Thursday, March 22, 2007

Pharmaceutical Gift Reporting in the Texas Legislature

Recently I was asked by the office of Sen. Eddie Lucio, Jr. of the Texas Senate to testify on behalf of his Senate Bill 414, which would require that pharmaceutical companies report annually to a state agency all gifts to physicians of greater than $75 in value. I gave my testimony, focusing on the ethical issues related to pharmaceutical gifts, but was most interested to see the ammunition brought forth by the bill's opponents. Two of us (the other being the local director of Public Citizen) testified for the legislation, and four testified against.

Two represented the biotech industry, and seemed to be saying--if you burden our companies with this reporting requirement, we'll take our jobs elsewhere and leave a bunch of Texans unemployed. (One fellow, representing Genentech, when quizzed by one senator about the high costs of cancer drugs, actually had the gall to claim that there is not a single person in the U.S. who is denied access to any cancer drug due to inability to pay, given that his company has such generous charitable and discount programs.)

Other testimony offered against the bill [by a Texas ob-gyn who had a list of drug company relationships as long as your arm, and by the PhRMA general counsel] was that it is really unnecessary. The people giving the testimony almost laughed at those of us who imagined that luxurious meals with wine, travel, junkets to fancy resorts, etc. were still being given out by drug reps. You silly people, they insisted, don't you realize that those are things of the past? Don't you realize that due to the PhRMA 2003 code of ethics, and the AMA code of ethics, and the Inspector General's anti-kickback report from DHHS, that the drug companies simply never any more give out those lavish, expensive gifts?

My reply to this line of testimony (I did not have the opportunity to say this at the hearing, so I burden you with it instead) was--that sounds really great; show me the numbers. When I was doing the research for HOOKED, one of the most elusive numbers of all those that I and some of my colleagues searched for was the total value of all gifts given by the industry to physicians in the U.S. This figure is treated by the industry as totally hush-hush. The commonly quoted numbers on the cost of all pharmaceutical marketing in the US (which includes direct to consumer marketing and drug samples as well as gifts to physicians) are the figures from IMS Health that place these expenses as roughly $21-23B annually. Marcia Angell, in her book on the drug companies, has shown reason to believe that the true figures are nearly twice that. But my main point is that if prior to about 2002-2003, drug companies used to give out these lavish gifts; and then they all stopped; one would imagine that these total marketing figures would have gone down at least a little--say from $21B to $19B or something. To the best of my knowledge there has been no such dip.

If there really was a demonstrable dip in industry largesse to practitioners due to voluntary codes of ethics or related actions, I for one would be happy to set the record straight. But, as I say, please show me the numbers. So far as I know, the numbers are not there.

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