Tracking Pharma Gifts to Doctors

By Megan Tady, The American Prospect. Posted October 11, 2007.

Reprinted with permission from Megan Tady, "Tracking Pharma Gifts to Doctors," The American Prospect Online: August 09, 2007. The American Prospect, 2000 L Street, Suite 717, Washington, DC 20036. All rights reserved.

While it's no secret that pharmaceutical companies lavish gifts on doctors -- everything from free notepads and pens to meals to the more extravagant paid trips or seminars -- most patients are in the dark about who, exactly, is courting their physicians. But Congress may be finally acknowledging this relationship, one important step toward creating a national gift registry so patients can track the perks Big Pharma is giving to their doctors.

In June, the nonprofit government watchdog Public Citizen testified before the Senate Special Committee on Aging in favor of federal legislation that would require drug companies to disclose payments to doctors. But the group urged lawmakers, before jumping on the proposal, to examine a Petri dish of existing disclosure laws. Although four states and the District of Columbia already have disclosure laws on the books, the group says they are "inadequate" and do not give patients a clear picture of how money is changing hands.

The pharmaceutical industry spent an estimated $25.3 billion peddling prescription drugs in 2003, and much of that money went to physicians in the form of free samples, meals, conference fees, air fares, and continuing medical education activities. The only reins on Big Pharma's giveaway are voluntary regulations set by the American Medical Association (AMA) and adopted by the trade association Pharmaceutical Research and Manufacturers of America. The AMA's ethical guidelines, which are supposed to "prevent inappropriate gift-giving practices," only sanction gifts valued at $100 or less.

The pharmaceutical industry is adamant that these gifts have no influence on which drugs physicians prescribe to their patients. But a growing body of evidence shows that drug companies' generosity may in fact be guiding the pen across the prescription pad.

"The drug industry doesn't spend $20 or $30 billion a year on advertising prescription drugs unless they believe it has an impact on doctors prescribing," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "You would probably like to know whether your doctor is getting no money, some money, a lot of money, or a huge amount of money, because it's going to influence what that doctor decides for you."

Public Citizen says a federal disclosure law would give patients the ability to track their doctors' financial ties to drug companies. "We need a strong, uniform national law that requires every state [to have] these kinds of disclosures," Wolfe said. "State laws are better than nothing, but filled with problems."

In March, Wolfe (along with three other physicians and one medical student) published a paper in The Journal of the American Medical Association (JAMA) that analyzed Vermont's and Minnesota's publicly available disclosures of payments made to doctors from 2002 to 2004. The researchers concluded that both states' laws failed "to provide the public with easy access to information about these payments," and were "insufficient for revealing the true patterns of payments."

In Vermont, patients can obtain an annual summary report detailing how much money drug companies have given to health-care providers, and the form and purpose of the payment. The report does not, however, list recipients by name, but rather uses generic terms, such as "family practice" or "oncology." Patients cannot search for their specific doctor, nor is the information available in an online database.

Vermont's reporting requirements have also been criticized for allowing pharmaceutical companies to claim a "trade secret" exemption, which protects them from disclosing many of their payments to doctors. Assistant Attorney General Julie Brill defended Vermont's report, saying it "does an analysis that we think gives the public a pretty complete picture of what is going on, although it doesn't name names."

Brill also said there were holes in the JAMA article, which she said "never discussed the reason for the trade secret exemption." Brill said Vermont's laws protecting trade secrets are broadly written, and the legislature feared drug companies would legally challenge the disclosure law if the trade secret exemption was not extended to them. "We would not like to see the [disclosure] law struck down, or be stuck in limbo, while this trade secret issue is being litigated," Brill said.

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Megan Tady is a national political reporter for In These Times and a freelance journalist based in Western Massachusetts.

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