Healthy Skepticism Library item: 15487

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Publication type: news

Barlow D.
Vt. taking on pharmaceutical firms
Times Argus.com 2009 Apr 19
http://www.timesargus.com/article/20090419/NEWS01/904190370/1002/NEWS01

Full text:

There’s a psychiatrist out there somewhere in Vermont – only a handful of people know this person’s identity – who walked away with $112,000 in gifts and payments last year from the pharmaceutical industry.

The payments, usually for speaking engagements or other services, came almost entirely from a single pharmaceutical company, whose identity also is unknown.

There’s also a geriatric medical doctor who received more $50,000 in payments last year. A dermatologist got $15,000 in gifts from the industry while another Vermont doctor received nearly $16,000 worth of meals on the industry’s dime.

All their identities – along with the dozens and dozens of other Vermont doctors, pediatricians and nurses who accepted payments from the pharmaceutical industry last year totaling $2.9 million – are secret.

“We’re not talking about pharmaceutical advertisements on the television or in newspapers to promote new drugs,” said Attorney General William Sorrell. “These are direct cash payments to doctors and nurses and others in Vermont who are prescribing the companies’ drugs.”

Since 2004, Sorrell’s office has compiled information on the financial relationship between the corporate medical industry and Vermont medical professionals and released an annual report – the product of one of the most aggressive transparency laws in the country.

But those reports contain only numbers, but no names. An exemption in the law – added by lawmakers at the insistence of the pharmaceutical industry when it was first passed – allows companies to declare some information as “trade secrets.”

According to the latest report, released last week and covering the fiscal year between 2007 and 2008, reveals that 37 of the 68 companies reporting data in Vermont had information that fell under this “trade secrets” category. In total, this represented $2.4 million in payments and gifts, or more than 80 percent of the professional marketing in the state by pharmaceutical companies.

“There are lots of doctors in Vermont who don’t take money from the pharmaceutical industry,” Sorrell said. “But because we can’t reveal the identities of those that do, it paints the whole industry with the same brush, which is a real shame.”

That all could change under a new bill considered this year by Vermont lawmakers. This proposed new law would ban most gifts between the industry and medical professionals working here in the state and bring a heavy dose of transparency to this cloaked relationship.

“This bill attempts to shine sunlight on an old Vermont basement that hasn’t been seen in years,” said Ken Libertoff, the executive director of the Vermont Association for Mental Health, a Montpelier-based advocacy organization that swore off corporate pharmaceutical donations in recent years.

Big Business

Producing and selling pharmaceutical drugs are big business – and the top companies in the field have impressive marketing budgets. The total annual cost of advertising medications in the United States is not known – although the Government Accountability Office reported three years ago that the companies spent $4.2 billion in 2005 directly advertising their drugs to consumers. That number does not include lobbying of doctors and other prescribers.

Financial lobbying of drug prescribers in Vermont has ebbed and flowed in recent years. The latest report from the Attorney General’s Office shows a decline in spending – in the previous year the companies had spent about $200,000 more. But when they spent $3.1 million during a 12-month period between 2006 and 2007, that was an increase of nearly $1 million from the previous report.

The latest report shows that 78 pharmaceutical companies spent $2,935,248 in gifts, payments and donations to Vermont medical professionals. And while the money is likely spread among many individuals in the state, nearly 60 percent of the money went to a select 100 people, who make up less than 5 percent of their field in Vermont.

“Nearly 50 percent of all marketing expenditures reported in FY08 were for speaker fees or other payments to recipients, nearly a quarter were for marketing of pharmaceutical products, and approximately a fifth were for educational purposes,” states the new Attorney General report. “Nearly 60 percent were direct payments to recipients in the form of cash or check.”

The Pharmaceutical Research and Manufacturers of America is the lobbying arm for a coalition of corporations. From their perspective, Vermont’s proposed new law will possibly obstruct the dissemination of information about new drugs between the makers and the prescribers.

Marjorie Powell, the senior assistance general council for PhRMA, said much of the interaction between their drug representatives and doctors and other prescribers amounts to education about new drugs coming on the market – including benefits and possible risks.

Powell said the industry has taken steps in recent years to police its own interactions, including a new code put in place Jan. 1 that bans all gifts between the industry and doctors, unless it has “direct value to the patients.”

“We believe that the legislation in Vermont is not necessary,” Powell said. “Vermont already has a disclosure system for marketing costs.”

But that ban does not include taking prescriber out for meals, so long as those meals are considered modest and the time is used for supplying information on new products, Powell explained. The free meals – sometimes either delivered to the office or taking a doctor out to a restaurant – are among the more controversial aspects of the relationship.

