NEW YORK -- Medical schools in several states are boosting programs that teach doctors and students to challenge the sales pitches of drug companies and avoid being dazzled by them.

The pharmaceutical industry spends billions of dollars a year on marketing to doctors -- sometimes throwing lavish events to seal the deal on certain medicines.

Critics say slick promotion is unduly influencing how drugs get prescribed, sometimes to the detriment of patients. A small number of schools are now adding lectures and continuing education seminars aimed at persuading doctors to challenge claims made during sophisticated sales presentations.

"We want to appeal to physicians' natural skepticism," said Dr. Ethan Halm, an associate professor of medicine and health policy at Mount Sinai School of Medicine.

The prestigious Manhattan school is including a new type of training at its Morchand Education Center, famous for its use of actors to play patients.

For these sessions, the actors will play pharmaceutical company sales representatives. The students will be taught "how to effectively spar with the drug reps" by asking aggressive questions, Halm said.

Another part of Mount Sinai's program will advise health care providers how to tactfully deal with patients who see a drug on television and demand a prescription for it.

Almost daily, Halm said, doctors prescribe wonderful but lesser-known medications, only to have patients react as if they've been offered a second-rate imitation.

"They say, 'What about that thing the actor was using on TV? Can I get that instead? My insurance company is paying. Don't give me the cheap stuff,'" Halm said.

Drug makers say there is nothing nefarious about having salespeople meet with doctors to discuss a new drug, and many physicians may there is nothing wrong with listening to a sales pitch over dinner.

Adriane Fugh-Berman, an associate professor at the Georgetown University School of Medicine, said she lectured fourth-year medical students last year about drug company influence on doctors, and got a hostile response.

"Physicians do not believe that they are affected by pharma," she said. "They all say the same thing: 'We are too smart to be bought by a slice of pizza.'"

The number of medical school professors even willing to broach the subject with students in a significant way is still small, she added.

Stanford University in September joined a short list of institutions that have banned doctors from accepting gifts from drug industry sales reps. Others include Yale University and the University of Pennsylvania.

Dr. Jerome Kassirer, a professor at the Tufts School of Medicine and a frequent critic of the doctor-pharmaceutical relationship, said schools need to do more than just lecture.

"The question to ask yourself about these programs is: What are the faculty doing? Because if the students walk away from those sessions and find out their faculty are off speaking for Pfizer, what are they going to think?"

An industry lobbying group, the Pharmaceutical Research and Manufacturers of America, said sales reps help busy doctors understand the proper use, benefits and side effects of drugs.

"They are providing information that is both informative and important for physicians to know about new medicines," said Diane Bieri, the group's deputy general counsel.

Money for some of the university programs about drug advertising comes from a $430 million legal settlement over promotion practices at pharmaceutical giant Pfizer Inc.

The company was accused of illegally paying doctors to prescribe its drug Neurontin for uses that had not been approved by the U.S. Food and Drug Administration. Doctors may generally prescribe pills for whatever use they see fit, but drug companies are barred from promoting medicines for ailments they have not been specifically approved to treat.

The settlement has so far awarded $11 million to 28 institutions. This week nearly $2 million in grants were awarded to Mount Sinai, the University of Arkansas, Florida International University, the University of Minnesota and the Institute on Medicine as a Profession, affiliated with Columbia University.

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By DAVID B. CARUSO
Associated Press Writer

Copyright 2006 Associated Press