Doctor-Drug Company Laws Questioned
By LINDSEY TANNER
The Associated Press
Tuesday, March 20, 2007; 4:39 PM
CHICAGO -- Want to know if your doctor accepts money and gifts from drug companies? Chances are it will be pretty tough to find out, a study of disclosure laws in two pioneering states suggests.
Minnesota and Vermont were the first two states to enact laws designed to shed light on the practice, but getting key information required a lawsuit in Vermont and photocopying individual disclosure forms in Minnesota, the researchers said.
Also, loopholes allow drug companies to hide millions of dollars in payments and make it difficult to know who's receiving them, according to the report.
The researchers said many doctors accepted amounts exceeding recommended limits, but that it was hard to sort out which payments were inappropriate.
The issue is important to consumers because doctors may end up recommending drugs because of industry influence, not patients' best interests, said lead author Dr. Joseph Ross, a researcher at Mount Sinai School of Medicine in New York.
"The hoops that we had to jump through just to get the data in each state is enough to show these laws really aren't working," Ross said.
Most payments studied were related to education, research, meals and personal visits with doctors to promote new drugs, the researchers said. But reasons for many payments were not specified, sometimes because companies declared them trade secrets.
The results highlight the need for better enforcement of existing laws, and should help others craft better ones elsewhere, the authors said.
Minnesota's law dates to 1993; Vermont's was enacted in 2001. Defenders say it's not surprising to find imperfections in these early efforts and that improvements in both states' laws are under way.
California, the District of Columbia, Maine and West Virginia also have disclosure laws and similar legislation was proposed last year in 11 other states, the researchers said. Ross said it's unclear whether similar problems would be found elsewhere.
The study appears in Wednesday's Journal of the American Medical Association.
Drug companies' efforts to influence doctors are pervasive. An article in the journal last year said about 90 percent of the industry's roughly $21 billion annual marketing budget is spent on doctors.
AMA guidelines recommend that gifts to doctors should not exceed $100 and should benefit patients. Other medical groups and the Pharmaceutical Research and Manufacturers of America, or PhRMA, an industry trade group, have similar recommendations.
PhRMA attorney Marjorie Powell said many payments cited would be considered appropriate under the group's guidelines, including money for research and medical education. She also defended companies' rights to declare some payments trade secrets to keep competitors from learning about drugs under development.
A JAMA editorial said the study results suggest lawmakers may be ambivalent about imposing strict limits on gifts to doctors and that the report "undermines faith in industry self-regulation."
The researchers examined disclosures in Vermont from July 2002 through June 2004, and in Minnesota from January 2002 through December 2004.
Vermont disclosures are required for payments of $25 or more, but with exclusions including prescription samples and money for research and education-related travel, which likely total huge sums of money, Ross said.
Also, Vermont law allows companies to designate payments as trade secrets and to withhold them from public disclosure. The watchdog group Public Citizen, whose researchers co-authored the study, have filed suit seeking information on "trade secret" payments.
In Vermont, 12,227 payments totaling $2.18 million were publicly disclosed. But that amount represents less than half of all reported payments because disclosure data on $3.41 million was withheld on trade secret grounds, the researchers said.
Of the publicly disclosed payments, the average payment to doctors was $177. Most payments exceeding $100 were for meals, education, and personal visits with drug reps.
The researchers couldn't find out how many Vermont doctors got payments because companies often didn't report doctors' full names.
Of the 7,290 publicly disclosed payments in Minnesota, most were for $100 or more, totaling $30.96 million. The average payment to doctors was $1,000 and nearly 2,400 of the state's roughly 17,000 doctors were recipients.
Indianapolis-based Eli Lilly and Co. was a major player in Minnesota, paying $4.2 million to doctors and other health professionals during the study.
Lilly spokesman Ed Sagebiel said the study "totally dismisses the importance of sharing information about new or existing pharmaceutical products with health care professionals in their effort to make appropriate prescribing decisions for their patients."
作者:admin@医学,生命科学 2011-01-19 17:14