Pharmaceutical and Medical Device Gift Ban is Working

Mass Prescription Drug Reform CoalitionIn 2008, Massachusetts enacted its a pharmaceutical and medical device gift ban and disclosure law, which limited industry representatives from wining-and-dining physicians in order to encourage the prescribing of their high-cost, brand-name products. The law also established annual reporting requirements for these industries to disclose details about permitted payments made to physicians and other prescibers.

The pressure from the statute led many pharma firms to voluntarily report their national spending on doctors, and, as part of the ACA, the federal government will require national reporting in 2013. For now, the public interest journalists at ProPublica have looked closely at the voluntary reports. Liz Kowalczyk of the Globe has mined two good stories based on their research.

Globe graphic showing declining payments to physicians from pharmaceutical firms

Boston Globe chart

Last week, Kowalczyk reported that the new transparency has already yielded positive effects:

Total payments to doctors for promoting pharmaceutical companies’ products to their colleagues appear to be falling in Massachusetts, suggesting that new restrictions designed to distance doctors from industry are leading some to abandon the lucrative speaking circuit.

Payments are down nationally, not just in Massachusetts, suggesting a halo effect from our statute. Of course, the pharma companies deny anything of the sort. For years they maintained that the speakers were critical to “educate” doctors about their products. Now they’re singing a different tune. Kowalczyk quotes a GSK spokeswoman as saying, “We felt it would be a better use of our resources to use fewer speakers more often. This reduces training costs and the number of contracts needed.’’

Then yesterday, Kowalczyk followed up with a story looking at pharma spending on meals for doctors. She reported that Attorney General Martha Coakley fined two companies, Analogic Corporation in Peabody and Lantheus Medical Imaging in Billerica, for improperly providing restaurant meals to doctors.

A patient shouldn’t have to wonder whether they are being prescribed a drug because it is useful, or because their doctor is influenced by benefits provided by a manufacturer. The added element of transparency holds the medical community responsible.

That the industry is paying less and more doctors are leaving the speaking arena proves that questionable ethics of pharmaceutical-doctor relations exist and that the ban is a step in the right direction toward a consumer centered health care system that focuses on quality care.

Curious about your doctor? ProPublica has created an easy-to-use interactive search tool to let you find out whether your physician has received money from drug companies.

The Public Health Committee will be hearing more bills to weaken our law in early October. We urge the legislature to not allow drug marketing to drive our public policy.
-Amanda Catalani

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7 Responses to Pharmaceutical and Medical Device Gift Ban is Working

  1. Pingback: DPH Posts New Pharma and Device Payment Data |

  2. Dr.Carl says:

    I am wondering why there can’t be happy medium between greed, what people need, and providing effective worthwhile pharmaceuticals to us. Too many technicalities and not enough logic or reason.

  3. Marcia Hams says:

    In Response to Fender,

    Market forces will not “naturally” reduce health care costs. In fact, study after study has shown that the U.S., the most market-driven system in the world, has the highest health care costs , without achieving better outcomes on many important measures. For the latest, see the April study by Kaiser Family Foundation. http://www.kff.org/insurance/snapshot/OECD042111.cfm). This is because, until the recent passage of health reform, we were the only developed nation without a national health care system that could effectively contain costs. But the Affordable Care Act is still far from being fully implemented and has few means to control pharmaceutical costs—for instance, the largest public payer, Medicare, will remain barred from negotiating drug prices.

    Massachusetts costs continue to rise for the same reasons as national costs, not due to our health care law. Indeed, we are ahead of the game, not only by having the lowest uninsurance rate in the country, but because we are closer to implementing proposals to reduce underlying costs, such as waste due uncoordinated, inefficient care and the failure to require that the best evidence be used to make treatment choices. In fact, the pharmaceutical gifts law was one early step in that direction.

    Academic medical centers and medical schools, including Tufts, Harvard, BU and UMass, have also enacted strong new policies and policies to restrict participation by physicians in pharmaceutical company meals, speaker’s bureaus and other perks. AMCs have done this throughout the country because they provide care to millions of patients, educate the next generation of physicians, do critical research, and set clinical and ethical standards for profession.

    These state and AMC reforms were not based on political rhetoric but on the facts. In 2009 the Institute of Medicine (IOM), the health arm of the National Academies of Science, reviewed the research and found that financial relationships between physicians and industry were associated with “reduced generic prescribing; prescribing patterns inconsistent with evidence-based guidelines; increased drug costs; and requests for additions [of drugs, by physicians,] to hospital formularies.” The IOM concluded that conflicts of interest “present the risk of undue influence on professional judgments and thereby may jeopardize the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.” (IOM, April, 2009: Conflict of Interest in Medical Research, Education and Practice). Congress responded to these findings by passing the Physician Payment Sunshine transparency provisions in the ACA, which are set to go into effect in 2013.

