Jul 16, 2010

Boston Business Journal: "Docs in the Dark"

The proposed repeal of the MA "gift ban" has moved to conference committee where three Senators (Benjamin DowningKaren Spilka, Bruce Tarr) and three Representatives (Garrett BradleyBrian Dempsey, Viriato deMacedo) will hammer out the differences between the two
versions of the bill, and therefore will determine the fate of the repeal.

The article highlights the basic arguments for and against the ban, and contrary to usual coverage, does a decent job of highlighting some of the more nuanced arguments for repealing the ban (i.e., collaborations beyond just marketing interactions are hampered) and exposes the  limitations of arguments for maintaining the ban: There is no evidence to support the premise that the ban will reduce heath care costs. 

Based on the quote provided by those supporting continuation of the ban, "We got some numbers from the Division of Insurance saying that drug costs have risen more slowly than other health care costs this past year. We can’t say for sure that the gift ban is responsible, but it’s interesting,” it appears that they should do a little brushing up on their economics.  As a start, they might consider reading 
Chaos and Organization in Healthcare by Drs. Tom Lee and James Mongan of Partners Healthcare fame. By no means industry shills, they point out that removing privately owned pharmaceutical companies from the healthcare cost equation would reduce total healthcare expenditures by ~1-2% for only 1 year. Not much of an endorsement of the "evil pharma" is driving up our costs argument.

We'll let you judge of the rest of the arguments ... feel free to leave a comment to spark some discussion...

Collaboration Gap
Gift ban is keeping some docs in the dark, hurting innovation

Boston Business Journal - by Julie M. Donnelly

For Dr. David Miller, it was a small act of civil disobedience.
“I was at a booth at a conference, and the sign said doctors from Massachusetts couldn’t take a cup of yogurt. It’s insulting — if I can be bought for a yogurt, I’m in the wrong business,” said Miller, an allergy and asthma doctor from North Dartmouth who has previously been a clinical researcher for potential new drugs. The asthma specialist often gave talks to peers about the latest treatments at events paid for by drug companies. Now those have been completely halted.

He said his invitations to events have been curtailed and suspects that his recent application to serve on the medical advisory board of a pharmaceutical company was rejected because the company did not want to deal with the onerous reporting requirements mandated by the law. He’s had it.

“I took the yogurt and said, ‘arrest me,’ ” he said, only half-jokingly. He explained that never in his talks did he endorse a specific product, and that it’s actually forbidden by the code established by the national industry organization, PHRMA.

Miller’s stint as a renegade may be coming to an end. The repeal of the controversial pharmaceutical and medical device gift ban, which, among other things, prohibits doctors from accepting food at conferences or restaurant meetings, is gaining momentum. Yet the repeal, recently approved by the House, faces an uphill battle in the Senate, where the gift ban has previously been supported by Senate President Therese Murray. Miller’s fear of being ostracized is backed up by a recent survey conducted by Dan Wolf, a recent graduate of the joint Harvard/MIT Biomedical Enterprise program.

“The most surprising thing I found is that the majority of doctors felt that the ban would hurt patient care long-term,” Wolf said.

The survey included 24 doctors in specialties including orthopedics, cardiology and general surgery. It also included executives from 16 medical device companies. Wolf said the burden of the ban is particularly acute in the medical device industry, where much of the innovation comes after market approval, when doctors advise companies on their experience using devices such as heart stents or knee implants. Most doctors surveyed, 83 percent, said that the law has led to an impaired ability to collaborate with industry to develop new devices. Medical device executives at six companies said they chose not to invite Massachusetts doctors to events this year, and according to Wolf, one company said it had removed Massachusetts doctors from its medical advisory board.

House Speaker Robert DeLeo said the law conflicts with other economic development efforts to attract companies to the state, and is hurting convention business. “We invite companies to come here, then whisk away the welcome mat,” he said.

“I’d have a problem if we were talking about taking doctors to an island or something. But for someone to be violating the law by giving someone a boxed lunch at a conference? No. It’s gone too far.”

But Brian Rosman, policy director at the nonprofit Health Care for All, said that the law is designed to drive health care costs down, and that some preliminary data shows it might be helping. “We got some numbers from the Division of Insurance saying that drug costs have risen more slowly than other health care costs this past year. We can’t say for sure that the gift ban is responsible, but it’s interesting,” Rosman said. A 2008 study from the Journal of the American Medical Association found that the industry-physician interaction does create a conflict for doctors, potentially contributing to drug costs doubling from $64.7 billion to $132 billion between 1995 and 2000.

“Most providers are honest, but let’s get rid of the whole equation. The doctors and patients I’ve talked to say they are glad to be rid of the intrusion (of drug sales reps) into the doctor-patient relationship,” State Sen. Mark Montigny said. Montigny was the original sponsor of the gift ban bill, and he is determined to keep it from being overturned.

The Senate announced this week that it will not concur with the House version of the Economic Development bill, and has appointed members to serve on a conference committee to work out the differences. The two chambers have two weeks to agree on a final bill before the legislature adjourns for the session.

Montigny says the repeal of the gift ban doesn’t belong in the economic development bill. He said representatives are mainly responding to constituents in the entertainment industry who have lost business as a result of the ban.

“Why the House found it necessary to pander to a few whining restaurants, I don’t know. There are lots of other things we can do to help restaurants, but don’t corrupt health care policy.”