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    Bill limits gifts from pharmaceutical companies to physicians

    Charges of ‘market manipulation’ drive legislative initiative


    Bob Gatty
    Washington—Jerome P. Kassirer, MD, distinguished professor at Tufts University School of Medicine in Boston and visiting professor at Stanford University, Stanford, CA, has told Congress and the American people that many doctors are "on the take" from the big pharmaceutical companies, which pay them in one way or another to prescribe their drugs to patients.

    Early in September, a group of influential senators introduced the Physician Payments Sunshine Act, which would require manufacturers of pharmaceutical drugs, devices, and biologics with annual revenues exceeding $100 million to make quarterly disclosures of the amount of money they give to doctors through payments, gifts, honoraria, travel, and other means. Failure to submit the reports to the U.S. Department of Health and Human Services for posting on a new public web site would carry penalties up to $100,000 per violation.

    While this legislation was pending in Congress in early November, a coalition of medical specialty societies, AUA among them, was negotiating with key members of Congress, including the Senate Finance Committee, to prevent a 10.1% reduction in the Medicare conversion factor from being implemented Jan. 1, 2008. On Nov. 1, the Centers for Medicare & Medicaid Services issued a final rule implementing the reduction. Negotiations were under way as Urology Times went to press. Look for details of the resolution in this column in the January 2008 issue, and also see, "Medicare final rule: Little good news for urologists").

    The "Sunshine" bill was introduced by Sen. Chuck Grassley (R-IA), ranking Republican member of the Senate Finance Committee, and Sen. Herb Kohl (D-WI), chairman of the Senate Aging Committee, in the aftermath of a June hearing by Kohl's committee in which Dr. Kassirer flatly declared, "I will assert that the medical profession has become excessively dependent on the largesse of industry, that these financial connections have a negative influence on the quality and cost of patient care and the trust of the public, and that the profession's response to these threats has been inadequate."

    Sen. Kohl referred during the hearing to an article in the New England Journal of Medicine (356:1742-50) that reported that 94% of physicians have received food and beverages, medication samples, and other gifts and forms of payments from drug companies.

    "It has been estimated that the drug industry spends $19 billion annually on marketing to physicians in the form of gifts, lunches, drug samples, and sponsorship of education programs," Sen. Kohl said. "Companies certainly have the right to spend as much as they choose to promote their products. But... the federal government has an obligation to examine and take action when companies unfairly or illegally attempt to manipulate the market."

    Dr. Kassirer is author of On The Take: How Medicine's Complicity With Big Business Can Endanger Your Health, in which he outlines "the complex intertwining of the medical profession and the pharmaceutical, biotechnology, and device industries and the consequences of these relationships."

    A necessary relationship?

    At the June hearing, representatives of the American Medical Association and the Pharmaceutical Research and Manufacturers of America outlined their organizations' voluntary guidelines governing marketing and gifts from drug companies to doctors. They emphasized the importance of physicians having accurate and up-to-date information about new drugs and their risks and benefits.

    "Informing health care professionals of the benefits and risks specific to a new or existing medicine, whether it be through responsible advertising or pharmaceutical sales representatives, helps ensure patients are safely and effectively treated," said PhRMA Senior Assistant General Counsel Marjorie Powell. "Pharmaceutical marketing is one of several important ways for doctors to receive the information they need to make sure their treatment choices are the right ones for each individual patient."


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.