Big PhRMA today smothered AB 2821 (Feuer), which would have limited the value of gifts given to physicians to $250 (about one-tenth of what is current practice for many companies), and required them to disclose any gifts (which includes meals, subscriptions, travel, trinkets, etc) of $50 or more. To read more about the bill, and research about pharmaceutical company gifts to physicians, see CalPIRG’s report here, UCSF’s research on the issue here, and our previous post about the issue here.
AB 2821 was a far more modest proposal than what the Journal of the American Medical Association had recommended for its community, but not this year and not this bill. It needed nine votes to pass, it got five.
Dr. Michael Steinman, a UC San Francisco medical school professor, spoke of his research, which showed gifts from pharmaceutical companies created an “expectation of reciprocity” — that doctors needed to somehow return the favor. His research has also shown how 84% of physicians believed their colleagues were influenced by drug company gifts
CalPIRG staff attorney Mike Russo testified that physicians are visited by drug company representatives an average of 28 times a week – or six times a day. These frequent visits, he said, harmed patient care by increasing the cost of drugs (extra marketing costs and the prescribing of higher-cost drugs when generics would be fine) and creating the appearance of a conflict with the doctor-patient relationship.
Pharmaceutical companies argued — as is their wont — that the legislation would be too cumbersome, expensive, yada yada…. The bottom line is, if this type of marketing didn’t work, they wouldn’t dedicate $19 billion annually to push their drugs to the fore.
The California Medical Association – which was neutral on the bill – said “Sunshine is necessary’’ but believed there were some “differences of opinion’’ about the studies and felt that studies did not suggest that gifts altered their prescribing habits and were offended by the characterizations that maligned doctors and questioned their integrity.
It should be noted that the Journal of the American Medical Association recognizes the potential for the appearance of a conflict of interest and has put forth its own guidelines for self-regulation, which includes a ban on *all* gifts (“eliminating potential gray areas and greatly eases the burden of compliance”), replacing drug samples with a “system of vouchers for low-income patients …that distance the company and its products from the physician.”