For another perspective on this issue, see the letter included below from four prominent MA medical leaders: Dr. David Coleman, Chief of Medicine at Boston Medical Center; Dr. Marcia Angell, former editor-in-chief, NEJM and Harvard Medical School; Dr. Jerry Kassirer, Tufts Medical School; and Dr. Steve Tosi, Chief Medical Officer, UMass. The letter was sent to Gov. Patrick and the Legislature back in June in support of Sen. Murray’s original proposal to ban all gifts to physicians.
June 23, 2008
Dear Governor Patrick, Senate President Murray, and Speaker DiMasi:
We are writing in support of legislation that would prohibit pharmaceutical and medical device companies from providing gifts to health care providers and health care providers from accepting gifts from pharmaceutical and medical device companies.
As physicians, researchers and educators who have closely examined the relationship between industry gifts to physicians and prescribing patterns, we believe the industry’s persistent use of gifts to market drugs to doctors has a corrosive effect on the medical profession and undermines patient care. Patients must have the confidence that their physician’s prescribing decisions are a result of a careful examination
of all the independent scientific evidence, not biased sales pitches sweetened with gifts to sell product. In addition, medical education should be as free as possible of potential commercial bias.
The New England Journal of Medicine recently reported that 94 percent of physicians have received food, samples, reimbursements or payments from the industry. While skeptics scoff at the idea that branded pens or coffee mugs can influence prescribing decisions, numerous studies have found that gifts of whatever value can and do have an impact. Gifts to physicians increase overall prescription rates, reduce
generic prescribing, and rapidly increase prescribing of the newest most expensive drugs, including those of only marginal benefit over existing options with real-world safety records. And, contrary to popular belief, the intellectual aptitude and education required to become a physician do not make physicians any
less susceptible to the persuasive power of marketing. There is abundant evidence that gifts, even small gifts, cause recipients to reciprocate, affecting their choices and decisions. Research also shows that
individuals cannot accurately assess their own bias.
For these reasons, many other professions adhere to strict ethics codes that bar receipt of gifts, while elected and government officials are guided by public finance laws prohibiting gifts from lobbyists. We do not believe physicians should be treated differently.
We would also like to respond to some of the arguments advanced by gift ban opponents, who claim the measure will have a negative impact on the life sciences industry in Massachusetts. Last month, the Association of American Medical Colleges (AAMC) issued recommendations for all academic health centers regarding physician-industry interactions. Representatives from the biotech and pharmaceutical companies were among the 30 participants on the AAMC task force. While many of us objected to the industry’s participation on a task force making recommendations on medical education, the task force did unanimously agree on the AAMC recommendation to ban gifts of any value to physicians and on the need for standards to guide physician-industry interactions. Indeed, such reform is already underway at numerous medical schools and teaching hospitals across the country. In fact, the Boston University
School of Medicine, Boston Medical Center, and University of Massachusetts Memorial Medical Center have recently passed strict new policies that ban gifts and free meals. A law banning gifts to physicians and other prescribers will ensure that reform extends to individuals, clinics and group medical practices,
We also find particularly outrageous GlaxoSmithKline’s threat to pull out of Massachusetts if a gift ban bill passes. We hope state policymakers will reject the biopharmaceutical industry’s attempt to blackmail
state officials in order to preserve unethical marketing practices. Contrary to the industry’s claims, gift ban policies at academic medical centers and a gift ban law will not discourage collaboration with life sciences companies on innovative disease-fighting research and treatment. These policies only ban inappropriate strategies to sell products, not appropriate sharing of information. If drug companies’ products have merit, why do they need to use gifts to sell them?
Given that Massachusetts boasts some of the world’s leading medical institutions and a life sciences industry poised to receive a $1 billion investment from the state, it is only logical that industry should be subject to standards to ensure collaborations are free of financial conflicts of interest and in the best interest of patients and taxpayers.
We urge the Commonwealth to help protect patients and taxpayers from harmful industry marketing practices that increase health care costs, diminish the quality of care, and decrease confidence in the medical profession.
Thank you for your consideration.
Marcia Angell, M.D., F.A.C.P.
Harvard Medical School
New England Journal of Medicine
Jerome P. Kassirer, M.D.
Distinguished Professor, Tufts University
School of Medicine
Visiting Professor, Stanford University School
David Coleman, M.D., F.A.C.P.
Chief of the Division of Medicine
Boston Medical Center
Chairman, Department of Medicine
Boston University School of Medicine
Stephen E. Tosi, M.D.
Sr. Vice President & Chief Medical Officer
UMass Memorial Health Care
CC: Massachusetts State Representatives and Massachusetts State Senators