“Doctors are really busy,” Powell said. “If you want to fit into their schedule, you have to do it when they’re not seeing patients. And that’s meal time.”

These free meals can be helpful for resource-strapped medical professionals because they also provide free education and free consultation, according to Kirke McVay, a psychiatrist with a practice in Bennington. He said these relationships are demonized as inappropriate and nefarious, but he has come to a different conclusion.

“We give the drug reps a hard time and lots of feedback,” he said. “And it usually amounts to telling them that their drugs are too expensive.”

Neale Senior, a Brattleboro psychiatrist, also said he doesn’t see a problem with drug companies paying prescribers because they are limited to promoting the products for only uses approved by the federal Food and Drug Administration.

Senior, who receives speaking fees from pharmaceutical companies, said in his office is posted a sign showing all the companies he has worked for. In the last five years, only a handful of patients have asked him about that relationship, he said.

“It’s a financial interaction between two parties,” he said. “And frankly, I don’t think it is anyone else’s business.”

Conflict of Interest

In Vermont, the trend among many medical professionals in recent years has been toward more transparency and less reliance on the pharmaceutical industry. Since the state passed its aggressive marketing laws in the early 2000s, more and more professionals have taken steps to distance themselves financially from drug companies.

The Vermont Medical Society and the Vermont Psychiatric Association swore off all pharmaceutical funding in recent years, saying accepting the money creates the appearance of a conflict of interest. The University of Vermont’s College of Medicine toughened its policies last year and in the summer of 2008, an ethics council for the American Medical Association stated that some gifts may be in conflict medical principles.

“Our 1,500-plus members have been very clear on this issue; they are not comfortable with even the slightest appearance of conflict of interest,” Paul Harrington, the executive vice president of VMA told lawmakers earlier this year. “Our support of this legislation is very public statement about the commitment of Vermont physicians to maintaining a strong level of trust with their patients.”

Libertoff, who supports more regulation of the pharmaceutical industry, believes that the complete lack of transparency is no longer acceptable to the public. For years, there has been little or no oversight of the financial relationships between the industry and physicians, he said.

“The question people are now asking is whether this marketing influences or actually even dictates prescribing patterns and practices,” he said.

Among the provisions in Vermont’s proposed new pharmaceutical marketing law is one that would require the Office of Vermont Health Access to analyze available data and report to lawmakers annually to what extent manufacturers may be influencing prescribing patterns.

Sorrell said he is shocked that the industry spends so much money on marketing in a state of 600,000 residents. He wonders what the total payments look like in larger states that don’t have a strong disclosure law that Vermont has.

“If we’re seeing millions of dollars in cash payments here, then what happens in New York State or California or Florida?” he said. “We’re talking about incredibly large amounts of money.”

Leader in Transparency

The pharmaceutical marketing bill was well received in the Vermont Senate, where 29 of the chamber’s 30 members sponsored it. Senate President Pro Tem Peter Shumlin has been a vocal and active supporter of the legislation, saying last December that “Vermont should be a leader in full transparency so that consumers can know whether or not their doctor has one hand in the pot.”

“I think we will look back at this era of drugging our kids as a dark moment in medical treatment,” he added.

If the version passed by the Senate earlier this session becomes law, it would be the strongest in the country, according to advocates and PhRMA. The ban on gifting would be nearly universal, with exceptions carved out for free samples, peer-reviewed articles and educational scholarships.

The House Health Care Committee will begin hearings on their own version of the bill late next week. Rep. Steve Maier, D-Middlebury, the chairman of the committee, said Friday that he doesn’t know too much about the issue yet, but is looking forward to hearing testimony.

Maier said his committee has focused on the rising costs of prescription drugs in recent years and the two issues certainly share that link. He said the House’s version of the bill would include the ban on most gifts and the creation of a searchable database on marketing to specific doctors on an easy-to-use state Web site.

He added that he has already been lobbied on the bill.

“Both sides of the issue have approached me,” Maier said. “There’s a lot of passion around this issue.”

Gov. James Douglas, the Republican executive who holds the final pen that could sign the bill into law, has also expressed support for its main goals of increased disclosure and transparency. He does, however, have some concerns, according to Dennise Casey, his spokesperson.

“He wants to ensure that it doesn’t have a negative impact on economic growth and development, which has occurred in some states that have passed similar pieces of legislation, such as Massachusetts,” Casey said. “For example, we need to ensure that our growing biotechnology sector isn’t hampered by this legislation.”