Physician Gifting Crackdown

Mar 26, 2008
By Pharmaceutical Executive Editors

The latest legislative maneuver to control pharmaceutical marketing: Last week, congressman Pete Defazio (D-OR) introduced the Physician Payment Sunshine Act, a bill that will create a public registry of gifts and payments to physicians in excess of $25 by pharmaceutical companies.

The equivalent Senate bill (S 2029) was introduced last September.

The bill before the House covers companies with revenue above $1 million, whereas the Senate bill calls for only companies with revenue over $100 million. The Senate version exempts payments for both clinical trials for which information must be reported under the Public Health Service and compensation paid to a physician who is directly employed by, and works solely for, the company. The House bill exempts payments associated with all clinical trials and drug samples.

Embarrassing the Doctors
More than a dozen advocacy groups have come out in favor of the bill.

The legislation doesn't make any judgment on the appropriateness of the payments?and indeed seems to concern only payments and gifts that are legal for physicians to accept. However, advocates feel that guilt might be the biggest punishment. "If someone is embarrassed by the dinner they are having courtesy of the drug industry, I guess that tells you all you need to know," said Allan Coukelle, of the Prescription Project, an advocacy project to promote "appropriate" prescribing. "This is part of the larger culture of change that is going around medicine and marketing."

"The evidence is absolutely overwhelming that the marketing spend?changes prescribing habits and drives doctors to prescribe higher-cost drugs," Coulkelle said. "As a matter of public interest, when you have financial relationships influencing the care people get, the public needs to know."

Others feel that the bill might not go far enough.

"I think this bill is a step in the right direction, but if the government says that gifts are wrong, then they should ban them like Minnesota has done." said Benjamin Schaefer, a cardiologist and board member of the National Physicians Alliance. "If they don't go with a ban, then every gift should be reported.

"There is no magic number here. It's been clearly shown that even small gifts have influenced decision-making. If we are going to report gifts, then we should start at zero dollars."

Similar laws already exist in West Virginia, Maine, Minnesota, and Vermont.

What About Pharma?
The Pharmaceutical Research and Manufacturers of America (PhRMA) has not taken a stance on either bill; however it stated in a release that "it is important for healthcare providers to have the most up-to-date educational information about the benefits and risks of medicines so that patients can be safely and effectively treated."

The lobbying group also made it clear that entertainment-based promotions should not be given to physicians and that only "modest"-cost meals should be offered at educational events.

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