Vermont drug law gains national attention

http://www.burlingtonfreepress.com/article/20090628/NEWS03/90627006/1095

June 28, 2009

Vermont drug law gains national attention By Nancy Remsen Free Press Staff Writer

MONTPELIER — Among all the laws the Vermont Legislature passed this year, one that has attracted almost as much national attention as the state’s gay marriage bill is a new drug marketing disclosure measure. National Public Radio, the New York Times, the New England Journal of Medicine — to name a few high-profile media — all have made note of the new law. As of Wednesday, Vermont will have the strictest law in the country governing how pharma´ceutical and medical device companies market their products to doctors, hospitals, the state’s medical school and other health providers.

It bans drug and medical device companies from providing gifts and free meals to doctors and others. It requires detailed annual reporting on marketing expenditures — by recipient’s name and by drug. It promises this data will be made public without the trade secret exception that has made the state’s 2002 drug marketing law a disappointment. “It’s a winds-of-change bill,” said Ken Libertoff, executive director of the Vermont Association for Mental Health and longtime advocate for greater public disclosure of how drug companies spend their marketing dollars. “It says the relationship between pharmaceutical manufacturers and the medical field will dramatically change.” Pharmaceutical companies argue their dealings with doctors, hospitals and medical schools were al´ready changing and are frequently misrepresented. The drug companies’ trade association — Pharmaceutical Research and Manufacturers of America or PhRMA — put in place a revised code of interactions with health profes´sionals in January. It pro´hibits gifts of noneducation items such as pens and mugs, bans restaurant meals and reaffirms a ban on gifts of entertainment and recreation. Paul Sciortino of Jeffersonville is a drug company representative who calls on doctors throughout the state. “I don’t care for the demonization of us, making us villains. We do help a lot of patients and physicians with education,” he said. He suggested the new law challenges the integrity of physicians by implying “they are going to be influenced by a ham sandwich.”

The Vermont Medical Society supported passage of the bill, however, because many members worried patients might think doctors were influenced by drug company gifts. “Vermont physicians want the doctor/patient re´lationship built on one thing and one thing only: trust,” said Dr. John Brumsted, president of the medical society. “Gifts from the pharmaceutical industry can create at least the appearance of conflict of interest, so in our minds that has a negative impact on our relationship with patients.” Pharmaceutical companies spent $2.93 million on marketing in Vermont, according to data from the most recent 12-month reporting period. That total doesn’t include drug ad´vertising or sales staff salaries. It’s any “gift, fee, payment, subsidy, or other economic benefit provided in connection with detail´ing, promotional, or other marketing activities by the company.” The total expenditure is 30 percent less than five years ago when the state began requiring annual reports under its 2002 law, but still significant, said Attorney General William Sorrell, whose office col´lects and analyzes the data. However, the trade se´cret exemption in the state’s earlier law pre´vented the Attorney General’s Office from disclosing details about 83 percent of the marketing expenditures — except in gross terms. For example, 10 health care providers received more than $50,000 in cash or benefits and one psychiatrist receive more than $112,000, but the state can’t release the names. The state could report that $860,000 was spent on food with one recipient receiving $15,000 in free meals — but couldn’t break down the food freebies by name.

Nor could the state identify the drug most heavily marketed except to say it was for attention-deficit/hyperactivity disorder. “We have a country where there has been al´most no transparency about the relationship between one of the most powerful industries in American — the pharmaceutical manufacturers — and physicians, hospitals and universities where this industry has invested millions of dollars in marketing,” Libertoff complained. At least in Vermont, the public has had an inkling, he noted. “If you are in Texas, California, New York — pick the state — you have no idea and you have no access.” “This bill sets a new standard,” Libertoff said. Senate President Pro Tempore Peter Shumlin, D-Windham, helped pass Vermont’s first marketing disclosure law. It didn’t end up working the way he had hoped, he said. “I vowed we would pass it again and not provide a loophole. “I believe in true transparency, so the consumer knows if their provider is taking money,” Shumlin said. “This is much less about sandwiches and more about hundreds of millions of dollars being given to doctors to influence their prescribing practices.” Shumlin noted a com´panion drug law, passed in 2007, revised in 2008, also takes effect Wednesday. This law — which faces a court challenge — could potentially cut off a supply of important information that drug companies have been able to use in marketing to doctors.

The so-called data-mining law says doctors must agree to the release of information about their prescription-writing practices or the data can’t be shared with drug companies. Data-mining companies have been able to aggregate prescribing information and sell it to pharmaceutical manufacturers. Shumlin said the pair of laws are important tools to curb the growing cost of medications. Sciortino has been a pharmaceutical rep for 20 years. He bristles at the harsh characterizations of his industry. “I’m a good person,” he said. He has no objection to the reporting requirements in the new law. “Transpar´ency — I’m fine with that.” He defended the controversial “lunches” that drug companies representatives may provide to medical practices. He complained that “it’s always about marketing. They never say physician education.” He added, “When I make a claim, I have to support that claim. We give a proof source.” He sells two hormones for people with diabetes. “How do physicians learn about these?” Sciortino asked. One way is “you set up a lunch for 15 or 20 people. You buy from a local sandwich shop. I tell them how these work.” He said such meetings are a quick way to give physicians and their staff some information about doses, interactions, insur´ance coverage and let them ask questions. He may get 10 to 30 minutes with the doctors if he comes during the lunch hour. “If I try to meet them during the day, they are too busy.” “We heard testimony from a lot a doctors that these things are valuable,” said Rep. Sarah Copeland Hanzas, D-Bradford, who led the fight for passage of the bill on the House floor. “To the extent they are valuable, they will continue,” she said. The only difference under the new law is doctors and their staff have to pay for any meals that Sciortino and his colleagues deliver. Not all doctors have been comfortable getting information from drug company representatives. Dr. Jonathan Weker, a Montpelier psychiatrist, discontinued seeing pharmaceutical representatives several years ago. “My concern about the information that drug company representatives bring us is that it is not objective,” he said. “If you are a mar´keter, your job is to make things sell. “There are lots and lots of other ways to get information about drugs,” Weker said. “It may not be as convenient as someone coming to the office, but I think that is a reasonable obligation for a physician to have.” Weker welcomes the data-mining law, too. “I don’t think most doctors knew it was going on. “We felt some degree of violation,” he said of the sale of individual prescription-writing information. “It was almost like we were being spied on.” Although the marketing bans take effect Wednesday, the new reporting requirements won’t yield more consumer friendly data until 2011. The next report from drug companies will be under the old rules, Assistant Attorney General Wendy Morgan said. It will be worth the wait, Libertoff said. “This bill will allow you or me or any consumer to go to a Web site and get some very important infor´mation about your physician,” he said. “It is going to lead to consumers getting independent informa´tion about medication. It will be a tangible reflection of a lot of rhetoric about empowering consumers.”