Conflicts don’t sicken health care

By Dennis Ausiello
20 april 2008--Many discoveries leading to extended longevity and improved life quality originate in Massachusetts clinics and laboratories. But they only benefit our citizens because of the private companies that develop, manufacture and sell medical products.
Therefore, for the Legislature even to deliberate passing a law imposing fines up to $5,000 and jail sentences up to two years on practicing physicians if they accept a pen, pad of paper or slice of pizza from a company representative reflects the success that critics hostile to commerce in general have had in capitalizing on profound misunderstandings of how these companies interface with medicine.
The real intent of these critics goes far beyond food and trinkets, and its true purpose is to curtail strictly or even eliminate all contacts between physicians and private industry. We strongly oppose this agenda.
Despite extensive training, physicians cannot know the details of all products, especially new ones. Therefore, company salespersons complement physicians’ information derived from many sources. They tell physicians about a limited range of products about which their employers train them under strict FDA regulations.
The proposed state gift prohibition aims at the misperception that the company sales representatives use gifts - essentially bribes - to cajole physicians into using company products, and that such use is medically inappropriate and unjustifiably increases costs.
Little evidence supports these concerns.
Federal laws already prohibit bribes and kickbacks between companies and doctors, and other laws encourage whistle-blowing if infractions occur. At the state level, attorneys general enforce these laws. Company representatives providing small gifts or meals to gain access to doctors hardly amounts to bribery or kickbacks.
But to emphasize that physicians and students in the academic institutions where we work want to learn about products because it is good for patients, we support hospital policies that eliminate these practices but not the relationships per se.
Companies certainly use sales forces to encourage product prescribing, and encounters between detailers and physicians demonstrably accomplish this goal.
New brand products are inevitably more expensive than older, especially generic ones, and, in some instances, newer versions may add only incremental value. Deciding in such cases to prescribe older products may be appropriate.
Unfortunately, defining such circumstances is often difficult, if not impossible. Although product prescribing always incurs costs, cost is not the only issue. What is more important is the cost benefit ratio in terms of better health. A good physician follows patients carefully and monitors their responses to whatever products have been prescribed.
Under the current system of product information, drugs are not even close to the top drivers of health care costs. Drug price growth in 2007 was 1.4 percent, and prescription medicines account for only 10 percent of health care spending.
We believe that the best approach to optimize cost effectiveness of product prescribing is to promote more, not less, interaction among all stakeholders involved in health-care delivery, including company marketing reps.
The language of the Legislature’s proposed anti-gifting bill is both severe and vague, inviting inquisitors and individuals with personal grievances to harass physicians involved in a large variety of potentially constructive research and educational activities. Such harassment will inevitably inhibit appropriate industry support of these legitimate activities.
The state should be cautious about embarking on the radical course epitomized by the law under consideration. It threatens to dismantle a system that has served us well, and is deeply disrespectful of physicians and companies alike.