Editor’s note: For opposing views, read this letter to Governor Patrick from House lawmakers or this letter from Wyeth Pharmaceuticals.
The Massachusetts Legislature recently adopted a comprehensive proposal to improve the quality of health care and to contain the rapidly increasing cost of care. Both goals are essential to sustaining the Commonwealth’s landmark health care reform law and keeping high quality health care affordable to all our residents.
Some of the most exciting and meaningful reforms in the bill – promoting reform and efficiency in the health care system, improving access to health care services, enhancing transparency of health care costs and quality, and encouraging the adoption of health information technology – will dramatically improve the care provided in Massachusetts as we expand access to care for all of our residents. However, one provision of the bill – regulating drug marketing practices – has generated heated, but not well-informed, discussions with representatives of the bio-pharma industry.
Those of us who helped to draft the Massachusetts Health Care Quality Improvement and Cost Containment legislation firmly believe that marketing practices of pharmaceutical and medical device manufacturers are an important factor in driving up health care costs without, necessarily improving the quality of care that’s delivered to patients here, and across the country. There are numerous books, articles, and academic research papers that clearly demonstrate the pervasive, even corrupting, influence of such marketing practices as gifts, travel, honoraria, and other valuable incentives offered by industry to those with the state licensed power to prescribe medication. Legislators are not alone in our sincere concern.
Dr. Mark A. Levine, Chair of the American Medical Association’s Council on Ethical and Judicial Affairs recently wrote: “While industry and medicine share the overall goal of improving health, their interests and obligations diverge in important ways. Commercial entities have a responsibility to their shareholders and other vested stakeholders to thrive as businesses and maximize returns on investment. Medicine has a responsibility to put the needs of patients first. As relationships between medicine and industry continue to expand, there is growing concern about the impact of industry funding on the integrity of professional education and its implications for public confidence in medicine as a profession.”
As Harvard Pilgrim CEO Charlie Baker wrote in his blog: “A task force that was put together by the Association of American Medical Colleges to study industry funding of medical education just issued a report that recommends, among other things, banning free food, gifts, travel and other services to doctors, staff and students at medical colleges. The report will be reviewed by the AAMC’s Executive Council shortly. He added that, “David Korn, the AAMC’s Chief Scientific Officer, didn’t deny the need for ongoing interaction between practicing clinicians and pharmaceutical and device manufacturers, but said, in effect, that whatever happens needs to be cleaned up, transparent, and tied to the specific practice of medicine.”
This is exactly the goal of Section 14 of Senate Bill No. 2863 which would add a new chapter to the Massachusetts General Laws – Chapter 111N “Pharmaceutical and Medical Device Manufacturer Conduct.” It directs the state Department of Public Health to develop regulations to establish a standard marketing code of conduct for all pharmaceutical or medical device manufacturing companies that employ a person to sell or market prescription drugs or medical devices in the commonwealth.
It’s important to understand that this new code must be based on applicable legal standards and incorporate principles of health care including, without limitation, requirements that the activities of the pharmaceutical or medical device manufacturer agents be intended to benefit patients, enhance the practice of medicine and not interfere with the independent judgment of health care practitioners. In other words, the Massachusetts law puts patients first, the integrity of physicians a close second, and enhancing corporate profits further down our list of priorities.
These regulations that DPH develops must be no less restrictive than the most recent version of the Code on Interactions with Healthcare Professionals developed by the Pharmaceutical Research and Manufacturers of America and the Code on Interactions with Healthcare Professionals developed by the Advanced Medical Technology Association. In other words, the codes that the industry itself has developed would be the basis for the Massachusetts code, and it will be legally enforceable if violated – something that the industry code does not provide. If the industry is serious about its own code of marketing and wants its member companies to follow, how can it be opposed to adopting that same code as the law for such companies doing business in Massachusetts?
The other industry concern – some say “red herring” – relates to the requirement to report payments to physicians in excess of $50 per year. Drug companies suggest that this reporting requirement and subsequent public disclosure will put them at a disadvantage to competitors in other states. However, information from all clinical trials is already public information through a federal clinical trials database. Other states already collect and publish information about research and clinical trials. Certainly, if there are any legitimate issues with the reporting and disclosure provisions, the Department of Public Health can address them in the regulations that must be developed to implement this section of the Quality Improvement and Cost Containment Law.
