Vermont, my home state and a bellwether for transparency reform in health care, just passed a law that goes further than any other in the nation. It limits drug company gifts to physicians and requires transparency for payments made to them by the pharmaceutical industry.
These are important reforms. In 2008 the pharmaceutical industry reported spending nearly $3 million on payments to the state’s doctors, hospitals, universities, among others, according to Vermont’s attorney general. And such expenditures have been shown to have an influence on the drugs you’re prescribed.
A recent report from the Institute of Medicine found that the drug company practice of giving doctors gifts and meals, along with other financial incentives, may influence physicians to prescribe a specific drug when another drug might be more beneficial to the patient. And another recent study published in the journal, Archives of Internal Medicine, found that even small gifts, like the pharmaceutical industry’s ubiquitous pens and coffee cups, can have an implicit effect on the attitude of medical students toward the drug that it’s branded with.
The Vermont law signed this week by Governor Jim Douglas, bans drug companies—and manufacturers of medical devices and biological products, such as vaccines—from paying for gifts, including meals and travel, to physicians, hospitals, nursing homes, pharmacists, and health plan administrators. Any allowable payments drug companies make to doctors, such as those for legitimate educational purposes, will be posted in a database on a public website maintained by the Vermont Attorney General. Information should be available starting in 2011.
The new law also closes loopholes that led to poor compliance of previous Vermont transparency legislation enacted in 2002. A study published in the Journal of the American Medical Association found that under the earlier law, 61 percent of payments by drug companies were not released to the public, and 75 percent of disclosed payments were missing information needed to identify the recipient.
The public appears to be quite supportive of such disclosure efforts. A Consumer Reports poll from earlier this year, found that 68 percent of Americans thought that drug companies have too much influence on the drugs that doctors prescribe, and 47 percent said that prescriptions are influenced by gifts from the pharmaceutical industry.
Conflict of interest and sunshine reforms help to limit the influence of drug companies on the treatments that patients are prescribed. And once consumers get a glimpse of sunshine, it tends to spread. Last year, the industry trade group, PhRMA, saw the light and updated its marketing code to recommend against using promotional items, like pens and coffee cups, restaurant meals and other perceived conflicts of interest. But those recommendations are voluntary. Several other states, including California, Maine, Massachusetts, Minnesota, West Virginia, and the District of Columbia, have disclosure legislation already, and a federal sunshine bill covering drug company gifts is in the works in Congress.
But in an editorial released Wednesday by the New England Journal of Medicine, Robert Steinbrook, M.D., argues that the pending federal law, The Physician Payments Sunshine Act, proposed by Senator Chuck Grassley, (R-Iowa), needs to be strengthened in order to live up to the standards set by the Vermont law—or else it may preempt stronger state laws. “The Sunshine Act would not,” writes Dr. Steinbrook, “ban gifts and some payments, or cover recipients other than doctors, as Vermont’s law does. By enacting the strictest gift ban and disclosure law in the country, Vermont has raised the bar for voluntary and legislative reform efforts.”
—Chris Hendel, associate director, Health & Family