April 13, 2009 | last updated May 26, 2012 7:16 am

No More Free Lunches For Doctors?

Connecticut doctors would be prohibited from accepting certain gifts from drug and medical device companies under a plan being considered by lawmakers.

The measure is drawing criticism from the pharmaceutical industry, which contends it would stifle the use of new medications while doing little to ensure the industry is exerting undue influence on doctors' decisions regarding which drugs they prescribe.

Patterned after an even stricter law passed a month ago in Massachusetts, the plan would ban industry representatives from buying meals for doctors and require them to report to the Department of Public Health any gifts worth more than $1,000.

The Massachusetts law now requires public disclosure of payments greater than $50 to doctors. Meanwhile, Vermont is also weighing tougher rules on gifts and compensation to health care providers.

"I think there's a growing awareness that gifts and payments of any kind can distort and harm the medical judgments that are made in prescribing," said Attorney General Richard Blumenthal, a major backer of greater regulation efforts.

Blumenthal referred to reports of Merck's aggressive sales representatives misleading doctors about the health risks of Vioxx, which was pulled off the market in 2004 because of concerns the drug increased heart attack risk.

A number of medical journal studies indicate that sales pitches from drug companies do influence physician choices when it comes to prescribing.

The state's proposed regulation — the first of the kind in Connecticut — does not ban sales pitches, but opponents of the strict regulations say they go too far to limit interaction between drug representatives and doctors to the point of limiting the opportunity for doctors to learn about new drugs. Most education efforts occur during sales visits and medical conferences, which would now fall under state scrutiny.

Most of the meetings between sales representatives and doctors take place during the rare downtime in a doctor's schedule — lunchtime. The proposed regulations would ban sales representatives from bringing meals into the doctor's office.

"It's wrong to think a physician is going to risk a practice based on a lunch to prescribe a medicine against professional judgment," said Paul Pescatello, president of Connecticut United for Research Excellence, the state's biotech cluster.

The tougher rules being considered by the General Assembly, proposed by state Sen. Edith G. Prague, D-Columbia, would also prohibit biotech companies from paying for doctors' cost of travel and lodging, as well as any entertainment items. Though the companies were already prohibited from taking doctors out for meals, the proposed regulations would also ban companies from bringing meals into doctors' offices. The bill has passed committee and is in front of the Senate.

Pharmaceutical companies dish out big money to market their drugs, with $7.2 billion spent annually to directly market to doctors, according to the Consumers Union. There's no way to tell how much of that marketing would be curtailed in Connecticut as a result of proposed restrictions.

According to a 2008 study, the industry spends almost twice as much on promotion as it does on research and development. The U.S. pharmaceutical industry spent 24.4 percent of the sales dollar on promotion, versus 13.4 percent during the same time period, according to a York University analysis of 2004 data.

Acknowledging pressures from states to toughen gift regulation, the national pharmaceutical industry group last year bolstered its own ethics code by prohibiting free pens, pads and any other logo-bearing freebies to doctors.

"From our perspective, these kinds of bills are not necessary in the state legislature," said Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America. "The pharma industry and its relationship with physicians is already highly regulated."

Despite stronger professional ethics codes instituted by PhRMA and the American Medical Association, Blumenthal said self-regulation efforts fall short.

"They're not enforceable," he said.

The state's biotech industry fears the proposed regulation could severely limit drug and medical device companies' access to doctors. Biotech organizations also warn a reduction in clinical trials would be a result of less interaction between the biotech companies and doctors, pointing to the sharp drop-off of clinical trials in Massachusetts over the past few months.

"There's a good crop of companies right now that are mature and getting to the point of approved drugs, and they have to get out there and educate the physician world about their drugs," Pescatello said. "You want more clinical trial work. It creates good jobs."

The Massachusetts example has also spurred concern about the future of the lucrative medical conference business.

The American Academy of Allergy, Asthma and Immunology canceled its 2015 convention of almost 8,000 doctors and other participants in Boston because of stricter regulations on activity between drug companies and health care providers. The American Society of Gene Therapy also removed Boston as a possible destination for its 2015 annual meeting because the new regulations will "cripple the content and quality" of the meeting, it said.

In both cases, primary concerns surrounded whether drug companies would be prohibited from presenting scientific findings.

A similar drop-off in Connecticut medical conferences would ultimately impact the tourism and hospitality industries, said Paula Newton, chairwoman of the New England Biotechnology Association.

Blumenthal said he was not concerned about Connecticut losing out on "legitimate" convention business.

Reader response:

"I think the practices and hospitals looking for research and $upport for their institutions are in for a rude awakening once they lose relationships with industry. We will spend our research dollars elsewhere. Isn't this a time when anyone who has dollars to infuse to the local economy should be welcome? It goes deeper then a sandwich...less money and attention will be spent on your institutions and your patient care..... It may take a couple years but you feel the impact. Way to go CT lawmakers!!'' -- John, K-Tech

"It's insulting to insinuate that doctors make medical decisions based on the basis of a free turkey sandwich. The business lunch has been a staple of business meetings in many industries. Have lawmakers discussed business over a modest meal? Of course they have. The pharma industry is already very regulated. There are no gifts, no pens, no notepads, no coffee mugs, nothing. All that is left are lunches in a physcian's office that must conform to a strict set of rules regarding cost and topics discussed (all must be educational and follow FDA approved messaging). There are no fancy restaurant meals - we are talking about a drug rep bringing in a platter of sandwiches for a very busy office in the hopes of spending a few minutes reveiwing FDA approved educational materials with a physcian during the 15 minutes he may have for lunch. Blumenthal likes to pretend that this is somehow sinister when in fact it's perfectly acceptable. How many of these lunches has he observed? My guess would be none. This guy is just a publicity hound, just look at his "performance" on FOX with Glen Beck. What a clown - all he wants to be is the next Eliot Spitzer (minus the dramatic fall from grace.) If your doctor decides what drugs to prescribe because he got a $5 turkey sandwich then he should be punished, but most resonable people realize that this is not the case. Modest meals during an educational dialog is not a sinister consipancy to undermine 10+ years of medical education. It's a reasonable interaction between two professionals. Stop treating it like it's a crime.'' -- Katlynn

"Everybody in the biz knows that pharma reps are useless. Do you really think a M.D that has spent most of his life learning medicine needs a pharma bop (I mean rep) to tell him what a new drug does? Send him a flyer and mail the samples.....then get a real job. It was fun while it lasted.'' -- pharma rep in CT

"Pharmaceutical Sales Representatives are much more then someone who brings in a lunch. All Rep's have to be highly educated as well as taking on going educational courses. All Pharma companies require all Rep's to pass with a score of 90 or higher. We take are jobs very seriously and we feel like we are saving lives. Perhaps everyone should look at the Insurance Companies. The Physicians are now taking double and triple booking in order to make money to keep their business going. This gives them no time to learn about new drugs or to even remember details about some less new drugs. All Reps are required to give fair balance on each and every call. Please give the Pharma Rep's the repect that they not only work for, but deserve!'' -- Carol

"It's surprising to read the anger in these e-mails, if sandwiches are such a trivial thing. Won't pharma reps be given the same time to educate physicians if they don't bring sandwiches? And why would pharma companies pull back donations to hospitals if this bill becomes law? Something weird is going on in these responses. If sandwiches don't influence anyone, anytime, why are they such a big deal to these commenters?'' -- J. Mott, Mott & Associates LLC

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