It said research had shown that even cheap gifts, such as pens, can affect doctors' prescribing decisions.
  
The Prescription Project, funded by the Pew Charitable Trusts and based in Boston, was founded to promote the JAMA article's recommendations for countering aggressive marketing to physicians by the pharmaceutical and medical device industries.
  
Marcia Hams, assistant director of the project, said she hadn't heard of a roundup like SDMC's either, and hopes other health organizations follow its lead.
  
"This seems like a pretty aggressive way to kick off a policy like that," she said. "It sends an important message, I think, for how a strict policy can be implemented in an effective way."
  
Hams said some organizations that have recently adopted strict conflict-of-interest policies, such as gift bans, include the medical centers at the universities of Massachusetts, Pittsburgh, Wisconsin, Michigan, Pennsylvania and California-Davis; Boston University and Stanford University; Kaiser Permanente, the country's largest HMO; and Veterans Affairs hospitals.
  
Many of SMDC's items will be going to the health system of the Evangelical Lutheran Church of Cameroon, which has three hospitals -- in Ngaoundere, Garoua-Boulai, and Ngaoublea -- plus 17 rural health centers.
  
Irons said there shouldn't be a conflict of interest in Cameroon because the advertised drugs aren't available there anyway. In addition, he said, one of the main languages used in medicine there is French.

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