Healthy Skepticism Library item: 7824

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Publication type: news

Appleby J.
States want info about drugmakers' gifts to doctors
USA Today 2006 Feb 16
http://www.usatoday.com/money/industries/health/2006-02-16-doctor-gifts-usat_x.htm

Full text:

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.

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. George 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 Powell, senior assistant general counsel for the group. “We don’t think there’s a particular need for states to get involved.”

Powell 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 Julie 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.”