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Relaxed Law Allows Docs to Dine with Big Pharma

Thursday, July 19, 2012


Doctors and public interest groups are opposing each other on whether the recently relaxed 'Gift Ban Law' is beneficial to patients.  The law, which was changed earlier this month, allows pharmaceutical companies to wine and dine doctors and provide coupons to patients for certain prescriptions. The two sides are taking opposite sides on who benefits from the changed law: patients or Big Pharma.

Consumer interest groups like MASSPIRG (Mass Public Interest Research Group) are saying this legislation will drive up healthcare costs up to $750 million in the next ten years and that doctors will succumb to pressures from big pharma to prescribe medications that will make them more money.

Dr. Charles Birbara, a Worcester rheumatologist, says that these measures will only help patients and that due to tight FDA regulations, there is no threat of lavish meals or doctors being manipulated to push various medications.

Healthcare Costs on the Rise?

Deirdre Cummings, Legislative Director with MASSPIRG has been fighting these issues since they were put on the legislative table in 2008. In previous years, both of these measures were illegal, but last week, Mass loosened their terms.

On the issue of coupons, Cummings says this will raise the cost of healthcare across the board, helping no one but the insurance companies and big pharma.

“It removed that prohibition on marketing coupons and set up a study to check the cost impact.  Everybody knows the coupons are designed to make money for the manufacturer,” she said. “We have now allowed the pharmaceutical companies to flood consumers through drug stores, commercials, and now their physicians, to choose or switch medications which will increase the profitability for the pharma companies.”

When the companies pay the copays for these drugs, it gives the consumer a short-term benefit, she said, but in the long run, the healthcare companies and consumers are still stuck paying the bulk of the costs.

Cummings said that data shows drug companies make four to six dollars for every dollar in coupons they spend. “It’s a mega marketing strategy,” she says.

“The pharma industry is very adept at persuading the public that coupons are good for consumers. The reality is that what the coupons will do is increase healthcare costs significantly. They’re designed to promote the sale of the newest and most costly drugs,” Cummings said. “In the end it leads to a less safe environment to consumers.”

She said that it’s safer and less expensive for consumers to take drugs that have been on the market for years.

“With so much attention to how we’re going to control the growing cost of healthcare, this is a clear case where it will add significant costs for everybody,” she said. “The big winner is the companies.”

Saving Patients Money

Dr. Birbara disagrees, saying that this legislation will alleviate costs for patients who cannot pay the costly bill to feel healthy.

“That is the most wonderful thing that can happen. In many cases the pharmaceutical companies will pay several thousand dollars a year on some very expensive medications that would usually be unaffordable to patients,” he said. “There are some crazy notions that this would lead to higher costs. This option only exists to give patient more options.”

Birbara said that many patients he sees can’t afford the medications they need and often stop taking medications for ailments they don’t feel, like Osteoporosis.

“Patients who are on a number of medications can’t afford them all so they leave something out. They leave out the ones they don’t feel. Blood pressure – you don’t feel anything it just decreases the risk of stroke,” he said.

Dr. Birbara says that the relaxed law is only there to benefit the patient and that doctors will better be able to work within patients’ price ranges.

“If one of these drugs allows a patient to have a better quality of life… I really think that most the bulk of physicians prescribe a mediation that fits with that person’s pocketbook,” he said. “I personally have never prescribed a drug because I have influenced by a particular pharmaceutical rep.”

The Reality of Wining and Dining

The Worcester doctor also offered his inside opinion on the accusation that the loosening of the “Gift Ban” would lead to doctors being “wined and dined,” thus altering their decisions on what medications to prescribe.

“Most politicians have a feeling that physicians are receiving gifts and being bribed, but when they go on fact-finding, they don’t see it as being similar to lobbying,” he said. “As it is now, we’re allowed to have meetings with drug reps in our office. In this era of managed care, if you think doctors are in total control, we are not.”

He says that a lot of the process is managed by a pharmacist at an insurance company and that at lectures, the FDA approves everything they can discuss.

“It would be nice to sit down and do a didactic lecture which can only give information to teach about new drugs,” he said, adding that if a patient asks them a question during a lecture, they must refer them to someone else. “I don’t think a lot of people who voted against all of this are aware of that, and I haven’t seen politicians shying away from lobbyists. What’s the difference?”

Birbara said that being “wined and dined” has hardly lived up to the extravagant stories that politicians and the media perpetuate.

“Since 2008, a turkey sandwich has been the “wined and dined” in your office. I don’t’ know of any luxury dining experience in an office,” he said. “Now you’re limited to a ‘reasonable meal’ in a restaurant. This whole issue of pharma companies, it’s such a small issue, but politicians are wined and dined for big money, and I don’t see the difference. Are they not influenced? I’m not influenced by a turkey sandwich, I’ll tell you that.”

“I don’t know of one physician who is being paid or otherwise gifted to the extent that he would prescribe a patient against their best interest,” he added.

Restaurants Losing Out?

One argument posed to this issue has been that restaurants are losing out, saying that they’re missing business without pharma reps being able to dine doctors.

“First of all, the department of revenue shows this isn’t the case and that restaurants are doing better on a whole than last year. That statement is wrong,” Cummings said. “Are there some restaurants who took a hit? Absolutely. But as a whole, the moms and pops we should care most about, those weren’t the places doctors were being wined and dined.”

“Healthcare consumers should have to pay for the success of a restaurant,” she added, giving an example of a Boston chocolate and local confectionery who was gifting a giant chocolate shoe to sellers if they met a certain threshold. “An ‘award for being able to get your foot in the door’ it said. The company said they weren’t selling them since the ban, and healthcare companies shouldn’t have to pay for that.”

Cummings said that since healthcare is the biggest cost to the state and a significant part of wellbeing, it should be handled better.

“No one is saying we shouldn’t have pharmaceutical companies in the state, but we need to control the costs of healthcare,” she said. “That’s what the measure intended to do.”  


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