Well, how about this: Turns out doctors and med students happen to agree that gifts from pharma companies distort the practice of administering medicine. A press release from Health Care for All:
PROMINENT PHYSICIANS, NATIONAL PHYSICIAN GROUP AND MEDICAL STUDENT SOCIETY CHAPTERS THROW WEIGHT BEHIND PHARMACEUTICAL GIFT BAN
BOSTON, MA – June 23, 2008 – Physicians and medical students are voicing support for legislation that would prevent pharmaceutical companies from giving gifts to health care providers. Four prominent Massachusetts physicians, the National Physicians Alliance, and the Boston University and Tufts University chapters of the American Medical Student Association sent letters to Governor Deval Patrick, Speaker of the House Salvatore DiMasi, and Senate President Therese Murray warning that pharmaceutical and medical device companies use of gifts to market prescription drugs to health care providers undermines patient care and the integrity of the medical profession. Together this group represents 970 practicing and future physicians throughout Massachusetts.
Click here for the letter from the four prominent physicians. Click here for the letter from National Physicians Alliance, and the Boston University and Tufts University chapters of AMSA.
“Senate President Therese Murray’s gift ban legislation is an important step in eliminating conflicts of interest from the doctor-patient relationship and controlling healthcare costs. It is time to insure that treatment decisions for patients are not unduly influenced by industry marketing practices,” said Dr. David Coleman, Boston Medical Center Chief of the Division of Medicine.
In addition to Dr. Coleman, other prominent Massachusetts physicians who signed the letter in support of a gift ban include Dr. Marcia Angell, former Editor-in-Chief of the New England Journal of Medicine; Dr. Jerome Kassirer, Distinguished Professor at Tufts University School of Medicine; and Dr. Steve Tosi, Senior Vice President and Chief Medical Officer at UMass Memorial Health Care.
The New England Journal of Medicine recently found that 94% of physicians receive gifts and other payments from pharmaceutical companies. Numerous studies have show that gifts large and small have an influence on prescribing decisions and lead to higher costs, rapid prescribing of the newest, most expensive drugs, and decrease prescribing of generics. The industry spends over $8 billion annually marketing directly to physicians.
A survey released last week by the Prescription Project shows that Americans disapprove of even small gifts to physicians and believe that the pharmaceutical industry has a large influence over prescribing decisions, and support legislation that addresses these issues. · Respondents tend to disapprove of most gifts to physicians:
· 86% believe free dinners should not be allowed
· 80% believe speaking fees should not be allowed
· 78% believe free lunches at the office should not be allowed
· 70% believe free note pads and pens should not be allowed
· 62% believe free attendance at mandatory continue medical education classes should not be allowed“Pharmaceutical companies provide gifts to physicians with one goal in mind – to drive up prescribing of the newest, most expensive medications, even while the long-term effectiveness and side effects of these newer drugs have not been fully determined. Gifts inherently influence prescribing decisions by fostering name recognition and reciprocity,” said Dr. Jean Silver-Isenstadt, National Physicians Alliance Executive Director. “The industry would not spend billions of dollars each year providing gifts if it didn’t increase sales.”
The gift ban, proposed as part of Senate President Murray’s healthcare cost control legislation has passed the Senate and is pending in the House. The legislation prohibits pharmaceutical and medical device companies from giving gifts of any value to any healthcare provider who can write prescriptions. Companies may provide reasonable compensation for physicians for work such as research, speaking engagements, or consulting as long as companies disclose those payments. The ban allows pharmaceutical sales representatives to continue to meet with health care providers, and to provide drug samples and informational materials.
If passed, Massachusetts would lead the nation by being the first state to ban the pharmaceutical industry from giving any gifts to physicians.
and I understand there’s some quality, not just quantity…
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p>but there are 206,410 Healthcare Practitioners in MA according to BLS. Now, to be fair, over half of them are nurses, and there’s also assorted other groups within that 200,000 who can’t prescribe medicine.
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p>Still, it’d be nice to see bigger numbers of doctors who actively agree that the ban is a good idea.
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p>Also, I wonder: couldn’t this be done at a trade level too? I’m not saying the state doesn’t have an interest, but couldn’t the AMA or some other group make the decision to not allow the doctors to receive the gifts? I’m just throwing that out, I have no idea if it’s a workable idea or not.
The AMA (among others) certainly could support the gift ban.
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p>But they don’t and they haven’t. See, e.g.: http://www.pharmalot.com/2008/…
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p>I’m shocked. Shocked.
A majority of all doctors support gift ban but the AMA which is made up of doctors doesn’t.
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p>I guess that says that the AMA believes that the acceptance of gifts is i) a matter of individual choice and ii) won’t affect the quality of the profession.
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p>Interesting that the Legislators know the medical profession better than the Medical Association.
The above article says 94% receive gifts. Sort of like Ron Paul being against earmarks but then writing a few hundred of his own.
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p>Anyways, where do you see data that shows the majority of all doctors support this ban?
