- The Washington Times - Wednesday, June 12, 2002

From combined dispatches
Vermont is about to become the first state to take aim at drug companies' practice of lavishing doctors and nurses with everything from ballpoint pens to free Caribbean trips.
Democrat Gov. Howard Dean, a doctor, plans to sign legislation tomorrow that will require pharmaceutical companies to report to the state any gifts valued at $25 or more, other than free drug samples.
Last year, pharmaceutical companies spent $7 billion to send gift-laden salesmen to woo doctors and $2 billion more on events for them. Pharmaceutical logos adorn doctors' coffee cups, stethoscopes and pens. Their expenses-paid seminars in the Caribbean are conveniently invisible.
Critics of the pharmaceutical industry say the freebies encourage doctors to prescribe new, more expensive brand-name drugs, which is not always in the best interest of their patients.
"This disclosure should embarrass this greedy industry into playing fair," said state Senate President pro tempore Peter Shumlin, a Democrat.
Drug makers are irate, saying doctors are not unduly influenced by the freebies and that the law is unnecessary. The pharmaceutical companies say they are merely educating doctors about new products, not trying to promote their new drugs over cheaper, equally effective alternatives.
The industry itself has adopted a voluntary code to govern marketing drugs to doctors, which is expected to go into effect July 1.
Under those guidelines, having a salesman spend several minutes pitching products to a doctor as he waits to pick up a takeout meal or have his gas tank filled compliments of the drug company is no longer allowed.
The voluntary code also prohibits or curtails most gifts, entertainment and consulting arrangements that drug companies have used to ingratiate themselves with doctors.
The American College of Physicians-American Society of Internal Medicine, the largest association for doctors of internal medicine, recently published its own guidelines saying that doctors "should not accept gifts, hospitality, services and subsidies" from drug companies that could intrude on the objectivity of professional judgment.
Prescription-drug spending rose by 17 percent last year to $154.5 billion, according to the National Institute for Health Care Management Research and Educational Foundation, a nonprofit research group.
Meanwhile, the pharmaceutical industry spent $13.2 billion promoting products to doctors. Nearly $5 billion of that was spent on the industry's sales force and its activities, according to the Kaiser Family Foundation. The nonprofit health policy research group said 61 percent of doctors say they have received free meals, event tickets or travel from a drug company.
The Vermont law is one of a growing number of state initiatives to control rising health care costs.
"This is model legislation that is being recognized and being shared with other states," said Bobbie Kamen, state director of the retiree group AARP, which lobbied for the law.
Vermont heads a Northeastern coalition that is trying to organize consumers from Maine to Pennsylvania into a large bargaining group that could negotiate lower drug prices. West Virginia has led almost two dozen states in a coalition that hopes to win discounts for Medicaid beneficiaries and state employees. Maine passed a law that uses the threat of price controls to try to negotiate lower drug prices for the uninsured.
Vermont's new law requires pharmaceutical companies to bid competitively to sell drugs to people enrolled in the state's health care programs, directs the administration to negotiate for rebates and authorizes the state to negotiate prices not just for people on state programs but also for those with private or no drug insurance.
"I have a problem with the idea there are a lot of doctors being sent to Jamaica," said Vermont Rep. Patricia O'Donnell, a Republican. "I don't doubt doctors get free pens and pencils and clocks. That's not going to influence whether they prescribe."
But Jeff Trewhitt of the Pharmaceutical Research and Manufacturers of America, an industry trade group, says it is more likely that a salesman buys sandwiches and pizza and makes an educational pitch to a doctor's office over lunch.
"That's well within the guidelines," he said, "and you're certainly not going to buy a doctor's soul for the price of a pizza pie."
Kristina Stefanova contributed to this report.


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