    Massachusetts public officials, medical leaders, advocates and members of Congress can rightly be proud of their determination to protect patients and professional ethics, based on sound research and economic realities.

    Marcia Hams
    Director of Prescription Access and Quality, Community Catalyst

    • fender says:

      The data for cost of plastic surgery over the past decade in the United States has come down approximately 15-25% depending on the procedure. Since this is a field of medicine which is least regulated, that is no third-party payment system, the least amount of government intervention, the numbers disagree with your assessment.

      Although plastic surgery is an elective procedure the economics don’t lie. Natural economic forces always act efficiently over time whereas third-party payment systems are inherently inefficient as money is spent collecting and paying for services arty rendered. This network of approvals and referrals and paperwork adds million without any medical benefit.
      Medical cost in Massachusetts and actually risen since the mass helathcare law and pharmaceutical ban has gone into effect. Emergency room utilization rates have essentially stayed the same despite the theroy that universal coverage would reduce that rate. Hospital’s actually did better with the free heathcare pool money for taking care of he uninsured in the past. Uninsured patients still show up for emergency care however now there is no free health care pool money to manage from as the state assumes everyone is insured. Hospital do worse under the new system !

      To suggest government regulation is needed for commonsense decisions by physicians is absurd. The majority of physicians can be trusted to make medically appropriate decisions regarding medications. Additionally there is are ready a tear system by insurance companies that retards non-generic medication usage.

      The argument for the pharmaceutical ban his based on pharmaceutical marketing techniques that are 10-15 years old. Just before the ban all of the pharmaceutical programs were restricted to FDA approved medical material only. The speakers could only discuss FDA approved data and slides. These meetings also allowed primary care physician’s to interact with specialist from different hospitals allowing discussion and sharing of knowledge beyond the scope of the to topic of presentation.

      Lastly pharmaceutical companies will spend their marketing budgets with or without the Massachusetts ban. That is if they cannot spend the money in downtown Boston restaurants than they will still spend the same amount of money on other non-educational less efficient marketing techniques such as TV advertising and magazine advertising, none of which helps downtown boston restaurants or businesses. To suggest that the money that is spent on pharmaceutical dinner increases medical costs is ridiculous as the money will be spent anyway!

      Massachusetts and Boston represents the forefront of academic excellence and medical pioneering. To retard and restrict pharmaceutical industry from investing and supporting the city of Boston is to retard the economic and scientific evolution of the state itself

    • fender says:

      marcia ,

      The natural pending expiration of patents for liptor & plavix will save more money than any phama ban will ever hope to achieve. The generic utilization rates will remain the same 70 to 75% in Massachusetts with or without the ban.

      If the goal of the law was to create a hostile environment and anti-business climate for the pharmaceutical industry, you had succeeded, as there is no evidence of cost savings from a medical standpoint since this law was past 3 years ago.

      The Massachusetts house overwhelmingly voted to overturn this nonsensical law , and hopefully, with logical thinking people, the rest of the Massachusetts government will yield the commonsense freedom for private companies to invest and market their products without fear government reprisal.

    • Beth says:

      Bankers get entertained, despite the government bailing them out. Legislators get entertained, despite costing everyone trillions. Yet, doctors can’t get entertained? The original post presupposes that all new and innovative treatments are unproven and do not increase quality of life. That’s simply not always the case.

  4. fender says:

    The point of the law was to reduce healthcare cost, there is no data suggesting proof of this as the generic utilization rate for physicians in Massachusetts has stayed approximately as it was before the ban. Major healthcare reduction costs will happen naturally without over regulation and government intervention. Pending expiration of pattents for Lipitor and Plavix will reduce pharmaceutical expenditures by millions when these drugs go generic over the next 6-12 months.

    Since the Mass health care law and pharmaceutical ban, healthcare cost of actually gone up in Massachusetts as well as higher with the same emergency room utilization rates. Ironically the only field and medicine where cost have come down is the field that is most unregulated, that is plastic surgery. Reason: natural market forces of supply and demand, which increased competition, lower-cost, and increased quality through competition, not regulation or intervention.

    The Atty. Gen. ironically was interviewed down in Washington DC coming out of a lobby sponsored pharmaceutical meeting just prior to losing Scott Brown . Seemingly it’s okay for her to do business while being sponsored with elaborate dinners by various lobbying groups, including the pharmaceutical industry, which she now bans from doing the same in her own state.

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