Friday, September 04, 2009

More Expensive Medicine

Minnesota has a rather nifty law on its books. It requires annual disclosure reports from pharmaceutical companies detailing payments made to doctors. The 2008 reports contained some rather interesting information, according to the Minneapolis Star Tribune.

Minnesota doctors were paid thousands of dollars in speaker fees and other payments last year by a pharmaceutical company now implicated in a congressional investigation for its aggressive promotion of a popular antidepression drug, according to documents filed with the state and analyzed by a nonprofit group.

Forest Laboratories Inc. paid 62 Minnesota doctors at least $1,000 each in speakers' fees, with 28 physicians receiving payments of more than $10,000, according to The Pew Prescription Project. All told, Forest paid Minnesota practitioners more than $750,000 in 2008.

Minnesota was the first among a handful of states requiring drug companies to disclose payments to doctors, and the annual disclosure reports have repeatedly revealed potential conflicts of interest in the way physicians prescribe drugs or conduct clinical research, while adding fuel to a national debate about greater disclosure of the financial ties between industry and doctors.

"The analysis tells us that a lot of doctors in Minnesota have become extensions of Forest's marketing campaign," said Allan Coukell, director of The Pew Prescription Project.

(For more on The Pew Prescription Project, go here.)

Given the current atmosphere for health care reform, surely such a law would be helpful at the national level, and one has been proposed as part of the House Bill. Even the Senate has begun looking into the issue, and some rather unlikely proponents introduced a bill, according to the STrib article:

A report released by congressional investigators Tuesday highlighted how Forest marketed Lexapro, a depression drug that reaped $2.3 billion for the New York-based company last year.

A $100 million "marketing plan" hatched by Forest in 2004 hints at the way some pharmaceutical companies encourage doctors to prescribe their brands, even if they are more expensive than others or if a generic version is available.

Those practices include paying "key opinion leaders" in certain clinical fields, such as psychiatry, to make speeches on Lexapro's behalf using slides provided by the company, authoring bylined articles for doctors about the drug, and funding their continuing medical education classes. ...

Grassley, an Iowa Republican who has been investigating the financial ties between drug companies and doctors, provided the Lexapro document to the Senate's Special Committee on Aging, which held hearings in July on whether the drug industry wields influence on doctors' medical education classes.

Grassley and Sen. Herb Kohl, a Wisconsin Democrat who chairs the Aging Committee, have sponsored federal legislation to make payments to doctors by drug and medical device companies public. The requirement is now part of the House version of the health care reform bill.

The bill proposed by Grassley and Kohl in a rather nice bit of bipartisanship is undoubtedly S301:

To amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP.

So, what's happening with that bill? According to Thomas, it was referred to the Finance Committee in January, 2009, where it continues to sit. Now ordinarily that would be considered just evidence of the slowness with which the Senate operates, but not this time. Sen. Grassley is the ranking member of the Committee, which is chaired by Sen. Max Baucus. Both seem to have changed their minds on a lot of things have to do with health care reform since January. I'm sure part of the reason for such flip-flopping has to do with the enormous amount of lobbying and fund raising done by the pharmaceuticals, along with the insurance companies and all the other big health care-related businesses.

I think we need to put some more pressure on Baucus and Grassley and the other members of the Finance Committee (a list of the committee members can be found here) and remind them about the existence of this bill and how important it is that it be moved along with a little more speed than has been shown.

Do it and make an old lady happy.

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