Jul 8, 2010

Gift Ban Repeal: How They Voted

As covered in the last post (HERE), the Massachusetts House of Representatives passed its version of the economic development bill yesterday. Normally, such an event would garner little interest locally and zero interest nationally. However, this particular bill could easily be a watershed moment for the conflict of interest movement that distinguishes Massachusetts as both the state with the most strict regulations on pharmaceutical/device maker marketing and the only state to repeal such regulations!

Of interest to the "locals" living under the regulations is how our public servants weighed-in on the issue. Below is the "Yea and Nay No. 427" report for a proposed counter-amendment which would have removed the "gift ban" repeal (thereby leaving the ban intact). For those that contacted their legislator, here's the moment of truth! A "yea", or a "Y" next to their name, means they think the gift ban should remain in effect. 

And for those that enjoy the nitty-gritty of politics, here is a transcript of the debate as reported by the State House News.  Mostly rehashed arguments, but interesting nonetheless to peer inside the process:

GIFT BAN PRESERVATION: Rep. Wolf offered an amendment striking section 105.

Rep. Wolf said the bill would repeal the gift ban we passed and the governor signed that does not allow the wining and dining of people in the medical industry and has restrictions and parameters around which information and education can take place between pharmaceutical companies and members of the medical profession. The provision was put into the original bill to keep the costs of pharmaceuticals down.

Many years ago Congress overturned previous bans to advertise pharmaceuticals and we see them advertised every day. A number of activities go on that are part education and are done at great expense of the companies and add to the expense of pharmaceuticals. Keeping down health care costs is the unfinished business of health care. The amendment hopes to not allow a provision to go down the drain so quickly after we passed it. I don't think we have had much of a chance to test out the ban. It's ludicrous to think that members of the industry might not be able to pay for their dinners. Think about what it would be like if we get rid of the bans we have with lobbyists. All hell would break loose. I don't think this is any different. Special interests going in and having the potential for increased health care costs is not in the interests of our constituents.

Rep. Dempsey said he opposes the amendment. I thank the members for their hard work today. The bill is a much better bill because of all of your hard work, bipartisan efforts. The amendment is one in which many members have passionate feelings about. We respect the sentiment around what we did a couple of years ago. At the time the discussion was centered on cost containment and if we could limit marketing efforts by pharmaceutical companies and the amount on educational dinners that that is somehow going to help us reduce the cost of prescription drugs. I never really believed that our efforts would actually lead to a reduction in cost but I did think it would elevate the discussion about the need for ethical behavior. It has served a useful purpose and been positive in enlightening folks to think about those issues. This has not saved any single person in the commonwealth a dime in what they are paying for prescription drugs.

It's a great theory that it will translate into reduced costs. I haven't seen it. I don't think anybody has seen it. If a publicly traded company is going to reduce its marketing budget it will be shifted to neighboring states or go into the dividend they are paying their shareholders. It's not coming back to the consumer. What we know is we have seen the loss of some convention business. It does not get the attention it deserves but we have seen a reduction in medical training and clinical research. The ban we have adopted has sent out a message, a chill on opportunities for training and clinical research. This has had an impact on the restaurant business but more importantly on clinical research. It's one of our natural strengths. The time has come to rethink this law. I hope the amendment is not adopted.

Rep. Lewis said he supports the amendment. I understand the intent is to help restaurants but this is not the best way to achieve this goal and we should not repeal this gift ban. We have more than 97 percent of residents now covered by insurance. The big challenge we now face is health care costs, which are causing significant hardship to our constituents. The share of family income dedicated to health care has gone from 7 percent to 17 percent. Costs are the biggest challenge facing local, state and the federal government. Prices of widely used drugs rose 50 percent from 2000 to 2006. Why is a gift ban necessary to address costs? The products offered are critical to patient health and safety but the financial relationship can steer providers away from the patients' best interests. About $9,000 is spent marketing each doctor in the United States. All of this spending is aimed at influencing prescribing behavior. A physician has a conflict if they are being paid by the company marketing the drug. The gift ban helps ensure that profits do not come before patients. More biotech is relocating to Massachusetts. There has not been a drop in convention business in Massachusetts that can clearly be attributed to this gift ban. The convention center is expanding to accommodate demand. BIO has announced its return to Boston in 2012. The gift ban is not the sole solution to rising costs and I hope before the end of the session we will take up a bill to address health care costs. It is an important component of the strategy to contain costs. It has been in place for just one year. Industry, hospitals, physicians and DPH have invested time and effort to implement the law. Rather than leaving Massachusetts, the health care industry has continued to invest and expand. Now is not the time to repeal the gift ban.

Rep. Lewis requested a roll call and there was support. Time was 6:33 p.m.

Rep. Bradley opposed the amendment. He said he wanted to give some facts. The unintended consequences of the law have been devastating and has wiped out hundreds of jobs. It has cost us at least one major convention. It's the most restrictive law in the nation. It is not a level playing field. This business is in jeopardy moving forward if business is lost to other cities. We will see a loss of jobs and tax revenues. A manager at the Seaport Hotel talked to a company from Buffalo and he said the regulations here are too onerous and that they will not come here. Also, the Mass. Convention Center now includes language in shows that allows cancellations without penalty.

Rep. Provost said she supported the amendment and noted other states are looking at gift bans. Private institutions have adopted their own bans on gifts and even on interpersonal meetings between their staff and representatives of the pharmaceutical and medical device industry. Harvard Medical School has adopted a disclosure policy for their professors, who must disclose financial interests they may have with pharmaceutical companies. No meetings were pulled out of Boston because of the law, according to an industry publication. BIO is coming to Boston in 2012. There is no evidence really that this is a loss to business. This is something to which the industry has accommodated itself and is the wave of the future. The selling of drugs and devices is not just about the bottom line. We are losing sight of patients, the individuals who come to doctors for the highest standard of care and the necessity that patients trust their doctors to consider their situation on the merits and that prescribing practices come first from the view of what is best for patients. The director of the GIC, to which we all belong, has contacted us and asked us not to repeal the gift ban. We would send the message that any law we passed, however well considered, that's up for grabs if it brings business in the door.

Rep. Feingold said sometimes when we pass laws there are unintended consequences and I am not sure we thought about medical device companies and the important role they play. I have a couple in my district. It is causing doctors to shy away to come and get trained on these devices. Understand that these companies don't have to be here. They can go to Berlin or London. We are competing against an international market. The bill we passed has had a chilling effect on the medical device industry. We have hotels that were 90 percent filled and are now 50 to 60 percent filled. If the federal government banned advertising for pharmaceuticals that would be a step in the right direction.

Rep. Malia said it's painful to listen to some of the inaccuracies. We have a crisis in medical costs. I don't think the pharmaceutical industry has been hurting over the past few years. They spend somewhere near $7 billion on marketing. I can't tell you how many times I answered the door of a pharmacy in a Boston hospital and there would be drug detailers. It was amazing. Some were nice people with degrees in education. They were not doctors or pharmacists, some were. And they would ask over and over again for time to talk to me. I said I am not a doctor or pharmacist. They had just delivered lunch to meetings, from favorite restaurants. It went on, pens, tie clips, pads of paper, everything with their names on it. I don't think it's changed much. I am very concerned about the fact that we need to stay focused on what is the most serious economic concern we have in this state, meeting our obligation for our health care costs. Repealing this ban will not help that at all. I urge you to support this amendment.

The chair opened a roll call on the Wolf amendment. Time was 6:58 p.m.