Trudy Haugen has been doing a lot of shopping over the past few months.

The office manager for the Madras Medical Group has stocked up on pens, notepads, staplers and other supplies as the physician office prepares to clean out its storage closets and toss all pharmaceutical-industry paraphernalia.

The small clinic of five physicians and one physician assistant recently adopted standards created through an American Medical Student Association movement dubbed ”Pharm-Free.” The physician office will no longer accept gifts from pharmaceutical sales representatives, including everything from notepads and pens to lavish lunch spreads and free drug samples. The supplies are marketing tools to promote medications.

”We decided it was time to get the pharmaceutical companies out of our office,” said Dr. Doug Lieuallen of Madras Medical. ”Everybody is behind this, although some of us are more enthusiastic than others.”

Physicians and employees often enjoy the gifts, Lieuallen said, and some in the community argue the free drug samples help patients who could otherwise not afford the medications.

But free samples eventually run out and may leave patients no better off than they were before they tried the drug, he said.

”A person comes in without much money and at the end of the samples they can’t afford the drugs,” Lieuallen said. ”Maybe we shouldn’t have started them on it in the first place.”

Plus, he said, physicians can’t be sure the information given them by pharmaceutical representatives is credible, as it obviously has a bias toward the company standing to profit from sales of the drug.

Instead, physicians at Madras Medical will educate themselves about new medications to determine what to prescribe patients.

The philosophy of self-education about drugs is encouraged by the pharmaceutical industry, said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America in Washington D.C., a trade organization representing pharmaceutical companies.

”We do encourage doctors to get information about medicines from a wide range of sources,” Trewhitt said. ”We encourage them to read the literature, journals, to listen to representatives from generic companies if they visit and they certainly should listen to the sales personnel from the innovative brand companies as well.”

He said that sales representatives are well-trained, often with a technical background, and that physicians control the length and scope of meetings.

But, Haugen said, the meetings are disruptive to busy physicians’ schedules and representatives will no longer be allowed to take up time at Madras Medical, unless they pay a price.

”I’ve offered to the pharmaceutical companies, you can continue still coming here, but don’t leave any gifts. The money you would normally spend in our office you can donate to our local pharmacy,” Haugen said. ”That way if we had a patient here that needed medication that they couldn’t afford, they would still have a way of getting that medication.”

So far, none of the pharmaceutical representatives have taken Haugen up on her offer.

Because some of the physicians have been on vacation, Haugen said she chose Jan. 13 as the day to purge the office of its many sponsor-advertised supplies, so all can participate.

”Through the years we have been noticing the gifts we get from them increasing. We get everything from clocks to staplers to forms that we would use every day with their name on it. Pens, pencils, sticky notes, cups – just about anything you can think of,” Haugen said. ”We started thinking about all of these gifts and all of these things the pharmaceutical companies do to wine and dine us. How does that play a roll in how much our patients pay for those medications?”

But Trewhitt said the free samples truly are meant as a stop-gap measure to help patients who can’t afford prescription drugs get the medications they need. He also said there are more than 475 patient assistance programs in the country that help low-income patients access medications after they no longer qualify for free samples.

”Free samples allow doctors to determine whether medicines are useful to their patients with no obligation to continue using them if they are not,” Trewhitt said.

Because of a change to marketing rules adopted by the industry group in July 2002, Trewhitt said physicians complain less about interruptions and giveaways from sales representatives. The rules say gifts can be worth no more than $100, that entertainment can not be a part of the marketing meeting and that only modest meals can be provided while business is discussed.

”A lot of these complaints you don’t hear very often anymore,” Trewhitt said.

Yet, the idea of going Pharm-Free is not new. The American Medical Student Association has been pushing the slogan for several years and a group of physicians began an activist organization several years ago called No Free Lunch, to encourage physicians to give up giveaways.

”What the Madras clinic is doing is very interesting, but it is certainly not unique either to the rest of the country or to Oregon,” said Jim Kronenberg, of the Oregon Medical Association. Kaiser Permanente and Providence Medical Group, both in Portland, have similar policies in place, he said.