PhRMA, the pharmaceutical industry trade group, is finalizing new gift restrictions that some state lawmakers say would make a proposed ban on gifts to doctors unnecessary. State Representatives meeting to revise a ban that has passed the Senate are getting calls and letters from PhRMA. Representative Peter Koutoujian says CEO Billy Tauzin told him that PhRMA plans to ban gifts, expect those for educational purposes, and will stop paying for meals outside a doctor’s office. Meals in the office would still be allowed. Koutoujian says with these changes, he doesn’t think a state ban is needed; and that the bill has already worked to tighter PhRMA gift rules.
I’m assuming, just by the timing of this proposal that they seem to be concerned and respectful of the role the legislature was taking right now in deciding whether to take action.
Other House and Senate leaders say the state must impose some restrictions to curb unfair marketing of drugs. A PhRMA executive says the changes are not a knee jerk reaction to any particular bill or event. PhRMA expects to release a revised ethics code early next month.
Sidebar: Trinket manufacturers are hoping a small gift will help persuade House lawmakers to reject the gift ban. One company gave Reps “State of Massachusetts” mugs yesterday with a letter telling them the ban would put the company out of business.
Unfortunately, research proves that industry standards cannot adequately address the threat of pharmaceutical gifts to providers. The “PhRMA Code” on gifts is voluntary and is not adequately enforced. In fact, when Senator Moore asked for examples of PhRMA sanctioning violators of the Code at the March legislative hearing on the Senate President’s cost control bill, the PhRMA representative could not point to a single example. Even if the PhRMA Code were enforced, the PhRMA trade group does not represent all pharmaceutical companies, nor does it represent biotech companies or medical device companies. In order to have a uniform, statewide standard, the state must implement one legislatively.
In addition, it is already clear that the industry’s new standards will not be sufficiently strong. The industry has said it will exempt educational items and in-office meals from its standards – two huge loopholes. The term “educational item” is broad and goes far beyond the printed informational materials that most of us would think of as educational. With this exemption, even companies that were abiding by the standards would be able to give gadgets to a provider to use in his or her practice, including laptops and PDAs. The in-office meal exemption is also problematic. Many offices get meals brought in by pharmaceutical companies regularly, some as often as daily. In fact, a recent letter from a caterer in Massachusetts estimated that the industry spends $40 million on these in-office meals. Research shows that meals are just as influential as other gifts, and, in fact, messages delivered over meals are more likely to be favorably received.
PhRMA is right that action must be taken to address the threat of pharmaceutical gifts to providers. Now is the time for the state to set adequate standards.
This is a good start, and I applaud PhRMA for cleaning up its own act. However, it makes no sense to ban off-site meals but to allow in-office meals. A bribe is a bribe, and the gift of food in the office is actually more lavish than a fancy restaurant dinner, because typically the reps bring food for the entire staff. This buys them continued and consistent access to the physician. Speaking from my own experience when I still allowed reps into my office, there’s nothing like food to make you “like” your rep, and when you like Shari the rep, you’re not far from making medical decisions like this: “I guess I’ll prescribe Shari’s drug–she brings in such great lunches.” It may be hard to believe that doctors can be influenced in this way, but it happens all the time–which is why the companies are so reluctant to give up the free lunches.
PhRMA self-policing will not work. They do not even enforce their current standards. Allowing reps to cater meals in the office, increases their access to doctors. This access increases the rate of prescribing more expensive (and not more effective) medications.
If we want to protect our patients we need to have a law banning gifts. PhRMA does not want to do this, as they know, without the gifts, few doctors will keep talking to them.
We have a large academic practice and practice evidence based medicine without seeing any reps. And I believe patients get better care because of it. We are spending what little time we have looking up evidence based information, rather then talking to reps and getting biased information.
Pharma has not demonstrated that it has the authority or can be trusted to police the drug industry. Senator Moore filed legislation that mirrored Pharma’s Code of Marketing Practice and added penalties for failure to comply. Pharma came to the hearing and opposed the bill.
Pharma doesn’t represent all drug manufacturers, and certainly doesn’t represent medical device manurfacturers who would be covered by the bill passed by the Senate.
Pharma has not demonstrated that it has the power to police the industry. Thankfully, some of the U. S. Attorneys – including Mike Sullivan, the U.S. Attorney for Massachusetts have the guts to enforce the Medicare fraud and anti-kickback statutes.
Can you believe that a vendor who provides gifts to doctors, according to WBUR, actually gave gifts to House members urging them to oppose the gift ban! If House members fall for that ploy and vote for to weaken or delete the gift ban, they would only be providing clear evidence of the corrupting effect of even token gifts to physicians or they may be demonstrating that they have lower ethical standards than physicians – in either case it would not reflect well on those House members. They should have the courage and wisdom to vote against any effort to weaken the ban on gifts to physicians by pharmaceutical and medical device manurfacturers.
[...] payments to physicians did not decline, but instead increased. In fact, in response to questions by Senator Moore at the legislative hearing on the cost control bill, PhRMA was not able to point to a single [...]