A recent Associated Press article, reporting on a study published in the March 21 edition of the Journal of the American Medical Association, indicated that Vermonters may be having difficult time learning if their doctor has received payments from pharmaceutical companies. A loophole in Vermont's pharmaceutical marketing disclosure law is to blame, the report said.
Let's be clear about this – no one should be blaming doctors for a lack of sunshine on prescription drug marketing practices. The Vermont Medical Society supports full public disclosure of gifts and payments to doctors and is working with the Vermont Attorney General's Office to make Vermont's pharmaceutical marketing disclosure law stronger.
Vermont's law requires pharmaceutical companies to report every gift or payment to a physician worth more than $25. It is the responsibility of the companies selling prescription drugs to report their spending. Under Vermont's law, doctors do not file any reports.
As the JAMA article noted, pharmaceutical companies can designate spending on physicians as a "trade secret," which prevents the public from finding out about it. Many companies are doing this. The Vermont Medical Society supports eliminating the trade secret exception, so that all pharmaceutical marketing spending becomes public record.
Why do physicians accept payments worth more than $25 in the first place? The vast majority of this spending is in the form of food served during educational sessions on new medications. Physician offices are very busy, so the best time to hold these sessions with pharmaceutical representatives is over lunch. Nurses and other office staff members also participate, but for reporting purposes Vermont's law requires that the cost of their meals be attributed to practitioners in the office who can legally prescribe medications. For example, the cost of a lunch for an eight-person office staff is split between the two physicians in a practice. Because of that, the meal amounts reported for doctors are inflated and trigger the reporting threshold.
There are other steps being considered by the Legislature that will greatly reduce pharmaceutical manufacturers' influence over physicians. The most important is a bill supported by the Vermont Medical Society that would stop chain pharmacies from selling data on your physician's prescribing habits to the drug manufacturers, who in turn use this information to push their expensive products – and drive up health care costs. Halting the sale of this information will take away the most powerful weapon that pharmaceutical marketers have.
David Johnson, M.D., is the president of the Vermont Medical Society.
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