Tracking Pharma Gifts to Doctors

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Thursday, August 9, 2007 by The American Prospect

Tracking Pharma Gifts to Doctors

by Tady

http://www.prospect.org/cs/articles?article=tracking_pharma_gifts_to_doctors

http://www.commondreams.org/archive/2007/08/09/3070/

A slow wheel is beginning to turn in Congress in favor of forcing Big

Pharma to disclose the amount of change it’s dropping into doctors’

pockets.

While it’s no secret that pharmaceutical companies lavish gifts on doctors

— everything from free notepads and pens to meals to the more extravagant

paid trips or seminars — most patients are in the dark about who, exactly,

is courting their physicians. But Congress may be finally acknowledging

this relationship, one important step toward creating a national gift

registry so patients can track the perks Big Pharma is giving to their

doctors.

In June, the nonprofit government watchdog Public Citizen testified before

the Senate Special Committee on Aging in favor of federal legislation that

would require drug companies to disclose payments to doctors. But the

group urged lawmakers, before jumping on the proposal, to examine a Petri

dish of existing disclosure laws. Although four states and the District of

Columbia already have disclosure laws on the books, the group says they

are “inadequate” and do not give patients a clear picture of how money is

changing hands.

The pharmaceutical industry spent an estimated $25.3 billion peddling

prescription drugs in 2003, and much of that money went to physicians in

the form of free samples, meals, conference fees, air fares, and

continuing medical education activities. The only reins on Big Pharma’s

giveaway are voluntary regulations set by the American Medical Association

(AMA) and adopted by the trade association Pharmaceutical Research and

Manufacturers of America. The AMA’s ethical guidelines, which are supposed

to “prevent inappropriate gift-giving practices,” only sanction gifts

valued at $100 or less.

The pharmaceutical industry is adamant that these gifts have no influence

on which drugs physicians prescribe to their patients. But a growing body

of evidence shows that drug companies’ generosity may in fact be guiding

the pen across the prescription pad.

“The drug industry doesn’t spend $20 or $30 billion a year on advertising

prescription drugs unless they believe it has an impact on doctors

prescribing,” said Dr. Sidney Wolfe, director of Public Citizen’s Health

Research Group. “You would probably like to know whether your doctor is

getting no money, some money, a lot of money, or a huge amount of money,

because it’s going to influence what that doctor decides for you.”

Public Citizen says a federal disclosure law would give patients the

ability to track their doctors’ financial ties to drug companies. “We need

a strong, uniform national law that requires every state [to have] these

kinds of disclosures,” Wolfe said. “State laws are better than nothing,

but filled with problems.”

In March, Wolfe (along with three other physicians and one medical

student) published a paper in The Journal of the American Medical

Association (JAMA) that analyzed Vermont’s and Minnesota’s publicly

available disclosures of payments made to doctors from 2002 to 2004. The

researchers concluded that both states’ laws failed “to provide the public

with easy access to information about these payments,” and were

“insufficient for revealing the true patterns of payments.”

In Vermont, patients can obtain an annual summary report detailing how

much money drug companies have given to health-care providers, and the

form and purpose of the payment. The report does not, however, list

recipients by name, but rather uses generic terms, such as “family

practice” or “oncology.” Patients cannot search for their specific doctor,

nor is the information available in an online database.

Vermont’s reporting requirements have also been criticized for allowing

pharmaceutical companies to claim a “trade secret” exemption, which

protects them from disclosing many of their payments to doctors. Assistant

Attorney General Brill defended Vermont’s report, saying it “does an

analysis that we think gives the public a pretty complete picture of what

is going on, although it doesn’t name names.”

Brill also said there were holes in the JAMA article, which she said

“never discussed the reason for the trade secret exemption.” Brill said

Vermont’s laws protecting trade secrets are broadly written, and the

legislature feared drug companies would legally challenge the disclosure

law if the trade secret exemption was not extended to them. “We would not

like to see the [disclosure] law struck down, or be stuck in limbo, while

this trade secret issue is being litigated,” Brill said.

The JAMA authors recommended that disclosure statements be made available

online, but Brill countered that in Vermont, “it was never envisioned that

there was going to be a website where people could have access to data.