Massachusetts is not alone in passing legislation to require reporting of payments by pharmaceutical and medical device manufacturers to those who prescribe medication for their patients. Minnesota, Vermont, Maine, the District of Columbia, and West Virginia have all enacted laws to achieve this goal. Eleven other states, including New York and California have seriously considered legislation of this type during the current term, and more will undoubtedly take action in the next session. In every case, the pharmaceutical industry has vigorously opposed such legislative initiatives claiming that they can regulate themselves. However, professional lobbyists for the Pharmaceutical Manufacturers Association traveled all the way from Washington, DC to Boston to testify in opposition at a public hearing on a similar bill that was considered during the current session of the Massachusetts Legislature.
Massachusetts sincerely values the research and products of the Bio-pharma industry. We believe that the industry is a vital part of the state’s economy, and we’ve offered to invest a billion dollars to encourage the development of that industry in the Commonwealth. We accept the word of the industry – as stated in their marketing codes – that the industry wants to preserve the integrity of the medical profession. And our legislation will help them attain this most laudable goal. Therefore, we urge the Governor to sign the Senate Bill No. 2863 into law without amendment!
Senator Richard T. Moore, Senate Chair, Committee on Health Care Financing
Mr. Chairman, if you really cared about cutting costs and helping people why don’t you combat the practice of Health Insurance companies giving out cold hard cash to doctors – but only if those doctors actually change how they prescribe medication.
So why then are you only going after certain industries?
See this I-team investigation video on the subject:
http://www.youtube.com/watch?v=Ae_JAYbgDS8
To stand up against that abuse Mr. Chairman you might actually need some conviction.
You fought so hard against the Romney administration to get access to Stem Cell research, and rightfully so, and now the state will try to stick it in the eye of these same life saving researchers? I don’t get it. As a die hard liberal myself I want to see stem cell research expand and grow right here in the Commonwealth, and this isn’t the way to do that.
[...] Chairman of the Joint Committee on Health Care Financing) posted a great answer to the ad on WBUR’s Commonhealth yesterday. This is definitely worth checking out – here are some excerpted highlights: “In [...]
This Makes Me Sick
When I was a child, I heard the phrase ‘war-monger’, I had to find out its definition, as I had no idea what that phrase meant. I knew others could, and were, labeled with this phrase, as I had heard it in the past directed at others whoever said these two words. So I felt a need to know what these words meant, and how they affected others who heard them.
Finally, I found the answer: a warmonger is one who promotes war, which is undesirable or discreditable. In this case, one labeled this would have an affinity for what others are reasonably opposed to share the same views:
Others promote other things besides war.
Disease mongering is when a large pharmaceutical corporation implements various unethical if not illegal activities in order to sell more of their products by either creating or expanding a particular illness. They do this by creating the perception that others are likely ill in some way when, in fact, they are not.
Drug companies do this by seeking more of those who should be patients in need of treatment with the drug maker’s promoted medications, regardless if they are in need of such treatment or not, clinically.
How this is done by these companies will be described soon.
The drug makers clearly place the needs for their drugs to be for medical conditions whose treatment regimens are to be viewed by others as incomplete or unmet. The companies want to let the public know of the progressive increase for the disease states and how their products treat this illness better than what is available now or has been used in the past. How ironic it seems that drug companies, who make drugs to delay the progression of, or cure diseases with these drugs, wish for others to become as sick as possible to profit from their suffering that they create with disease mongering and sell more pills.
This disease-mongering in fact does occur often to widen the diagnostic boundaries of an illness, disorder, or syndrome by creating awareness of such medical conditions to the public. The drug companies do this by utilizing in several ways the delivery of fabricated if not baseless information during this process.
Usually, the pharmaceutical either creates or expands a disease state by deception directly to consumers, often. Then the consumer, who now believes that they are ill, go see their health care provider. The health care provider, due largely to the unfamiliarity of the patient’s symptoms expressed by the patient, if not the drug the patient is requesting, usually writes a prescription for the drug requested by the patient.
First, let’s take a look at this label of disease mongering. It is inappropriate in that, unlike diseases and illnesses, mongering occurs with medical disorders and syndromes as well.