None of the so-called doctors who oppose lunches and note pads actually practices medicine. They are all academic “thinkers.”
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p>The psychological stress of doing primary care is getting to be unbearable, and countless primary care doctors are quitting. One doctor in Revere in her early fifties just quit to open an ice cream parlor in Brighton. Another doctor in Everett in his forties just quit, with no idea what he will do next.
Many doctors are retiring early, if they can, and few new doctors are entering primary care.
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p>The lunches are a welcome break in the day. The drug reps treat doctors the way doctors wish everyone treated them.
It’s a time to relax and have a few laughs. Do you really think doctors get “bought” with a sandwich and a pen? How stupid do you think we are?
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p>There is a growing crisis in Massachusetts of a shortage of primary care doctors. Banning drug company lunches just adds to the problem.
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practices urology in Worcester and has for years and years. He is not an “academic ‘thinker'” but an in-the-trenches physician who also happens to have administrative responsibilities at UMass/Memorial.
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p>I worked (in my previous career) in community-based primary care medicine (for UMass/Memorial) for 16 years. The lunches are a joke, and if you think real professionals are finding respite in the grinders and pizza from the local pizza joint, you need to spend some more time in physician practices and clinics. Drug reps are a pain in the ass, candidly, and a huge disruption in the course of a clinical day. Many of the practices I worked with–135 physicians in all–refused to see reps and even more consigned the reps to the clinical paraprofessional in the office.
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p>And as for the pens, pads, and paraphernalia, well, all I can say is we tossed that crap by the boatload. There’s only so much room to store hundreds of cheesy pens and pads of paper shaped like feet.
So why should MA ban the free lunches? This is the point that I just don’t get. Is anyone really arguing that having an inexpensive lunch available at a sales pitch or getting a free note pad is actually influencing the decisions of the doctors? I just don’t see the need for a complete zero tolerance ban.
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p>I’m not in the medical industry, but I’ve gone to sales pitches and received the small gifts or the free snacks. It didn’t make me any more likely to urge my employer to do business with the rep’s company. I don’t understand why we can’t give doctors some credit here.
I agree that docs are overworked, but why should they get free lunches from drug companies?
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p>This is a classic collective action problem – not many doctors want to be the only ones to refuse the gifts, but if everyone opts out together, it is easier.
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p>That’s why this legislation makes sense. Don’t listen to the phrma trolls.
I hope it was a happy thing that kept you away from here in the last weeks.
I wasn’t talking about academic centers or clinics. I was talking about the few doctors in Massachusetts who still do private practice in a private office. For those of us who do that, the hour we spend with the drug reps is a welcome break from the grind of practice, because of the socialization. This is especially true now that hospitalists have taken over hospital practice. We now spend the whole day in the office.
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p>Banning free lunches will have no effect on the cost of medicines prescribed; but will hasten the end of primary care private practice which is already on life support.
For primary care, the practice of medicine has changed a lot in the last five years. Before that, doctors would make daily rounds at the hospital, and socialize with other doctors and health care professionals. Now that hospitalists have taken over the hospitals, primary care docs spend the whole day in the office. The work is difficult, stressful, and boring. Many doctors grab a quick bite for lunch and get right back to work. They will burn out.
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p>The drug reps are younger, attractive men and women; cheerful, respectful, and eager to please. The lunches we get are better sandwiches from Flour in the South End, Sam LaGrassa’s, the Milk St. Cafe, etc. My partner and I set aside one hour each day to have lunch with the reps. Our receptionist and our medical assistant join us. We talk about our vacation plans, sports, politics, the news, the reps’ pending marriages, etc. We have a few laughs. It’s a pleasant break in the day, and it is the only socialization we get at work.
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p>Why do you want to ban this?
Mikberg,
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p>If I read this correctly, the change in rules would not preclude you from having lunch with these business associates. It would just require you to do what many in the public sector already have to do . . . pay for your own meal.
You are right. I could pay for my lunch. But practically speaking, the lunch custom would end. I believe there would be no net benefit to Massachusetts; drug costs would not fall.
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p>There are three areas of harm: It would hurt the state economy because many local restaurants and caterers would lose a chunk of lunchtime business. It would remove a small, psychological support from the burdened, primary care physicians. The drug industry might retaliate to this first-in-the-nation law by chanelling research money away to other states. I think the potential harm outweighs the potential benefit.
If you pay for your lunch, as opposed to the pharma company, how does that shortchange the business selling the lunch?
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p>”The drug industry might retaliate to this first-in-the-nation law by chanelling research money away to other states. I think the potential harm outweighs the potential benefit.”
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p>Nice threat.
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p>I guess pharma companies never have to swear “do no harm.”
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p>If these gifts don’t affect doctors’ decisions, then banning them won’t hurt pharma sales. But Pharma is pushing hard to keep them, which means gifts must be an effective way to increase pharma sales. There’s something really unsavory about the opposition to this gift ban.