Groups want tighter controls over drug industry influence

Pharmacy
Minnesota lawmakers plan to go after the pharmaceutical industry's relationship with doctors again this year.
MPR Photo/Tom Scheck

A coalition of consumers, labor groups, doctors and insurers are asking Minnesota lawmakers to pass legislation that would make it harder for pharmaceutical companies to influence doctors.

When doctors prescribe medications to their patients, pharmacies track details of the prescriptions and sell that information to data-mining organizations. Those data miners then buy another list of all the nation's physicians and essentially match every doctor with every drug he or she has ever prescribed.

Researchers buy the information to study trends in prescribing practices, but pharmaceutical companies can buy the data too.

"They actually know exactly what your doctor is prescribing," said Pete Wyckoff, the man leading the Minnesota coalition's efforts at the Capitol.

Wyckoff said in 2008, drug companies spent nearly $15 billion on direct physician marketing in the hopes of influencing their prescribing behavior.

"Pharmaceutical detail people have one major objective and that is to press and to sell the drugs of the manufacturer that they represent," he said.

Wyckoff said the influence of drug companies can lead to doctors over-prescribing newer, more-expensive drugs that may have riskier side-effects than older drugs. He said one of the three bills the coalition is backing for the coming Legislature would prohibit pharmaceutical companies from buying a physician's prescribing records.

Pete Wyckoff
Pete Wyckoff of the Minnesota Prescription Coalition points to a chart showing how much pharmaceutical marketing costs have risen between 2000 and 2006
MPR Photo/Lorna Benson

Some physicians agree that the arrangement does present a conflict of interest. Dr. Chris McCoy with the National Physicians Alliance said many doctors have become way too dependent on the information given to them by drug companies because they're too busy to do their own drug research. He said there's also a sense of entitlement among physicians that is sometimes at odds with what's best for patients.

"We, as physicians, shouldn't expect that out education is going to come free of charge and with a lunch that comes with it," McCoy said. "We need to recognize that if we want to have the best, unbiased information we are going to have to go out there and seek that."

Following on that proposal, a second bill would try to replace the information doctors get from drug companies with unbiased drug data. The bill would create a panel of independent medical experts to advise doctors.

But some physicians are deeply skeptical of that approach and believe it could end up harming patients. The Association of Clinical Researchers and Educators, which has many physician members, says some states have used this approach to push generic medications. The group also worries that if pharmaceutical companies and doctors don't work collaboratively to share information, clinical research projects may not get off the ground.

Marjorie Powell predicts that may happen. She's senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, the drug industry trade group also known as PhRMA. Powell said limiting the exchange of information between doctors and drug companies may hurt research projects.

"I may need that to develop or do a clinic trial or I may need it to be able to tell them that I have a new medicine that might treat that patient," Powell said.

A third bill that would tighten Minnesota's existing ban on gifts to health providers is also unpopular with the drug industry. The legislation would apply the same standard to doctors that's currently used for legislators. It would also expand the list of businesses that must report physician payments to include medical device manufactures, distributors and medical supply companies.

PhRMA's Powell said the legislation would prevent pharmaceutical companies from paying doctors for the real value of their work. She said it also discourages doctors from sharing their expertise because they have to report their consulting fees.

"A number of doctors have said that they're uncomfortable having their name in a publicly accessible Web site that says they received a gift for what they consider is a reasonable consulting activity," she said.

Proponents of the bills say they are not trying to attack the pharmaceutical industry. Rather, they say the legislation is intended to re-direct the money that's being poured into drug marketing, into research that can actually improve the lives of patients.

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