D.C. surgeon touts own ideas for reform, gifts

Although he works in the political capital of the world, Washington, D.C.-based orthopedic surgeon Peter Lavine, MD, said he's not going to be running for office anytime soon, and that gives him the freedom to speak his mind without worrying about the consequences.

"Because I have no political aspirations, I don't have to wear the cloak of political correctness," said the president of the Medical Society of the District of Columbia and 1984 graduate of the Georgetown University School of Medicine.

As the MSDC president and as a member of the AMA House of Delegates, Dr. Lavine has fought for medical liability reform and increasing the Medicare fee schedule. He also has taken stands that do not necessarily mesh with other leaders of the medical community. In particular, his criticism of the AMA policy on drug industry gifts to physicians has garnered him a lot of attention.

Dr. Lavine received attention after calling the AMA policy ineffective and "ignored by most physicians," but he added that the media sound bites did not include the most important part of his message: That doctors who put the interests of their patients first are unlikely to be swayed to do otherwise by a fancy meal; that industry-sponsored education conferences are useful but also can be seen as a gift; and that he believes safeguarding physician prescribing histories will soften hard-sell tactics.

"Physicians should not change their practice based on gifts -- that makes sense and is an irreversible principle," Dr. Lavine said. "I don't think people are going to change their practice parameters over a couple of steak dinners, I think the government attention to this is simply a smokescreen and propelled by their inability to do anything about drug prices."

Modest gifts allowed

The AMA allows for the acceptance of modest gifts that have some value to patients or medical practice and for accepting modest meals if there are educational presentations that accompany them. Cash payments should not be accepted, and gifts should never come with strings attached.

"I think it's a balanced view," said Priscilla Ray, MD, vice chair of the AMA Council on Ethical and Judicial Affairs. "There are some who say, 'You should allow a drug company to pay for cruises to the Bahamas for me and my wife,' and there are some who say, 'You shouldn't even take a pen.' "

Dr. Lavine has introduced resolutions to change the policy at both the 2002 and 2004 AMA Annual Meetings, but Dr. Ray, a Houston-based psychiatrist, said she didn't mind the repetition because the discussion helps remind people of the policy.

Dr. Lavine said he knew his last resolution wouldn't get much support.

"It was no surprise to me that it was going to be squished," he said. "You can't go up to a group of people who have their minds made up already and say, 'I disagree with everything you believe in.' But it's not a popularity contest, and you shouldn't be afraid to debate unpopular topics."

Dr. Lavine also has spoken out against government proposals to limit the use of family members as translators and for the reimportation of prescription drugs.

Dr. Lavine said part of his motivation for proposing the gift-policy resolutions comes from the confusion over what is acceptable for continuing medical education. AMA policy allows for company subsidies to lower the cost of registration fees, but states say subsidies should not be accepted to pay for travel and lodging.

"If a physician gets free airfare or hotel, it's a violation, but it's OK for the organization running the course to take a big check," he said.

Dr. Lavine believes the best way to end industry influence on physicians is to block its access to a physician's prescribing history.

Court Rosen, a representative for the industry group Pharmaceutical Research and Manufacturers of America, would not comment, but Arthur Kuebel, a former Washington state-based drug industry sales representative turned industry critic, endorsed Dr. Lavine's idea.

Kuebel said drug manufacturers buy prescribing data from companies who gather such information to see who is prescribing a competitor's products and then tailor the messages of sales reps and educational conference speakers to persuade them to switch.

Getting and analyzing data add to the cost of drugs, Kuebel said. "Marketing costs don't develop drugs, nor do they make people well," he added.