Doctors On The Take

March 6, 2008

Brand-name prescription drug companies spend billions of dollars a year on marketing. Much of that money goes toward persuading physicians to prescribe their products. To that end, they shower doctors with gifts, free trips, free meals, paid consulting contracts, even Super Bowl tickets.

Drug companies say their generosity is in no way intended to influence doctors; they're just trying to help them make better medical decisions.

Studies show, however, that the number of prescriptions for a drug rises in direct proportion to the handouts a physician accepts from the manufacturer of that drug. (Those studies include a January 2000 report in the Journal of the American Medical Association, "Physicians and the Pharmaceutical Industry — Is A Gift Ever Just A Gift?")

Consumers, therefore, should know if and to what extent their doctors have become beneficiaries of pharmaceutical company largesse. Since the first legislation was passed in Minnesota in 1993, several states have enacted laws to require disclosure of gifts to health care providers or limitations on them.

But two measures proposed by Connecticut Attorney General Richard Blumenthal that would accomplish that have yet to make it past the General Assembly's Committee on Public Health, headed by Sen. Mary Ann Handley and Rep. Peggy Sayers. A hearing on the first bill in 2007 resulted in no vote. The proposal would have required drug companies to disclose gifts and other promotional incentives to health care providers. Failure to report carried a fine of up to $10,000.

This year's bill, which would have banned any gifts given in exchange for writing prescriptions and any gifts for a physician's personal use, was never even raised for consideration. The measure would have allowed business gifts of minimal value, such as post-its and note pads, and patient-benefit gifts, such as free samples of prescription drugs. Payments to physicians to serve as consultants would require written contracts, documentation of the criteria for selection and proof of a legitimate need for such a service. Recipients of scholarships and other educational assistance would have to be selected by an academic or training institution. Violators would be subject to a fine of up to $10,000 for each incident.

Drug companies, represented by the Pharmaceutical Research and Manufacturers of America, say new laws aren't needed. Federal law and industry standards already prohibit giving physicians anything of value in exchange for writing prescriptions, a spokesman said.

That's true. But it's easy to see how a doctor might feel obligated to prescribe a particular medication after receiving a generous gift from a sales representative, even if no quid pro quo is suggested.

Aggressive marketing by Merck & Co. contributed to the widespread prescribing of Vioxx, an arthritis drug that was later found to double the risk of heart attack and stroke. Vioxx was pulling in about $2.5 billion a year when Merck took the drug off the market in 2004. Thousands of patients who took Vioxx have since sued the company.

Connecticut lawmakers should pass legislation to force disclosure and limitations on drug company gratuities to physicians. Residents' health might depend on it.

Copyright © 2008, The Hartford Courant

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