DURHAM - As part of their hands-on training, budding doctors at Duke University learned about the underbelly of the pharmaceutical industry Friday.

More than 100 were crammed into an auditorium to hear Dr. Sidney Wolfe of Public Citizen, a Washington consumer advocacy group, speak about unethical drug research, misleading drug advertisements and Food and Drug Administration shortcomings that have put patients at risk.

Wolfe, long a pharmaceutical industry critic, excoriated Andrew von Eschenbach, the current FDA commissioner, as one of the worst heads of the regulatory agency. He implored the audience to report all observed complications from prescription drugs to the FDA's Medwatch. And he called for more regulatory vigilance to root out drug advertisement violations and for eliminating drug makers' financial influence on the FDA.

Spurred by deepening public concerns, Congressional scrutiny of the FDA has increased in past years. On Friday, regulators were considering proposals to require TV drug advertisements carry a toll-free number where patients could report serious problems. The Consumers Union, another consumer advocacy group, supported the proposal.

But the pharmaceutical lobby is one of the most powerful and well-funded in Washington, Wolfe told the Duke crowd.

"There are about 700 lobbyists for the drug industry in Washington," he said. That compares to 535 federal lawmakers.

Doctors don't have many chances to hear the consumer advocacy perspective, said Dr. Kevin Schulman, a Duke health policy expert who invited Wolfe to speak.

It's no longer enough for doctors to know about diseases and their treatments, Schulman said. Health care policy should be part of the training tomorrow's doctors receive.

"It's important we all get more knowledgeable about these issues and how they're presented," he said.

"There's a whole host of influences," Schulman added. "The idea of just you and the patient in a room doesn't exist any more. It's crowded."