Drug companies' gifts to doctors under new scutiny

BOSTON — Free meals, conferences, pens and note pads emblazoned with the names of the latest prescription drugs are some of the goodies Big Pharma companies lavish on doctors to get their products prescribed.

With Massachusetts spending enough on health care to pay for almost three Big Digs, those freebies are under scrutiny as part of a sweeping effort to rein in soaring health care costs that was passed last week by Beacon Hill lawmakers in both the Senate and the House.

A 2006 report by the Boston University School of Public Health estimates the cost of health care at $62.6 billion a year — the cost of 2.8 Big Digs at $22 billion each.

Rising costs threaten to undermine the state's landmark health care law, which requires considerable state subsidies, as Massachusetts moves toward its goal of insuring all its residents.

Dr. Mario Motta, the Gloucester cardiologist who is also now president-elect of the Massachusetts Medical Society, doesn't want to see a total ban on gifts. He said the Senate version of the health-care cost bill went too far, banning drug samples that he dispenses to help indigent patients or those who need a dose or two to tide them over. He also accepts educational material on how to use drugs, which he reviews first, then passes along to patients.

Motta said he complies with American Medical Association guidelines on receiving gifts, which ask doctors not to accept any gift of value that does not help patients. "As long as it benefits the patient, there should be no problem," Motta said.

That means drug reps better come to his office with peer-reviewed articles, not drug company propaganda or lavish gifts.

But Motta does accept trinkets like pens and memo pads, which he says don't influence doctors.

"If you're talking about a fancy paperweight or a clock for the wall, that crosses the line," Motta said.

Daniel Carlat, a Newburyport psychiatrist, said the House fumbled a chance for real savings last week when it didn't approve a ban on gifts to doctors.

"It's all part of the puzzle of trying to contain costs," Carlat said. "Allowing drug company reps to shower even small gifts has an effect. It encourages doctors to prescribe new and more expensive drugs."

The method is subtle, said Carlat, who does not accept gifts from drug company representatives.

"The psychology is not that you're given a pen or clock and then say, 'I'm going to return this favor,'" Carlat said. "It's the visits, the lunches they bring into your office, the gradual process of buttering up a prospect. It's about a friendly relationship with your drug rep. You want to reciprocate."

The cozy, boundary-bending relations go back to medical school.

John Raser, a doctor at Greater Lawrence Family Health Center who graduated from Dartmouth Medical School in 2006, recalls daily lunch conferences at the school sponsored by pharmaceutical companies.

"There's clearly an influence, even the smaller gifts," said Raser, who also does not accept drug company gifts. "I consider the pharma companies sophisticated. They wouldn't spend millions of dollars (on doctors) if it didn't profit to give those kind of gifts."

The House bill passed last week would ask drug companies to adopt a voluntary code of conduct limiting gift-giving to doctors, something Senate leaders say they'll support.

Rep. Patricia Walrath, D-Stow, said lawmakers backed away from an outright ban following a June biotech conference in San Diego. There, drug and life sciences company executives protested the ban, proposed in February by Senate President Therese Murray.

Walrath said pharmaceutical companies argued that a full ban would deprive doctors of valuable information in one-on-one meetings with drug company reps.

Alan Sager, director of the Health Reform Program at Boston University's School of Public Health, said banning gifts to doctors won't do much — and there are bigger issues.

Health care costs are out of control because the way health care is delivered is broken, he said. Patients go to specialists when a primary care physician is more appropriate. And if they did want to see an internist, good luck. Massachusetts has a glut of specialists and a shortage of generalists.

The bill lawmakers passed doesn't address any of that, he said.

"This bill will not save serious money," Sager said. "It doesn't attack the sources of the real problems in substantial ways."

The bill would require that doctors adopt electronic medical records by 2015. Hospitals would have to report infections patients acquired to the state. It also includes a program to help doctors repay loans so they can focus on areas where specialists are in short supply, such as family practice and obstetrics.

And a commission would devise regulations for treating patients. The state would reward doctors and hospitals that focused on preventative care and less on expensive high-tech gadgets, similar to the way it regulated care in the 1970s and 1980s.

Health Care for All research director Brian Rosman said he's disappointed the gift ban will not make the final bill. But he said the measure will help corral runaway costs.

"We're encouraged," Rosman said. "It has the potential for leading to transformative changes."

"It's not going to be quick or easy," Rosman said. "These things take time."

Time may not be on the side of the state or the nation.

In Massachusetts, employers are balking at Gov. Deval Patrick's proposal to have businesses shoulder more of the cost of expanded health care access. And exploding health care costs have made their way into the presidential race. U.S. Sen. Barack Obama supports moving the nation toward universal health care.

Pushed aside following the Clinton administration's disastrous venture into health care reform, health care costs may be the biggest issue facing Americans.

"It's going to be the major problem the country has to wrestle with," Motta said. "We'll either solve it in the next year or two or health care will be in deep trouble."

Local News

Search Results

Related Photos

Discussion

Site Map

Contact Us