Doc Debate Continues On Medical Gift Ban Law | Measuring the price of influence
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Stephen Tosi, chief medical officer at UMass Memorial Health Care.
Last month, when Gov. Deval Patrick signed a much-publicized bill that will, among other things, ban certain gifts from drug and medical device companies to medical professionals, the responses were somewhat predictable.
Life sciences companies complained that the new regulations could disrupt their scientifically valuable dealings with doctors, while consumer advocates praised the notion of limiting commercial influence-peddling at the doctor’s office.
But the ultimate effects of the law’s requirements aren’t yet clear, and predictions about what they will be depend partly on the interpretation of how gift-giving leads to influence.
Medical Conduct
The real “gift ban” aspect of the health care law is based on codes of conduct written by two industry associations: the Pharmaceutical Research and Manufacturers of America and the Advanced Medical Technology Association. Among other things, it bans gifts of trips and sports tickets, cash and any meals that are outside doctors’ offices or hospitals or that don’t include informational presentations. The legislation also requires public disclosure of any gifts worth more than $50.
Stephen Tosi, chief medical officer at UMass Memorial Health Care, calls the law a good compromise. But he also notes that UMass has adopted an internal policy that goes far beyond the new legal requirements. At the hospital, doctors can’t take gifts of any kind, including pens and sandwiches. Companies can give the hospital drug samples and money for educational programs, but they can’t go to individual doctors. One reason for the stricter rules, he said, is that studies suggest any gift, even of something worth far less than $50, can lead the recipient to respond with a show of appreciation.
“Many doctors and nurses and other caregivers will say, ‘Are you implying that the gift of a coffee mug is going to influence me?’” Tosi said. “The answer is, from the perspective of the sociological studies that have been done, yes.”
Dr. Bruce Auerbach, president of the Massachusetts Medical Society, isn’t so sure.
“I can tell you, as an individual, never in my professional career have I ever chosen a drug because I was using a 22 cent pen that someone gave me,” he said.
Still, Auerbach said the MMS would have no problem with the idea of banning or requiring disclosure for small gifts, even if it’s just to eliminate the appearance of a conflict of interest.
One area where Auerbach is pleased that the gift ban ended up relatively unrestrictive is in its support for research and education. He said the MMS opposed an item in a version of the bill originally passed by the Senate that would have eliminated corporate funding for research, educational events and reprints of articles from medical journals.
Auerbach said grants from pharmaceutical and medical device companies are a good source of funding for educational events — as long as they are provided to hospitals and medical organizations without any strings attached. And he said articles reprinted by the companies can help medical professionals get important information, as long as the articles come from respectable, peer-reviewed journals.
“We can’t be so restrictive and draconian in our pursuit of an ideal that we make it more difficult for physicians to get the important information,” he said.
But advocates for stricter conflict-of-interest policies say corporate-sponsored educational efforts can affect the way doctors write prescriptions by giving them far more information about new, expensive brand-name drugs than about cheaper, older generics.
Drawing The Line
Lisa Kaplan Howe, consumer health policy coordinator for Boston-based Health Care for All, said the advocacy organization is pleased with an aspect of the new law that calls on the Department of Public Health and the University of Massachusetts Medical School to provide unbiased information. The initiative will compile data about all drugs, including older and generic ones, and send medical professionals to hospitals and doctors’ offices to present the information.
Meanwhile, the full extent of the new law’s reach remains unclear. The legislation leaves it up to the Department of Public Health to flesh out some of the specific rules for life sciences companies.
And Tosi said the law may simply not be relevant to many large hospitals, which are likely to take the same route UMass has and implement much stricter in-house rules. He noted that the Association of American Medical Colleges has made recommendations much stricter than the Massachusetts law, and the association’s recommendations tend to get adopted at teaching hospitals.
“I think that going forward you’ll see more and more of this,” Tosi said. “As these medical centers adopt similar policies to ours, they’ll be more than compliant with the legislation.”
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