Even as doctors nationwide face criticism for their methods of prescribing medicine and the U.S. Senate moves to tighten regulation of the pharmaceutical industry, the University Health System is gaining national recognition for its ethical prescription policies.

The American Medical Student Association awarded the University Health System an "A" grade in its national evaluation of 116 medical schools released May 10.

The University was one of five schools whose health systems received an "A" rating by the AMSA - which gave 40 other health systems an "F" - in the association's first annual PharmFree evaluation, a nationwide campaign that rates the precautions taken by American medical schools to separate their operations from the interests of the pharmaceutical industry.

Medical Prof. Steven Bernstein said the University was in the forefront of limiting the influence of pharmaceutical companies. It prohibited University physicians from distributing most medication samples to patients in September 2002 and enacted regulations for pharmaceutical representatives in March 2003, he said.

Most other health systems did not start enacting similar policies until 2005 and 2006, Bernstein said.

John Billi, the University's associate vice president for medical affairs, said he is proud of the University's national recognition for regulating relationships between University physicians and pharmaceutical representatives. All academic institutions should limit the pharmaceutical industry's presence in their facilities for the benefit of their patients and trainees, he said.

Billi said pharmaceutical companies only produce samples of expensive, brand name medication and that many doctors are prone to prescribing medications they receive samples of rather than looking into more effective options.

"Almost never are samples the preferred drug," Billi said. "If samples were the preferred drugs, then we would be working hard to get doctors to use them."

Not everyone at the University immediately accepted the health system's reforms, Billi said.

Many University doctors who treat patients with financial difficulties objected to the rule because they thought that free medication samples were in their patients' best interest, Billi said.

"Pharmaceutical marketing is one of several important ways for doctors to receive the information they need to make sure their treatment choices are the right ones and their patients are properly treated," said a statement issued March 18 by Ken Johnson, the vice president of the Pharmaceutical Research and Manufacturers of America.

But Billi said it's bad practice for doctors to begin treatments with expensive sample drugs that patients will later have to pay for because there are often cheaper, equally effective generic drugs available.

Bernstein said that in March 2003 the University forbade pharmaceutical representatives from giving gifts to staff members and required them to make an appointment before visiting the hospital to promote their medications. Pharmaceutical representatives must get departmental approval before they can distribute informational materials to the University, he said.

Retired Medical School Prof. Jeoffrey Stross said that the school has a responsibility to inform its students about effective medications.

"It is not the responsibility of the pharmaceutical representatives to teach our students," he said.