July 10, 2008, cbsnews.com – Drug company sales representatives will have to stop doling out coffee mugs and pens that push their products when they visit doctor’s offices. But they can still sneak in the occasional free lunch.

Pharmaceutical Research and Manufacturers of America announced Thursday that it has revised its conduct code for interacting with health care professionals. The updated guidelines ban the knicknacks bearing company and product logos.

Sales representatives also are prohibited from providing restaurant meals and entertainment or recreation. But they can still provide the occasional meal in a healthcare professional’s office “in conjunction with informational presentations,” according to a statement from PhRMA.

The association represents pharmaceutical and biotechnology companies and is made up of executives from companies in the industry.

The new rules take effect Jan. 1. PhRMA said meetings between sales representatives and doctors should be focused on informing health care professionals about products, sharing scientific and educational information and supporting research and education.

“We are also concerned that our interactions with healthcare professionals not be perceived as inappropriate by patients or the public at large,” the Washington, D.C.-based trade group said in a news release. “This code is to reinforce our intention that our interactions with healthcare professionals are professional exchanges designed to benefit patients and to enhance the practice of medicine.”

The trade association said in January that it was considering a revision to its 2002 code.

“There’s been a backlash to some of our members’ sales and marketing practices,” Ken Johnson, a PhRMA senior vice president, said at the time. “While it’s not bubbling up all across the country, prudence dictates that we take a look at the problem and see if we can address concerns of physicians and patients.”

Critics of these sales practices have included the nonprofit organization No Free Lunch, which is run by a New York-based internist. It urges medical school students to pledge that they’ll shun free gifts or meals from the drug industry.

No Free Lunch also promotes a pen amnesty program on its Web site, where it offers to replace with “no questions asked” drug company pens that doctors receive. It states that the pens will be “donated to a worthwhile cause.”

Members of PhRMA are required to state their intention to comply with the code, and Johnson & Johnson, Merck & Co., Amgen Inc., Eli Lilly & Co. and AstraZeneca PLC did so Thursday morning.

AstraZeneca said its U.S. representatives will not give doctors items including pens, pads of paper, hand soap and tissues as part of sales visits. The company said its sales representatives will still be able to offer educational items like teaching models if they “are not of substantial value.”

While taking health care professionals to restaurants is not allowed under the new code, sales reps are still permitted to bring meals occasionally if they are small and not part of an entertainment or recreational event.

AstraZeneca said it will still support medical events for health care professionals through grants to independent providers, and the British company says it will not give any guidance about the content or faculty of those events and will provide no direct support for meals.

Lilly said in a separate statement that it will comply with or exceed the new guidelines. It said the revised code will help ensure “the information exchange with healthcare providers continues to be appropriate and ethical.”


The following link is to one of the most amazing video expositions of the intelligence of crows. Because the link and the video may disappear, let me briefly describe what the video shows.


It starts with a crow dropping nuts from a great height to break them. That doesn’t always work. So, the crows (in Japan) started dropping them on roads so that cars would run over them. While that worked, it was a little dangerous to swoop down on the road while cars are going by. So, the crows started to drop them in pedestrian crossings where the cars stop for passengers. The video suggests that they actually watch the walk signs and approach the cracked nut when the light for the pedestrians turn green. If true, this indicates a level of logical thinking that goes beyond anything that we might expect from animals. The crows in Japan have been observed doing this since 1990 but this sophisticated approach to cracking of nuts has apparently spread to California.

According to Wikipedia, the 40 or so members of the genus reside on all temperate climate continents except for South America. The members of the genus (called corvidae and corvid is the adjective) range all the way from the pigeon-sized jackdaws to large ravens. Their intelligence was recognized even in ancient times. They use to be hunted but their population and a large number of crow species have been decimated by human colonization of their habitats. They have complex vocalizations, including mimicry of other birds, and their communication with each other have many of the characteristics of language. Gatherings of crows (literally called a “murder” of crows) often show complex societal hierarchies, tight life-long family units, and even division of labor. Most crows have relatively long life-spans, with a life expectancy of 10±3 years and the oldest known wild American crow lived to be 29.5 years old. Young crows have long developmental periods.

