Will your free dinner appear online?

October 19, 2007

Perspective

The notion that some trinket or honorarium could alter their prescribing habits strikes most doctors as absurd, as various surveys have shown.

And yet, drugmakers continue to lavish as much as $19 billion annually on marketing to physicians-which suggests to some people that either companies have foolishly wasted their money all these years or doctors have grossly miscalculated the subtle power of persuasion.

Some members of Congress seem to be of the latter school.

If passed, the bill would require the Secretary of the Department of Health and Human Services to collect gift and payment data from large drug, device, and medical supply makers doing business with the government-companies, that is, with annual gross revenues of more than $100 million. Beginning in January, and each fiscal quarter thereafter, these companies would be required to report any physician receiving a gift, fee, payment, or rebate exceeding $25. HHS would then collect these names and, by next June, make them available online in a user-friendly and downloadable format. The bill doesn't apply to patient product samples or to payments related to clinical trials. Nor does it affect physicians who receive anything of value when they're not acting as . . . well, physicians.

Washington lawmakers aren't alone in taking aim at the gifts-for-scripts issue. To date, along with the District of Columbia, five states-California, Maine, Minnesota, West Virginia, and Vermont-have some form of mandatory disclosure program in place. And, in 2007, at least 27 states debated this or some other pharmaceutical marketing or advertising issue, according to the National Conference of State Legislatures.

Some see disclosure as off target

Not everyone thinks all the attention is warranted.

PhRMA, the pharmaceutical industry trade group, argues that companies provide real educational value to physicians and that its voluntary ethical code, adopted in 2002, has been endorsed by the OIG and praised by federal prosecutors. For its part, the AMA has taken no position to date on physician gift registries per se, but it has developed its own set of voluntary ethical guidelines, which resemble PhRMA's in lots of ways. In testimony before the Senate Special Committee on Aging this summer, the AMA assured committee members that it has been working hard to reduce conflicts of interest.

Perhaps so, say advocates, but voluntary guidelines are nevertheless inadequate to the task. State-run programs-which some see as riddled with loopholes and difficult for the public to access-have also been criticized. As for the disclosure bill now in Congress, it gets higher marks, although not everyone thinks disclosure alone will solve anything.

"It doesn't really get at the problem," said Boston internist David Blumenthal last year on PBS' the NewsHour with Jim Lehrer. Blumenthal, who co-authored a report that appeared in JAMA on the conflicts of interests faced by physicians and their institutions, favors a self-imposed gift moratorium, which several of the nation's top medical schools have already adopted.

As Blumenthal explained: "This is something we are . . . recommending that the profession and the institutions of the profession impose on themselves, not that government impose it on anybody."