We’ve all seen trademarked skeletons, wall charts, calendars, paperweights, and supplies in doctors’ offices. And it’s blatantly clear that these items came from pharmaceutical companies—their names are written all over them. But soon, those long waits in the examining room before the doctor comes in may be quite boring because there won’t be much to look at. Trade groups and legislators have been cracking down on pharmaceutical industry gifts and payments to doctors for the past couple of years—and they’re making a lot of progress.
Vermont is the latest state to enter the list of those against the controversial gift-giving relationship between industry and healthcare providers. The argument goes that payments and gifts to healthcare professionals from pharmaceutical company representatives may persuade doctors to prescribe certain medications over others without scientific justification.
The new Vermont law, to take effect July 1 if the governor signs the bill, would require drug and device makers to publicly disclose, including names and dollar amounts, all money given to physicians and healthcare providers. The law also would ban industry gifts, including meals, to healthcare providers.
Vermont’s law is the strictest legislation of its kind in the US thus far, according to a May 20, New York Times article. Minnesota requires doctor payments to be reported and Massachusetts limits the types of gifts industry can provide to doctors, but the Vermont bill is the only one to ban all free meals and the only one that affects every healthcare provider with the authority to prescribe drugs or medical devices.
On the national level, Congress has been circulating the Physician Payments Sunshine Act since 2007. The act, which may finally be addressed this year, would create a national registry to track industry payments to doctors. PhRMA changed its Code of Interactions with Healthcare Professionals last summer to prohibit noneducational gifts such as pens and mugs to doctors, and to prohibit sales representatives from taking doctors out to meals. NIH requires researchers to report payments over $10,000 from drug companies. And in April, Johns Hopkins Medicine issued a policy prohibiting staff from accepting food or entertainment gifts from drug companies, and declaring that meetings with pharma representatives must take place in areas not dedicated to patient care. Finally, a few pharma companies such as Merck and Lilly have decided themselves to voluntarily disclose speaking fees paid to doctors.
Vermont marketers spent just over $2.9 million in FY 2008 on healthcare professionals according to an April report from Vermont State Attorney General William H. Sorrell, so one can only imagine the money spent at the national level. The top five spenders in Vermont were Eli Lilly, Pfizer, Novartis, Merck & Co, and Forest Pharmaceuticals, with each spending an average of $303,494 in FY 2008. Internal medicine physicians received the highest percentage of gifts, followed by psychiatrists and family practitioners. The greatest company expenditures targeted drugs for diabetes, hypertension, depression, ADHD, Alzheimer’s, and cholesterol. And according to the report, the most popular type of “gift” in the state by far was food, equaling $861,911 in total payments throughout FY 2008.
Overall, I understand why pharma companies make these gifts and payments to doctors. They need to inform doctors about their products and treatments but they don’t have many options to do so. Not many can just call up doctor after doctor and say, “Hey, I’m from Pharma Company X and I’d like to talk to you for 20 minutes about this new drug and how it may help your patients.” With as many as 50 patients a day and emergency calls at night, doctors are too busy to accept such calls, even if the calls would be beneficial. Scientific and academic peer-review journals as well as educational conferences may be the best ways for pharma to update healthcare providers about the latest in medicine, and if the trend against gifts and payments continues, those may be their only options.
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