Healthy Skepticism Library item: 10912

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Publication type: news

Hotakainen R.
Congress may require doctors to disclose free gifts
Miami Herald 2007 Jul 15
http://www.miamiherald.com/152/story/171008.html

Full text:

Two senators are proposing a national gift registry for doctors to report free trips, meals and drugs received from drug makers.

WASHINGTON — Congress is considering a plan that would require doctors to disclose the millions of dollars worth of free trips, meals and drugs they receive from drug makers each year.

At a recent Senate hearing, Sen. Claire McCaskill, D-Mo., told the story of how doctors were routinely wined and dined at her brother’s restaurant in Springfield, Mo.

‘‘He said the most lucrative part of their business was the private room that was reserved by the pharmaceutical companies four nights a week,’‘ she said. ``And the wine consumed was unbelievably expensive. The dinners were unbelievably expensive.’‘

Amid fears that the medical judgment of doctors is being compromised, McCaskill and Sen. Herb Kohl, D-Wisc., are proposing a national gift registry for doctors, where physicians would be forced to report their freebies.

The drug industry opposes the plan, saying it has its own voluntary ethics code.

Opponents of the registry also say that drug samples are aimed at helping patients, not doctors. And they argue that it’s important for the drug industry to stay in close contact with doctors to keep them up to date on the latest drugs.

Minnesota and Vermont already have passed registry laws, but critics say they have not gone far enough. Proponents of a registry say it would help patients understand the oftentimes cozy relationships between doctors and the pharmaceutical industry.

‘‘If it becomes a public record, it will have a cleansing effect on what I think is an insidious practice,’‘ McCaskill said in an interview.

Jerome Kassirer, professor at Tufts University School of Medicine in Boston, said medical meetings for doctors have become ‘‘mini-circuses, replete with enormous glittering displays and hovering attractive personnel.’‘ And he said many of the marketing efforts are ‘‘thinly disguised bribes’‘ that are couched as education.

‘‘The magnitude of drug promotion astonishes, as 100,000 drug reps visit doctors, residents, nurses and medical students every day and ply them with free gifts, meals and gadgets,’‘ said Kassirer, the former editor in chief of the New England Journal of Medicine, who has written a book on the subject

A TRIP PLUS STIPEND

Earlier this year, the New England Journal of Medicine reported that 94 percent of physicians had received food, trips and free medicine from the pharmaceutical industry. The New York Times reported last month that one company invited doctors to a weekend training session in Florida, giving them information on asthma medicine, along with free airfare, a hotel room, a rental car and a $2,700 stipend.

In a three-year period in Minnesota, doctors received 6,238 payments from drug makers for $100 or more, totaling $22.4 million.

Vermont reported 2,416 payments of $100 or more over a two-year period, but a majority of the payments were not disclosed because of claims of trade secrets.

EXPENSIVE DRUGS

Kohl, the chairman of the Senate Special Committee on Aging, said recent studies have shown that the more doctors interact with drug marketers, the more likely they are to prescribe expensive drugs that are being marketed to them, even if cheaper generics would do just as well.

Overall, Kohl said, the drug industry is spending $19 billion each year on marketing to doctors in the form of gifts, lunches, drug samples and the sponsorship of educational programs.

‘‘Many of these gifts are not illegal, but we need them disclosed,’‘ he said.

The American Medical Association has declined to endorse the idea, saying it has not yet considered it. But the issue is prompting plenty of debate among doctors.

Greg Rosenthal, a co-founder of Physicians for Clinical Responsibility, said that doctors are now living ‘‘in an age of pharmaceutical influence,’‘ and he expressed fears that medical research is getting compromised.

`BIG PHARM’

‘‘The influence of Big Pharm, as we call it, is pervasive,’‘ he said. ``Research used to be independently funded and designed, but with the decrease in public funding, drug companies have moved in aggressively. Even good research is tainted by the possibility of bias, and it’s very difficult to know what and what not to believe.’‘

While no legislation has been introduced, staff members for McCaskill and Kohl planned to meet this week to discuss what steps to take next. In the interview, McCaskill said she wants Congress to act on a bill to make sure the public knows what’s going on.