It is accurate and factual, however, that disease mongering does happen with deliberate intent and reckless disregard for the well-being of others by drug companies.
There was a book written by Ray Moynihan and Allan Cassels called, “Selling Sickness” in 2005. The book thoroughly described how big pharmaceutical corporations are turning all of us into patients, and into a over-medicated society.
Disease mongering progressively continues to create patients with illnesses, disorders, or syndromes that in fact may not exist without any intervention to discontinue this behavior.
What the drug company implements to make sure this happens includes the following:
1. Paying medical journals to publish fabricated clinical trials involving their promoted medications after paying those involved with such a clinical trial to create such fabricated data. That is disease mongering to the health care provider.
2. Subjective screenings, such as those for various mood disorders. These screenings, as well as the affective disorders, which were rare until about 1995, involve leading questions often- created by the drug company. It was around this time that the United States was becoming more of a psychotropic nation.
These screenings that involve the leading questions responded by select groups of people. They are asked these questions by certain disease state support groups who have been converted into front groups after being funded by those big pharma companies who produce drugs for particular mood disorders.
3. Disease creations I: Social Anxiety Disorder, or social phobia: This condition is in the DSM IV which was published in 1994, and some were forced to delete the statement regarding this disorder that said, “Social Anxiety Disorder is not well-established, and requires further study.”
Aside from what may be simply amplified introversion, social phobias are likely due to societal dysfunctions and certainly should not be labeled as a pathological condition requiring pharmacological treatment.
4. Disease creations II: Premenstrual dysphoric disorder. I call this a mid-life crisis, yet it was entered by instruction by the APA (American Psychiatric Association) into the DSM (the psychiatrist’s bible) in 1993. Anxiety about the inevitable does not require pharmacological treatment.
5. Direct to Consumer Advertising:. Most memorable were those commercials for erectile dysfunction. Their absurdness in creating these commercials appears to have multiple psychotic components:
A healthy man who could probably run a marathon is having a decent time with his wife at some upper- middle class location. He is smiling all the time. Because now, his marriage is secure due to his ability to copulate- which was apparently absent before this wonder drug entered his system. Of course, it is not possible to have a happy marriage without intercourse, right?
Then there are other conditions which are entirely natural in the human lifespan, yet have been determined to be diseases by those who can profit off of these lifespan events. Examples include osteoporosis and menopause, as well as erectile dysfunction. It’s insane the FDA approves pharmaceuticals for these natural events that occur normally in a human being.
Finally, there are the required medical guidelines for various disease states, such as dyslipidemia. Drug companies that make medications to treat this disease are more than happy to support the financial needs involved in creating these guidelines. Dyslipidemia, for example:
Publications such as the Lipid Letter, and Lipid Management, both offered more aggressive management of the lipid profiles of the patients of the readers. And both publications were funded completely by those big pharma companies that promote statins. Same with cholesterol screenings that occur often that are implemented by those drug companies with drugs that treat the disorder of dyslipidemia.
A myth is something unproven. A false belief, or invented story.
Disease Mongering is not a myth. Large pharmaceutical corporations promote illness and disease- not desired by anyone and discredited by many, and these companies do this for profit and profit only.
I worked for three of the largest pharmaceutical companies in the world for over a decade, and the disease mongering protocols were similar if not identical with all of these companies consistently,
Dan Abshear
http://collections.plos.org/plosmedicine/diseasemongering-2006.php
Please review the link above, as there appears to be with some in the pharmaceutical corporate world that are offended by being labeled disease mongers. Often, others are offended by facts that exist as a reaction, it seems. Clearly, disease mongering is real, and activities illustrate this behavior.
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Dan Abshear clearly does not believe in enhancing Qulaity of life.
“healthy man who could probably run a marathon is having a decent time with his wife at some upper- middle class location. He is smiling all the time. Because now, his marriage is secure due to his ability to copulate- which was apparently absent before this wonder drug entered his system. Of course, it is not possible to have a happy marriage without intercourse, right?”
Your a dufus! NO! It is not possible in most cases to have a happy marriage without sex if your normal! Also, do you mean to tell me that the number of supposed people seeking cures for made up disease are so great that the pharma companies build a whole business model around it? Your delusional. Maybe you need to seek parmas help for your delusions.