… And one would have to imagine that it's going to be pretty close to what the Senate passes. John McDonough calls it “strong legislation”, most critically banning drug companies from giving bribes “gifts” to doctors, and having the state provide “an evidence-based outreach and education program designed to provide information and education on the therapeutic and cost-effective utilization of prescription drugs to physicians, pharmacists and other health care professionals”.
This may sound like common-sense stuff, but it's really amazing how difficult it's been to pass simple legislation like this in other states. Oregon went through the ringer with the PhRMA lobby trying to set up its own Drug Effectiveness Review Project, because PhRMA doesn't find a well-informed marketplace to be in its interests. You know, I kind of feel that screwing your customers, keeping them in the dark, is not good business practice. Perhaps things are changing.
Now, will this hold up in the House? Or do the lobbyists still run the show, as in our Senate? Now that there's a big push and widely acknowledged need for this far-reaching and cost-saving legislation … what else gets thrown in the sausage? If the bill's going to be effective at what it purports to do, someone big is going to have to be cut out of the deal.
Congratulations, President Murray.
to see how the uncorruptible speaker of the house responds to this legislation. An apparent oversensitivity to the concerns of certain lobbyists is one of the failings that I personally associate with Speaker DiMasi, but one can never be completely certain of this . Current ethics legislation, and campaign finance regulations, seem to be insufficient to remove the influence of corporations and lobbyists on legislators. This is as true in MA as it is at the Federal level. I am always annoyed to see that the state ethics commission is busy chasing down obscure elected officials from Western Mass over relatievely trivial matters while the fate of the entire Commonwealth is decided in back-room or golf-course negotiations among various corporate interests.
Seriously, do we really think it makes sense that doctors cannot receive any gifts of any value (not even a pen or a box of tissues) while legislators can receive gifts of up to $50 from lobbyists? Is there something inherent about being a physician that they are more susceptible to pandering than legislators?
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p>A significant part of the reason health care is expensive is the outrageous gifts (theater tickets, nights on the town, lavish dinners, etc.) that pharma companies offer. Those deserve to be banned. Honestly though, they can’t give your family physician a free box of kleenex? That just seems silly and, perhaps, infringing upon free speech and advertising. Limits? Yes. Total bans? No.
Or set the max for both at $2.19 (the cost, according to Peapod, of a Box of 200 Kleenex ™ Brand Facial Tissue.
Throw out the Bad Baby with the Bathwater.
Let’s at least be equal in our silliness. If doctors can’t receive gifts then legislators shouldn’t be able to receive gifts, like you say, though you may have been saying it only ingest. (Get it? ingest vs. ‘in jest’ Oy, someone get me some oxycontin.)
If you believe advertising works — and frankly, it does — then what on Earth are we doing advertising for particular drugs or drug companies inside doctor’s offices?
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p>Not allowing them to gift means we won’t have doctor’s offices looking like NASCAR pit row. That will help patients and doctors choose medicine based more on facts and research, and less under the influence of advertising.
If I see a box of tissues with a ahem big sign on it saying VIAGRA I may ask my doctor, “hey doc, how about a script for some weenie-uppers?” It is up to the doctor to make the decision because they are prescription only.
but it does. Not on every person, on every product, in every situation — but in aggregate, it clearly works.
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p>Spin it another way. If the makers of Viagra didn’t think advertising worked, why would they pay for the tissues, pay extra for the word Viagra to be printed on them, and then pay to distribute them to the doctors?
They advertise to sway the consumer. The hope is that patients will request the product advertised whether on the box of tissues, the television screen or the porn site.
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p>It is up to the doctors to say yes or no based upon what is best for the patient.
After all, in many cases there are a few drugs, each with advantages and disadvantages, and the doctor has to choose one of them to prescribe first…
Most health plans specifically state which medication (be it antihistamine, athsma, weenie-uppers, etc.) are allowed and will be paid for. Doctors can, after filling out significant paperwork, say that the patient needs this other medication (original medication didn’t work, created allergic or other negative reactions, etc.) but most doctors hands are tied as I understand it.
but I suspect that there are other situations where there are a few different drugs, each covered by the insurance company.
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p>Besides, since a single drug can often cover multiple symptoms, etc., I suspect that there are plenty of cases where if a doctor wants to prescribe X but Y is the protocol, he can over or under emphasize different patient symptoms to come to a slightly different diagnosis and prescribe X anyway. I’m not suggesting anything nefarious or substantial, but rather it seems to me that diagnosis is as much art as science, and that different diagnoses can be simultaneously correct.
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p>In any case, I don’t think that Phrma is wrong in their analysis that it’s good business to put those gifts in doctors’ offices… so it “must” have some positive impact on sales.
announced yesterday that they are closing a 24 bed, med surg wing because they are $2.3 million in the hole.
Why you ask, because of a surge in unreimbursed medical care (read FREE medical care) and flat medicare/medicaid reimbursement.
Charley, I’m with you on the need to contain health care costs. Also agree that powers-that-be will fight any reasonable effort, tooth and nail.
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p>This may be well intentioned. And while I worry (if pharma companies don’t take my wife to fancy dinners, that burden may shift to me!), I agree this is common sense.
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p>But let’s appreciate that the last 10 years have seen scores of state efforts across the nation. The 3 common outcomes are:
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p>a) Haven’t yet gotten traction (including the Oregon thing you cited)
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p>b) Create best-case actual savings in the <$5 million per year range (remember that MA’s total health spending is something like $70 billion)
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p>c) Now dead
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p>This is a great quickie history.
… is actually not part of the plan. This is about a hell of a lot more than that. You’re right in that it may be futile to try some of these things on the state level; but there are a lot of admirable and sensible things in the bill, even so.
goes beyond bulk purchasing. scroll down to “other efforts” (including the Oregon-type evidence effort you cited).
Just to set the record straight, giving gifts of ANY value to legislators by lobbyists (legislative agents) is illegal. Not a stick of gum, not a cup of coffee. This was part of the campaign finance reform law passed in 1994 when Sen. Stan Rosenberg and I chaired the Joint Committee on Election Laws.
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p>Also, in Sen. Murray’s cost bill, approved yesterday, criminal penalties for gift giving by drug reps to physicians were removed at the recommendation of the Attorney General’s Office.