Pharma Gifts to MDs

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States want info about drugmakers' gifts to doctors

By Appleby, USA TODAY

From mugs and pens to expense-paid trips, the

pharmaceutical industry's largess to doctors and

hospitals has come under increasing scrutiny in recent

years. Now, a number of states want an even closer

look.

At least nine states are considering bills that would

require drugmakers to publicly report how much they

and their sales representatives give to doctors,

hospitals and pharmacists each year. A few proposals

go further: A bill under debate in Massachusetts would

ban all gifts to medical professionals from the drug

industry.

" If a doctor needs a Caribbean vacation or a mug or a

pen, he or she is probably not very successful and

needs to be in another business, " says state Sen. Mark

Montigny, D-Mass., who sponsored the bill.

Under the microscope

States considering bills that would restrict or

require reporting of gifts include:

California

Hawaii

Illinois

Massachusetts

Mississippi

New Hampshire

New York

Ohio

Pennsylvania

Sources: Dendrite International, National Conference

on State Legislatures

Growing interest in regulating marketing activities

comes four years after the industry updated its

voluntary code restricting lavish gifts and setting

other marketing guidelines. The federal Office of

Inspector General issued official " guidance " to the

industry on marketing practices in April 2003.

In May 2004, Pfizer paid $430 million in civil and

criminal fines to settle charges that a company it had

bought in 2000 unfairly marketed the drug Neurontin,

including flying doctors to lavish resorts and paying

some to " ghostwrite " articles touting the drug.

Still, some state lawmakers say the industry's

voluntary code and the federal guidance aren't enough.

They want to know how much is being given and by whom.

" The No. 1 thing that keeps government and corporate

officials honest is transparency, " Montigny says.

" There ought to be, online, a report that everyone can

see that says doc so-and-so has taken more than most. "

A push for transparency

State Sen. Maziarz, R-N.Y., sponsored a bill to

require such reporting after working in an office

complex that also housed several doctors.

" They would show me their gifts: watches, leather

jackets, golfing trips, " he says. " Someone is paying

for that. "

Four states — Vermont, Minnesota, West Virginia and

Maine — and the District of Columbia have laws

requiring gift reporting by drugmakers.

California requires that drugmakers declare they are

compliant with federal and industry gift guidelines.

" Within a year or two, we may have 20 or 25 states

with these restrictions, " says Ron Buzzeo, chief

regulatory officer at Dendrite International, which

advises the pharmaceutical industry and has developed

a way firms can track state regulations and

requirements.

Most of the state proposals are aimed at reporting the

gifts, with some requiring disclosure of anything

worth $25 or more. A few also want information on the

drug firm's advertising budgets.

The Pharmaceutical Research and Manufacturers of

America, the industry's trade and lobbying group, says

such laws are not needed.

" All of this is very heavily regulated by the FDA

(Food and Drug Administration), which controls what

companies can say to physicians about their drugs, "

says Marjorie , senior assistant general counsel

for the group. " We don't think there's a particular

need for states to get involved. "

and others say the industry has sharply

curtailed the lavish gifts and free trips that

prompted media attention a few years ago. Sales reps,

they say, provide an important educational function

for doctors. Gifts, such as free lunches, help the

reps get time with the doctors and their staffs.

Concerns among doctors

But those small gifts have raised concern among some

physicians. An article in the January issue of the

Journal of the American Medical Association proposed

more stringent regulation of drug industry gifts,

including a ban or strict limits on even small gifts.

" Social science research demonstrates that the impulse

to reciprocate for even small gifts is a powerful

influence on people's behavior, " says the piece,

written by Troyen Brennan of Brigham and Women's

Hospital in Boston, along with 10 co-authors.

Many of the proposals being considered this year are

modeled after a 2002 law in Vermont. The law requires

drugmakers to report to the state's attorney general

all gifts of $25 or more given to doctors, hospitals

or pharmacists. Aggregate numbers are published but

not the names of individual recipients.

" People see (drug) ads on TV, they read them in

newspapers, so they understand that is going on, " says

Brill, assistant attorney general in Vermont.

" What they don't see happening is the much larger part

of marketing that occurs with respect to physicians. "

Dr. DeSiena, D.C.

Washington Street Chiropractic Center, L.L.C.

771 Washington Street

Eugene, OR 97401

(541) 686-BACK (2225)

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