One of their most remarkable capacity appears to be recognition and creative reaction to new situations, suggesting significant cognitive capabilities. In addition to the use of cars at pedestrian crossings to break nuts, there are many other examples of corvid creative use of tools and performance of complex tasks requiring sophisticated cognition and memory.

1. Use of bread-crumbs for fishing (observed in Israel).
2. Ability to count numbers (such as the number of hunters going into a blind)
3. Use and manufacturing of hooked tools from twigs.
4. Cooperative lifting of a garbage can lid by one crow while others scavenge through the garbage
5. Ability to observe where other crows keep their valuables and ability to remember their own hiding places for nine months or longer
6. One researcher recalled that when they collected crows for research, they had to wear masks or else they would be “persecuted all over campus” by other crows, suggesting that crows not only can recognize human faces but maybe able to communicate this information to other crows.
7. Bending a straight wire into a hook to retrieve a bucket of food through a tub.


Stories of the intelligence of individual crows abound. For example,

Jack the jackdaw was raised by wildlife film producer John Downer. As soon as Jack was mature, he was released into the wild. However, he couldn’t stay away. “One thing he is totally fascinated by is telephones,” said Downer. “He knows how to hit the loudspeaker button and preset dial button. Once we came into the office to find him squawking down the telephone to the local travel agent.”

Jack also likes to fly down onto the mirror of the production car when he sees somebody going out. “He turns into the wind, gets his head down and surfs on the air current until we reach about 30 mph when he gives up.

“Like all jackdaws, Jack shows great versatility and intelligence. Because he has to exploit a wide range of foods, he is investigating things all the time.”

Ravens also have been observed to engage in play activities that cannot be mistaken for anything else. For example,

Ravens are the only birds that been seen unmistakably playing. Two of these fun-loving birds were photographed in Wales in 1980, sliding down a 10 ft. snow bank on their backs. They even came back to do it again the next day.


How is such intelligence possible with such a small brain? As one writer asked, how does the crow brain which is the size of a “fava-bean” do the following:


In the Brevia section of the 9 August 2002 issue of Science, Weir et al. report a remarkable observation: The toolmaking behavior of New Caledonian crows. In the experiments, a captive female crow, confronted with a task that required a curved tool (retrieving a food-containing bucket from a vertical pipe), spontaneously bent a piece of straight wire into a hooked shape—and then repeated the behavior in nine out of ten subsequent trials. Though these crows are known to employ tools in the wild using natural materials, this bird had no prior training with the use of pliant materials such as wire—a fact that makes its apparently spontaneous, highly specific problem-solving all the more interesting, and raises intriguing questions about the evolutionary preconditions for complex cognition. The crow’s behavior was captured on an unusual video clip. …

Recent studies indicate that a single gene called microcephalin influences brain size. Identified for people with abnormally small brains, i.e. microcephaly, mutations of this gene cause changes in brain size. Brain size is clearly a critical determinant of evolutionary success. If you have too large a brain, that is a significant disadvantage from the viewpoint of energy utilization (the brain consumes more energy than any other organ) or weighing down the body (important in the case of birds who need to fly). One would have thought that brain size is a complex multi-gene phenomenon. However, from the viewpoint of evolution, it is a singular advantage to have one single regulatory switch that can adjust brain size.

The following is a list of brain sizes for comparisons. The crow brain size is somewhere between the rat and marmoset.

Typical brain sizes

Whale 6800 grams
Elephant 4717 grams
Dolphin 1735 grams
Man 1444 grams
Walrus 1126 grams
Camel 762 grams
Horse 532 grams
Macaque 106 grams
Dog 79 grams
Cat 25 grams
Marmoset 7 grams
Rat brain 2.4 grams
Mouse 0.5 gram

While the crow brain is indeed small (as are most bird brains), the corvid brain-to-body size ratio is greater than all other birds and greater than the ratio in humans and dolphins. On the other hand, the crow brain is smaller than that of a cat and lacks a prefrontal cortex common to all other “intelligent” animals. Nevertheless, it is interesting to compare the size of the crow brain with those of other animals. The attached picture shows that a rat, pigeon, mouse, and goldfish brain (left to right).

In the end, it is perhaps how big are brains are but what we use it for.