There may be laws in Vermont and Minnesota requiring that payments made to doctors by drugmakers are disclosed, but gaining access to the data is very difficult. But once the data was analyzed, it turns out some payments - cash, gift certificates, luggage, meals, textbooks, conference fees - during 2002 through 2004 were excessive, a JAMA study finds.

Even though the American Medical Association suggests a $100 cap on ‘gifts,’ nearly 20 percent of 12,227 payments totaling $2.18 million that were made to Vermont doctors exceeded the limit. In Minnesota, there were 6,946 payments totaling $30.9 million, and 6,238 were for more than $100. In fact, the median payment was $1,000. Glaxo doled out the most - nearly $5.8 million, followed by Lilly’s $4.2 million.

And this is interesting: In Vermont, 61 percent of payments were not released to the public because drugmakers described them as ‘trade secrets,’ and 75 percent of publicly disclosed payments were missing information necessary to identify the doctor. Glaxo and AstraZeneca, for instance, repeatedly declined to disclose payments. In Minnesota, only 25 percent of the companies bothered to reported in each of three years data was examined.

In an accompanying editorial, Troyen Brennan of Aetna and and Michelle Mello of the Harvard School of Public Health wrote that they find such behavior “disappointing.” And while they recognize that drugmakers are more concerned with shareholder value and an “altruistic commitment to patients…at some point, the leadership of the pharmaceutical industry and their boards of directors must begin to recognize that growing public and professional mistrust could substantially detract from that value.”

As if there hasn’t been substantial mistrust generated over the past few years? Stern lecturing and moral suasion are unlikely elixirs. Instead, tougher disclosure laws - in all 50 states - would be a good step and, perhaps, would limit such shenanigans. As for the doctors, that Hippocratic oath says nothing about meals, tickets or luggage, does it?

The JAMA study (subscription required):
The Hippocratic Oath;
American Medical Association ethics code. [tags]Abbott Laboratories, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, Wyeth[/tags]