Green mountain state strengthens disclosure law

In the eleventh hour of its legislative session Friday night, Vermont passed a bill that would: -ban most gifts to physicians, -lift the trade secrets exemption in Vermont’s current gifts disclosure and transparency law, -extend it to medical device manufacturers, create a public website to house the information, and -broaden the type of payment recipients that companies would be required to disclose.

The bill strengthens a law first passed in 2002, which required companies to disclose payments to physicians, but allowed them to designate payments as trade secrets, effectively hiding the details of those payments from the public. The bill, which now awaits action from Gov. Douglas, closes the trade secret loophole.  An earlier provision that would require disclosure of those who accept drug samples was struck from the bill before it passed 137-4, but the attorney general will study the samples issue more.

“This bill will establish a national model for disclosure,” Ken Libertoff, executive director of the Vermont Association for Mental Health, told the Burlington Free-Press. The VAMH, as well as the Vermont Medical Society, Vermont PIRG, and the National Legislative Association to Reduce Drug Prices helped build to build the bill’s overwhelming support.

White coats at white oak state house

And in Connecticut, where lawmakers are considering a gift ban of their own, Community Catalyst’s Marcia Hams spoke about the influence of gifts on prescribers and the proposed law on Connecticut Public Radio’s “Where We Live,” along with representatives from the National Physicians Alliance, Connecticut State Medical Society, Consumers Union and Connecticut United for Research Excellence.  The Torrington Register-Citizen has an editorial supporting the gift ban here, and the American Medical Student Association turned out the white coats at the state house last week to support medicine based on clinical evidence, not marketing.

AMSA students stand up for unbiased medicine at Connecticut state house

The price is right? Rx use down, but costs up

And even though prescription drug use in the U.S. fell last year, overall spending on the drugs still went up, according to the latest Medco numbers. Though demand for brand-name drugs lost market-share to generics, the average price of brand-name pharmaceuticals spiked again, rising more than 8 percent in 2008, the fastest increase in five years.

That’s just one more argument for doctors to steer clear of prescription drug samples, write authors Susan Chimonas and Jerome Kassirer. In an article in PLoS Medicine this week, they challenge the assumption that  “good trumps harm when prescription drugs are provided free to practicing doctors,” bringing evidence that samples raise health care costs, do not improve health care for the indigent, and an lead to marketing-based irrational prescribing.

“The tradition of physicians dispensing samples has many serious disadvantages and is as anachronistic as bloodletting and high colonic irrigations,” the authors conclude.  “As the profession begins to slowly extract itself from the influential grip of industry, it must also deal with the undue influence of free samples.”

Do med students sweat the small stuff?

Do small gifts really change attitudes? That was the question researchers were after as they looked at two groups of medical students: one in an academic medical center where drug reps were allowed to troll the hallways with free stuff, and the other with strict vendor restriction policies in place.  In their findings, published this week in the Archives of Internal Medicine, they found that fourth-year medical students at Miller school of Medicine at the University of Miami exposed to small gifts – specifically, Lipitor tchotchkes – had more favorable attitudes toward Pfizer’s Lipitor than their counterparts at Penn, an academic medical center with strong pharm-free policies in place.  According to the study, “63.3% of students at Penn agreed that gifts and food from pharmaceutical sales representatives would influence their eventual prescribing in contrast to just 29.4% at Miami.”

This story in the Globe and Mail looks at the implications of the Archives study, and another in the journal Cancer, which found a third of more than 1500 cancer studies published in the eight prominent medical journals in 2006 were authored by researchers with conflicts of interest. As with similar studies, the authors found that when a drug trial reported a conflict – many which were company-sponsored research or consulting arrangements – it was more likely to report positive outcomes than those in which no conflict was reported.

Farther afield

Seeking to regulate the physician-industry relationship and minimize non-rational prescribing, the Brazilian government passed a long-discussed resolution in January, and it means bold changes for industry’s marketing model there.

According to this Intellectual Property Watch report, “Article 5 of Resolution 96/08 prohibits distribution of gifts or publicity in prescription form. Artists and laypeople are not allowed to do drug merchandising or advertisements.” In addition, the resolution prevents companies from distributing over-the-counter drugs as free samples, and contraceptives and antibiotics can only be sampled if the whole treatment course is provided.

And in the other hemisphere, the Dutch are hinting at letting in some disclosure sunshine of their own. Earlier this month, Health Minister Ab Klink told the Trouw newspaper that he would like to see pharmaceutical companies disclose all payments made to physicians. Though he would prefer to see legislation, Klink told the paper that companies should prepare to publish payment information voluntarily, according to this Radio Netherlands brief.