Connecticut AG Urges Curbs On Pharma Influence
10 CommentsBy Ed Silverman // March 2nd, 2010 // 7:58 am
For the second time in the past two years, Connecticut Attorney General Richard Blumenthal is urging legislation requiring strict limits and disclosure of gifts from drugmakers to doc that may influence health care decisions. His proposal was made during testimony on the legislation.
“This proposal recognizes that health care providers and pharmaceutical companies should interact and exchange ideas and experiences - but in the sunshine of transparency and disclosure,” Blumenthal says in a statement. “Addicted to profits, drug companies focus relentlessly on practitioners, seeking enhanced sales and profits. While certain pharmaceutical drug companies may be taking steps toward self-reform, we cannot rely solely on such efforts to break an industry attraction - some might say addiction - to such practices. A state law readily enforceable by our state agencies would protect the physician-patient relationship from drug company influence.”
And what would such a law contain? Requirements that drug and device makers adopt a code of conduct, along training and monitoring to ensure compliance with the code; annually report all authorized payments or other goodies provided to health care providers that are individually in excess of $50; and prohibit direct payments or other compensation to health care providers, unless in exchange for a bona fide service. Some drugmakers are starting to disclose payments, and PhRMA has a code, but this hasn’t distraced Blumenthal before (see here).
However, the legislation would also allow reps to provide reasonable compensation to health care providers for services; peer-reviewed academic, scientific and clinical journals; medical device demonstration and evaluation units; rebates or discounts; and modest food and beverage when associated with an office visit regarding the provision of product information. There was no definition of ‘reasonable compensation’ or ‘modest’ food and drink.
Justice in MI
Perhaps someone has a reference that breaks down gifts-to-docs by relevant categories–that is, what proportion goes into food and trinkets for everyday detailing interactions versus the variety of “consultancy” services?Likewise, how many docs are involved in the latter kinds of categories rather than the former?
I’d expect a steep curve, with a lot fewer docs getting a lot more stuff, and those relative few making up the lion’s share of “gifts-to-docs” more generally. Does anyone have some numbers?
Would also be interested in how it breaks down cross-sectionally, by specialty.
Justice in MI
p.s. I understand very difficult to get good numbers since a lot of stuff is “given away” collectively at meetings, etc. Just looking for a ballpark with some differentiation of money for suites, box seats, bleachers, etc.
M. Black
I’m still waiting for an answer from a month ago: what are the repercussions of a sales rep leaving a flomax pen at a physicians office? How is this enforced? IS this enforced? What about 10 flomax pens? What about lunch at a 4 star restaurant in Manhattan? Where is the line drawn? How is the line drawn, and how are infractions enforced?
I’ve thus far heard a bunch of candy coated bullshit with no teeth.
~ MB
M. Black
You know what’s sad? Some sales reps a couple years into their position have no idea what a peer reviewed study is. Is it the fault of the training, or mental retardation by those who don’t understand why they do what they do?
In my opinion, it’s the fault of the company not ensuring their reps have THE MOST BASIC of BASIC understanding needed to understand the dynamics of their profession.
Piss Poor. Piss, Piss Poor.
Ugh - go sell cars. The salary isn’t bad if you’re a good salesman, and no science is involved. But for Christ’s sake stop taking dumps on your profession.
harpy
I’ll take a stab - most giveaways are no longer kosher under the new industry guides - AdvaMed and PhRMA - not to mention some of the new state laws. Food is still allowable but under much tighter restrictions. And I must protest that consultancy, at least in devices (my field), is absolutely essential for our business to continue. I do hope that one thing to come from all of this scrutiny of these industries is someone will eventually realize that devices are not simply an off-shoot of pharma. While similar, we are really a completely different animal. And, yes, I’m aware I say this on a pharma site.
M. Black - while no one is going to be dinged for giving a pen, a dozen pens, or maybe even an hundred pens, it does speak to the culture of compliance at a company which, in turn, will say a lot to the DoJ when they bust your ass for something else. Somewhat akin to being pulled over for speeding and having the cop realize you’re not wearing your seatbelt, have empty liquor bottles on the floor, a roach in the ashtray and expired plates. While speeding alone may not have gotten you a ticket, combined with the rest you’re going to jail. I believe this is what happened to the Purdue Pharma guys, but I’d have to look it up.
