The issue is this—when corporations like drug companies and pharmaceutical manufacturers have a product to sell, they oftentimes go to the source—doctors. The only way for them to sell products is for doctors to know about them. In an ideal world, a doctor would hear about a product, research the product with the company and in the medical literature, ask colleagues about it, learn the risks, benefits and alternatives, and then decide whether the product is good for his/her patients.
In reality, what happens too often is that a sales rep for the corporation (frequently, with no medical training) will stop by the doctor’s office with lunch or “toys” (stress balls with the corporate logo, calendars with the corporate logo, pens with the corporate logo, stationary with the corporate logo, etc…), and try to convince the doctor to use the product. If I was a doctor, I’d feel a little obligated to return the favor if someone bought me lunch. I’m betting most doctors feel the need to reciprocate a little, by ordering some of the product for patients. However, the conversations doctors have with these sales reps often times are rushed (doctors are busy people); and one-side (and, did I mention that most sales reps don’t have medical training?).
Vermont is poised to join a cadre of states with laws on the issue (assuming it is signed by the governor). If passed, it will require drug and device manufacturers to publicly disclose all money given to healthcare providers—including the names and specific dollar amounts. Additionally, gifts, including meals, would be banned. Some good talking points from the law:
• drug detailing encourages doctors to prescribe newer, more expensive, and potentially more dangerous drugs instead of adhering to evidence-based treatment guidelines;
• According to a 2009 report from the Institute of Medicine of the National Academies, acceptance of meals and gifts and other relationships are common between physicians and pharmaceutical, medical device, and biotechnology companies. The report found that these relationships may influence physicians to prescribe a company’s medicines even when evidence indicates another drug would be more beneficial to the patient;
• The federal Office of Inspector General (OIG) has taken enforcement action against several medical device manufacturers in recent years for violations of fraud and abuse laws. Through its investigations, the OIG found medical device manufacturers providing kickbacks to physicians in the form of all-expense-paid trips, false consulting arrangements, meals, and other gifts. The OIG recommends subjecting the financial relationships between medical device manufacturers and physicians to reporting requirements and greater transparency.
So, it looks like progress. Certainly, corporations have a right to peddle their products. However, patient safety needs to be the top concern—making this process transparent means that doctors will have extra incentive to act appropriately when prescribing products. Likewise, limiting gifts also precludes the need for quid pro quo. However, it also means that corporations will know how much their competitors are spending on specific doctors, meaning they will know where to target their future marketing efforts.