Lest you think this is all hyperbole and Chicken Little language, read this letter from Anil Nair a clinical neurologist from Boston University, to Governor Patrick.
Dear Governor Patrick,
As a practicing neurologist and a clinical researcher at Boston University Alzheimer’s Disease Center, I’d like to thank you for the leadership you’ve exhibited to build upon the Commonwealth’s already strong presence in the life sciences. I was proud and deeply encouraged when you signed the related legislation into law less than two months ago.
This amazing commitment to create the nation’s premiere environment for the advancement of life sciences provides optimism to those of us who have a vested interest in a strong and vibrant research community. And importantly, it offers great hope for patients who anxiously await new cures and treatments for Alzheimer’s disease and other devastating ailments.
However, I am deeply concerned that the great promise afforded by this initiative could be endangered by subsequent healthcare legislation (S 2683) awaiting your signature. While I fully endorse the underlying intent of the legislation – lowering healthcare costs in the state – Section 14, which requires disclosure of payments valued at $50 or more by pharmaceutical companies to physicians and other healthcare professionals, is troublesome.
Posting this information – essentially a list of companies, dollar figures and doctors’ names – on a public Web provides a one-dimensional window into the existence of a professional partnership. It offers little if any useful information and threatens to raise unnecessary suspicions and misinterpretations.
Of particular concern is the fact that those who access and make judgments on such information may lack the context to understand the true nature of the payments.
For example, in many cases a payment provided by a pharmaceutical company to a physician is used to cover the hospital and staff expenses necessary to conduct the research, as opposed to being actual compensation to the individual physician. Some hospitals or academic research centers even insist that the physician take the payment in his or her name, so that the institution can avoid the appearance of having received payment from a company.
The disclosure requirement disregards such complexities and nuances in the partnerships between researchers, institutions and companies. If enacted, it is possible – perhaps even probable – that an entire grant will be linked to an individual physician’s name, creating misimpressions in the public eye as to the level and purpose of the compensation. Such misperceptions could unfairly impact the physician’s reputation, and more alarmingly, could jeopardize the relationship shared with his or her patients.
If Massachusetts adopts this disclosure requirement, I fear future research, patient access to clinical studies and the state’s life sciences program would suffer irreparable harm. I urge you to return S 2863 to the legislature with an amendment to eliminate Section 14.
Sincerely,
Anil Nair MD.
Assistant Professor, Department of Neurology Boston University School
Boston, MA
Governor Patrick should veto this bill.
Even after reading Dr. Nair’s letter I can’t see what the harm is in showing how money flows. Maybe the law should require hospitals rather than physicians to be named, or maybe the disclosure website should explain why the money is being spent. If Dr. X says that medicine Y produced by company Z is the greatest thing since sliced bread, then I certainly would want to know that the money Dr. X used to research medicine Y was provided by company Z. I also don’t understand the Herald’s contention that doctors may not want the public attention. If I were a doctor I would see that as good for me and my employer. As for the fear labs looking elsewhere I always say we should do what is right for us and not be afraid of other states. Yes, I do think your use of the word “assault” in the title is hyperbolic.
Look at the way campaign donations are sensationalized. Imagine if David Duke made a contribution to the McCain campaign and was discovered months later. For at least a day, McCain would be “in league” with David Duke on sensationalistic blogs. Same as if Mumia Abu-Jamal made a donation to Obama’s campaign.
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p>Any legit transfer of money to a doctor can be sensationalized if the giver of the money becomes some controversial figure. It doesn’t matter what the truth is; if the story is sensational enough, it will get played up.
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p>I think the there are points to consider, especially how this information can be used and abused. I may not be sold that this piece needs to be vetoed, but I think these concerns should be vetted and alleviated.
And worth further critical thought and discussion.
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p>I will add my half-serious, smart-ass rhetorical answer as food for thought. It’s a response Conservatives are quite found of:
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p>If the doctors that receive this money from pharmaceutical companies aren’t doing anything wrong, then they have nothing to worry about. In other words, if all the money goes to above board activities and can be accounted for, then the doctors shouldn’t need to keep these funds secret.
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p>My first reaction is to lean towards not vetoing the bill, but take into consideration the concern represented in Dr Nair’s letter and modify the laws to be more fair in the future. It think the protection is a good first step and it would be easier to implement and then improve later than to strip it now and possibly loose it for ever.