M Helm, MD
Recently a friend of mine (an LPN) who works for a family medicine clinic was invited to (and attended) a speaker program at a very nice restaurant. An MD “expert” gave a talk on rotavirus and HPV vaccines. This was all paid for by Merck’s Vaccine Division.
My friend’s impression of the event was that it was avery nice meal, but the subject matter was not interesting. Who would enjoy hearing about diarrhea and genital warts and their link to cervical cancer over dinner?
Never mind the subject matter, and the fact that my friend can not prescribe these medications (admittedly, she may handout the informed consent materials, but she should not be answetring patient questions and concerns). Merck apparently had no problems buying her (and others from her practice - presumably to include some of the MDs) a nice dinner for the opportunity to present their interpretation of the utility, safety and need for these vaccines.
This occured within the past two weeks. This is well after PhRMA “code of conduct” guidelines on appropriate an inappropriate promotional activities. Apparently taking an office staff out to dinner to fill the seats for a “approved speaker” physician-delivered pitch is still OK within the new guidelines.
Surely, by the end of the evening, considering the cost of the speaker honorarium and the meal (not sure about adult beverages, but my friend is a tea-drinker anyway) Merck surely approached the proposed $50 limit with my friend the LPN. Through in a few lunches or snacks at the clinic, and that would surely top it out.
Would a car company (or dealership) ever do that?
harpy
yep, I have a friend does care coordination for HIV+ and PWAs, no prescription power, who was recently invited by Merck to a dinner presentation at a nice restaurant. Not against the PhRMA Code, or AdvaMed for that matter, as long as it’s “modest” for the area and conducive to doing business. “Modest” is arguable, always, without exception.
I haven’t read all of Connecticut’s proposal, but it seems like it would be in line there, too. The $50 limit, if you look closely M. Helm, is for reporting authorized payments or gratuities. In Massachusetts, one can only take a doctor somewhere within their place of work. I’m sure legislators were thinking cafeterias, but someone has to be clever enough eventually to put something a wee bit more upscale in a hospital setting. just sayin’
Former Pharma Marketing Director
Gifts doesn’t really touch the bigger issue. THe bigger issue is the strong influence peddling that ties in with the clinical trial work. Doc’s are under the pressure to publish or perish, additionally, most academic places are under pressure to do research. Industry helps meet both of those objectives. However, some of the clinical trials are a pure waste of time, i.e. more like phase IV marketing trials.
The lines becomes very blurry, unfortunately doctors start to look at pharma as colleagues, this is dangerous. It is like thinking you can tame a wild animal and then jumping into the swimming pool with let’s say an Orca whale for example. The pharmaceutical company is not a humanitarian aid organization, they must make profits and they must be competitive.
There really should be more independent research going on, but me thinks that will not likely happen. Too much money is at stake, and beside we are talking about “other” human beings, not ourselves, so why should we care.
The alterity of patients to both doctors and pharma employees makes it easier to hide negative results, pay off doctors to go on speaker tours to promote bogus clinical data. Travel first class and the enjoyment of being away from home all the time is after all much more exciting then dealing with patients every day….
This is a nice start, but it barely touches the crux of the problem. I just hope that everyone who is responsible for this irresponsible behavior gets on the other end of it…Get really sick and try to see your doctor, try to pay for the drugs, try to make sense of the bogus clinical data, all the while trying to hold your life together…
The patients that we do this to are the real heroes. We are the villians to humanity.
M. Black
M Helm,
Yes, car dealerships would do that, and frankly I see no problem with it. Case in point: Garden State Honda on Rt 3 in Clifton ( I think ) has one of those one-cup gourmet coffee machine in which you could stand next to while you wait ( Hondas are good - especially these days……. ) and drink coffee until your heart explodes.
I don’t know what it is, but I think an issue is being skirted. I see no problem in Hondas making coffee available. However I do think the “PhRMA Code” is about the biggest crock of doo doo, and frankly insulting. This is what I ask. Show examples of its teeth. Give an example of an infraction that resulted in a finger being bitten off. Can you provide a metric? Are there any stats that would let the numbers do the talking? Hell, that’s how it is in QA / QC / and Manufacturing.
BTW the Honda dealership mentioned is highly recommended. Ask for Jimmy D. Tell him his buddy Joey from the Poconos recommended him.
harpy
Show examples of its teeth.
It has none.