Bill would shed more light on drug marketing

April 29, 2009-Burlington Free PressBill would shed more light on drug marketing By Nancy Remsen Free Press Staff Writer MONTPELIER -- Should pharmaceutical sales personnel be banned from providing lunch to doctors and their office staff during a noontime presentation about new medications?Or should drug companies have to disclose for public review only the names of the doctors who received lunches and presentations and which drugs were promoted?That's what the House Health and Welfare Committee will decide by Thursday as members fashion their version of a drug disclosure bill the Senate passed earlier.Vermont requires financial disclosure of spending on drug marketing, but many details remain secret. The pending legislation would shine new light on this marketing by eliminating trade-secret protection that prevents public release of information on about 80 percent of the expenditures. The bill could ban or more tightly restrict other practices such as providing gifts, free lunches and free samples.According to the sixth report on annual pharmaceutical drug spending under the existing disclosure law -- released two weeks ago -- 78 pharmaceutical manufacturers spent $2.9 million to market and provide education about their products to Vermont doctors, hospitals and university researchers during a 12-month period that ended July 1. This spending doesn't include advertising on television, radio, or in newspapers and magazines."It raises disturbing questions about whether health care is patient-centered or market-directed," said Ken Libertoff, executive director of the Vermont Association for Mental Health, referring to the roughly $3 million spent on marketing in each of the past two years.Marjorie Powell, senior assistant general counsel with Pharmaceutical Research and Manufacturers of America, argues that Vermont doesn't need tougher regulation. If patients want to know if their doctors accept materials or meals from drug companies, "all the patient has to do is ask."Powell complained that the annual disclosure report issued by the Attorney General's Office mischaracterizes the expenditures as gifts or rewards for prescribing. She said the money provides, for example, educational materials and sessions to help doctors and their staffs remain up-to-date about new drugs.Powell defended buying lunches for staff in busy medical practices, which has become a point of debate as lawmakers consider the legislation. "It's easier to get everyone together if a pharmacy rep can bring in sandwiches and talk about a medication," Powell said. A flat ban on meals also would create problems when doctors involved in clinical trials meet, she said.Susan Baker, health-care advocate with the Vermont Public Interest Research Group, supports tougher restrictions, including a meal ban or cap. "The medical profession isn't low-income," Baker told the House Health Care Committee. "They can afford their own food."Baker added that allowing drug-company representatives to pay for meals "leads to the appearance of influence, and it also leads to increased costs. Someone has to pay for those meals," she said.Members of the House panel haven't made up their minds about a ban or cap on meals. "I'm still struggling that doctors would sell their souls for a ham sandwich," said Rep. Scott Wheeler, R-Derby. "I almost think some of the other stuff we are doing would take care of that."The House committee also has considered placing medical-device companies under the same umbrella as pharmaceutical companies. Representatives of medical-device manufacturers testified Tuesday they are different and deserve different treatment."Banning gifts like pens and coffee mugs and expensive meals is a good thing," said Jessica Wolfe, manager of state government relations at Boston Scientific Corp. "It is the disclosure," of money spent on the development of products in collaboration with doctors.Wolfe argued for delayed disclosure of expenditures associated with a device company's work with physicians -- "a two-year dark period for disclosure of payments made." This would provide protection during product development, she said, followed by complete disclosure before devices came into use.Many device companies work with individual doctors to make modifications to devices, said Thomas Tremble, associate vice president of the 1,300 member Advanced Medical Technology. "A physician may be using a device and say, 'Why don't you make this change.'"The device representatives suggested Vermont wait for Congress to act on a bill. "We need a national standard," Wolfe said, noting it would be difficult for companies to respond to 50 sets of gift restrictions and disclosure requirements. "Let the federal government do this."Philene Taormina, director of advocacy at AARP Vermont, countered although her organization supported national legislation, the proposal in Congress is much narrower in scope than what's pending in Vermont. "We support going further," she said.