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"I look forward to those. I frequently go right to the bottom" of Fleg's e-mails, says Dr. Alan Cross, chairman of UNC-CH's Department of Social Medicine and a pediatrician whom Fleg considers a mentor. "He uses self-deprecation and a little bit of humor to poke fun at the pomposity of the rest of us."

UNC-CH also graded

Fleg's main purpose at UNC-CH this year has been to persuade the medical school to adopt a policy limiting pharmaceutical company involvement in hospital and academic programs. UNC-CH has no formal rules limiting or banning drug company activities on campus.

Drug company-sponsored lunches that feature lectures about the newest medicines are weekly or even daily events in some clinics, Fleg says. He says you can't walk into many clinics without seeing brand names on clocks, staplers, clipboards, mugs, soap dispensers and other drug company freebies. UNC-CH rated a "C-" grade on PharmFree's scorecard.

"The scorecard was a truly ingenious thing," says Fleg, noting that the ratings were based on data collected by a pre-med student who interned with the student medical association. "Once you start grading schools based on whether they have a policy, it becomes much in their favor to say we do have a policy."

A vice dean of the medical school recently indicated that UNC-CH will have a policy in place by the end of the school year.

"We were worried that people would get sick of hearing his message," said Stephanie Wolfe, a second-year medical student at UNC-CH and president of the medical school's chapter of PharmFree's parent organization, the American Medical Student Association. "It really hasn't happened yet."

Fleg and others involved in the national PharmFree campaign are in the process of finalizing this year's scorecard, to be released next month. He led efforts to make the ratings more detailed, judging medical schools not just on whether they have a conflict-of-interest policy but on what specific steps they take to limit drug company influence.

Community crusades

PharmFree isn't Fleg's only cause.

He and his wife, Shannon, a Navajo Indian from Arizona, established the Native Health Initiative, which partners with American Indian tribes in North Carolina to improve health and well-being. Fleg, who taught third- and fourth-graders in inner-city Baltimore before enrolling in medical school, is in the Chapel Hill public schools on a regular basis as a speaker and mentor. Today, the Flegs will serve as keynote speakers for Orange County's observance of Human Relations Month.

Fleg is determined that a career in medicine, and the financial rewards that often accompany it, won't change his principles. It's a trait he gets from his parents, who are both physicians.

"I never tell anyone up front that I'm a doctor because I don't want them to treat me any different," said Dr. Rosemarie Fleg, Anthony Fleg's mother and a radiologist practicing in Maryland. She said that she and Anthony's father, Dr. Jerome Fleg, a cardiologist, still live almost as frugally as they did when they were medical students. "Money doesn't make you happy. It's what you do in life."

It's a lesson Anthony Fleg has taken to heart.

After completing his residency training, Fleg will practice in a federally designated health-care shortage area as a member of the National Health Service Corps. In exchange for Fleg's commitment, the U.S. government is footing the bill for his medical education. The deal will allow Fleg to graduate from UNC-CH debt-free, liberating him from the pressure to make money to pay off school debt. But Fleg says serving in an area where doctors are most needed won't be much of a sacrifice.

"It's something I'd be doing anyway," he says. "It's ultimately what is going to make me happiest."

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