From Health Care for All's Healthy Blog
Since Senate President Murray introduced the bill in March, the most debated component of the bill has been the section related to pharmaceutical and medical device company gifts to health care providers. The final language enacted is a good compromise and a great first step for the Commonwealth. It requires the Department of Public Health to implement (and enforce jointly with the Attorney General) a statewide code of conduct on gifts based on industry trade group internal codes of conduct (the PhRMA Code and AdvaMed Code).
While it allows companies to continue to provide gifts and payments that do not violate the standards to be adopted by DPH (such as compensation for research), it requires companies to disclose those payments to DPH and the public.
Since its passage, we have heard a number of misstatements and untruths about the provision on pharmaceutical gifts to providers. Below we attempt to clarify:
First, the new law does impose restrictions on industry gifts to health care providers but does not create new rules to follow. It requires the Dept. of Public Health to establish regulations that take, as their foundation, the industry’s own codes of conduct. We have relied on companies to voluntarily adopt and enforce these codes for years and, during that time, gift giving has only increased. However, companies should have no problem following rules they have set themselves.
Second, pharmaceutical industry threats that companies will leave the state if this bill is signed into law don’t hold water. These rules apply to all companies that sell their products in Massachusetts and no company is going to stop selling its products here (nearly $4.5 billion was spent on prescription drugs in 2006 alone). In fact, GlaxoSmithKline, which wrote letters threatening to leave the state months ago, has since rescinded that threat.
Third, the new law does not prevent or inhibit research. Drug and device companies will continue to be allowed to compensate doctors for research, as long as that compensation is reasonable and disclosed to the state (as several other states require).Massachusetts has one of the largest, most dynamic research clusters in the world. It is underpinned by some $2.2 billion in annual NIH funding. That isn’t going away, and Massachusetts will remain a research nucleus.
Fourth, the new requirements that companies disclose their financial relationships with health care providers do not limit anyone’s ability to do business. We have a transparency law because the public has a right to know if the doctors who treat them are getting money from the companies whose drugs they prescribe. That’s why half a dozen states have now passed one kind of disclosure law or another. The industry itself supports federal disclosure legislation.
Because companies already track this information and disclose it in other states, such a provision imposes few new costs. The wealth of research shows that gifts inherently influence prescribing decisions, threatening affordability and patient safety. Consumers deserve the peace of mind of knowing that we’re being prescribed a drug because it’s the right drug for us, not because a doctor has a relationship with the pharmaceutical company. And, the Commonwealth has a right to expect these companies (which, by the way, the state has just invested $1 billion of taxpayer money in) adhere to ethical standards in conducting business and cease practices that threaten patient care and to bankrupt our health care system.
The MPRC applauds the tireless efforts of Senate President Murray and Speaker DiMasi in realizing that costs must be controlled. We encourage Governor Patrick to do the same.
Massachusetts Prescription Reform Coalition
Who We Are The Massachusetts Prescription Reform Coalition (MPRC) is a diverse group of non-profit national and local organizations, community organizations, healthcare advocates, private insurers, public payors, and healthcare providers. Members include:
The note at the end of the Op-ed says that…Sally C. Pipes is president and CEO of the Pacific Research Institute.
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p>What they neglected to add was the end of the company name “of Public Policy”.
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p>That’s the Pacific Research Institute of Public Policy. This is not any kind of Biopharmaceutical research.
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p>They are bought and paid for PhRMA.
We’ve discussed Ms. Pipes’ truly lame work previously.
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p>That’s not right, is it? Or what is meant by “take the payment in his or her name”? Grants are typically tied to names of researchers, but the key is, aren’t they called grants, not payments — so that’s how you know they go for research expenses, not, say, for a new BMW?
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p>I am a scientist in the pharmaceutical industry. I am all for restrictions/oversight of marketing payments to physicians (and would like to see direct marketing to consumers abolished all together).
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p>I don’t have the understanding I need of the implications of this bill in order to make a reasoned judgment of it. Why must there be so much nuance and complexity around the nature of a grant?
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p>Admittedly there may be business reasons why a company may not want to give too much away about their exploratory clinical studies. Other things being equal, it may make sense for a pharmaceutical company to choose to undertake clinical trials in states where there is is less required disclosure, and therefore less turbulence on the Street when an early study is hyped and then terminated.
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p>I do have coworkers who are concerned about prospects for our research site remaining in Massachusetts if the bill goes through, so I suppose it’s time to study it further.
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