That takes money; that takes time.”

In Minnesota, researchers found that payment data was never compiled into

a report or a database, and that to obtain the records, they had to

physically travel to the state’s Board of Pharmacy’s office and make

photocopies themselves. Since then, the documents have been digitally

scanned and are available online. Unlike in Vermont, the vast majority of

the disclosure statements do contain doctors’ names. But Cody Wiberg, the

board’s director, said that patients wanting to find information about

their doctors “may have to do a little work” because the documents have

not been indexed by the doctor’s last name. “Admittedly, it’s not

searchable,” Wiberg said. “You actually have to go through document by

document, and there are thousands of documents.”

Wiberg said the state’s poor showing in the JAMA article can be attributed

to a lack of money and clear direction from the legislature. The board

plans to hire additional clerical staff and expects to create a searchable

database in the coming year, according to Wiberg.

During the Senate hearing last month, Public Citizen also offered analysis

of disclosure laws in two other states, Maine and West Virginia, plus the

District of Columbia. Dr. Lurie, deputy director of Public Citizen’s

Health Research Group, testified, “Although these statutes are undoubtedly

intended to increase the transparency of the physician-pharmaceutical

company relationship, it is clear that all fall well short of their

aspirations.”

And while these laws are falling short, the vast majority of states have

no disclosure laws at all.

“One of the standards for [deciding if] it’s appropriate to take a gift

from a company is asking, ‘What would my patients think if they knew out

about this?’” Wolfe said. “Since most doctors don’t even have to face the

prospect of their patients finding out about it, they can evade that test.

And none of them should be able to evade that test.”

Wolfe said a federal disclosure law would offer patients better

protection. “Ideally, patients should be able to go to some central,

national, online database, put in the name of their doctor, and get all

the gifts the doctor has gotten from all of these companies,” he said. “We

are nowhere near that yet. Slowly, it might happen at a state level, but

ideally it should happen at a federal level so you can have the same

requirements affecting doctors in Maine or Massachusetts or Montana or

California.”

Following Public Citizen’s testimony, Democratic Sens. McCaskill of

Missouri and Herb Kohl of Wisconsin said they intended to push for a

national registry. McCaskill’s press office would not give details about

any forthcoming legislation, but said the senator has “moved in the

direction of a national disclosure registry for gifts to physicians.”

”If it becomes a public record, it will have a cleansing effect on what I

think is an insidious practice,” McCaskill told the Miami Herald in July.

To avoid the same pitfalls as the state laws, Wolfe said Congress has to

“be serious” about creating legislation that does not shield drug

companies and doctors. But with lawmakers remaining mum about it, it is

too early to tell if possible legislation will have any teeth.

But even as Public Citizen is advocating for a national disclosure law, it

admits that such measures are simply a Band-Aid for a more systemic

problem - that pharmaceutical companies are allowed to give gifts to

doctors in the first place. As Lurie told the Special Committee on Aging,

“Payment disclosure laws are a first step toward addressing the problem,

but they are not the only method or even necessarily the most effective

one.”

Tady is a national political reporter for In These Times and a

freelance journalist based in Western Massachusetts.

© 2007 The American Prospect

- comment from coffeelover August 9th, 2007 3:10 pm

I recently retired from the Navy, and my last visit to the doctor, I asked

the doc “are you a pharm whore?”. He got pissed off and became offensive!

I told him it was a legitimate question due to the fact, that his pens,

notepads, mouse pad, and hell - half the office was from a drug company

promoting all kinds of new stuff. The most cool one was a plaque with a

anatomical cutaway kidney on it with a drug name below it, that one must

have cost the company a couple hundred dollars or more to make. I told the

Commander straight out that he did not pay for it, the consumers paid for

it. He was going to me a prescription for my back, however I got what I

wanted by being adamant, to have them take X-rays. Then when nothing was

found wrong, I knew right away that I pulled some muscles. I had them

print me out a panmphlet on exercises to relieve the tension. I got what I

wanted!

Big Pharm has infiltrated even the military hospitals.

Coffeelover,,,,,,,,

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