"Gift Ban" Needed to end Medical Conflicts of Interest
Minnesota Health Plan
Information and Resources
by Senator John Marty
October 29, 2008
Drug companies aggressively market their products. Since the FDA first allowed direct-to-consumer drug advertising a decade ago, this advertising has grown to about $100 million per year in Minnesota alone – that's $100 million of our health care dollars being used to persuade us that we need certain high-priced drugs.

Yet drug companies spend even more to persuade doctors to prescribe their products. Drug marketing to U.S. doctors amounts to $7 Billion per year, much of that spent on meals, gifts, honoraria for speaking, and generous compensation for consulting. Manufacturers of medical devices such as stents or pacemakers also spend lavishly on gifts and favors for doctors.

In 2006 a team of medical researchers led by Dr. Troyen Brennan from Harvard wrote an article in the Journal of the American Medical Association (JAMA), stating that physicians’ responsibility to put the interests of their patients first, is challenged by financial conflicts of interest, as is the doctors’ scientific integrity. They said one major conflict is the relationship between medical device or drug manufacturers and doctors, and that this is a threat to the trust patients have in their doctors.

Breaking this conflict of interest is essential not only for cost control, but also for patient safety. The pain-killer Vioxx, was heavily marketed to physicians by drug company representatives who down-played reports about risk for heart problems. As a result of the aggressive promotion of the drug, doctors prescribed Vioxx to large numbers of patients until it was pulled from the market for safety reasons.

Critics are not accusing doctors of trying to do wrong, it's the reality that gifts have a powerful impact on our minds. That's Psychology 101.

Several years ago, Minnesota was the first state to pass a "gift ban" for drug manufacturers, but the law has loopholes. Fortunately, there is renewed interest in addressing this issue, much of it coming from doctors and medical students troubled by the situation.

This summer, Massachusetts passed legislation regulating drug company gift giving. To its credit, the University of Minnesota Medical School is in the process of adopting a code affecting all medical school faculty and students. St. Mary's Duluth Clinic Health System has implemented a ban on all gifts including trinkets from drug manufacturers. Last month, the Wisconsin Medical Society adopted a policy banning all gifts from drug manufacturers to doctors.

Doctors who prescribe drugs and use medical devices need to work with the manufacturers to provide advice and feedback; this can lead to more effective medical products and treatments. However, these relationships need to be transparent and avoid excessive compensation.

An investigative report in the Star Tribune last summer revealed that one physician received $344,375 in 2006 from one device manufacturer – that's on top of the physician's regular income! None of this was disclosed to patients or to other physicians who attended talks presented by that doctor.

A New York Times article about Minnesota's gift ban described how drug manufacturers reward doctors who write many prescriptions for their drugs, paying them as much as $5000 to speak at their seminars, with some doctors receiving over $100,000 in a year for speaking.

This generosity makes a difference. The pharmaceutical industry spends the $7 billion per year on marketing to doctors because they know it pays off. The JAMA article reported on research showing that the rate of prescriptions increases substantially after a doctor meets with a drug company representative, attends a seminar sponsored by the manufacturer, or receives free samples.

Disclosure of such financial arrangements is a must, but it is not enough. The authors of the JAMA article described as a "myth" the idea that disclosure of financial conflicts is sufficient to protect the interest of patients.

Most drug company relationships with doctors involve far less money than the ones mentioned above, but even small gifts have an impact. The article in JAMA also said it is not true that small gifts have little or no influence on behavior. The doctors wrote that "social science research demonstrates that the impulse to reciprocate for even small gifts is a powerful influence on people’s behavior. Individuals receiving gifts are often unable to remain objective."

Last spring, I introduced legislation to close loopholes in Minnesota's law banning gifts from drug companies. The proposal would ban all gifts, not just those over $50. My legislation would include medical device manufacturers under the gift ban, prohibit excessive compensation to doctors for consulting services, and require doctors to disclose to their patients any financial arrangements that they have with drug and medical device companies.

Passage of this legislation will eliminate the conflict of interest. That is good not only for the consumer's pocketbook; it also ensures that the care they get is based on their doctor's unbiased judgment.


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