More states consider laws for reporting industry gifts

They say that "information equals power" and, in more than a dozen states, there are lawmakers who hope information may also equal lower prescription drug costs.

Legislators in at least 14 states introduced bills this year that would require pharmaceutical sales representatives to file reports detailing the gifts they give to physicians. Drug manufacturers are opposing the bills. Most medical societies are keeping an eye on the bills but haven't gotten involved so far because doctors won't see the financial and administrative burdens that the drug industry would see if the legislation passes.

"Any legislation that makes drug company blandishments to doctors transparent is an improvement, but it would have to include education support," Marcia Angell, MD, the former editor of the New England Journal of Medicine, said in an e-mail.

According to the National Conference of State Legislatures and Sharon Treat, executive director for the National Legislative Assn. on Prescription Drug Prices, reporting bills have been introduced in Connecticut, Illinois, Massachusetts, Nevada, New Hampshire, New York, Oregon, Rhode Island and Washington. Measures were introduced but defeated in Hawaii, Mississippi, Montana, New Mexico and Wyoming.

Oregon state Rep. Carolyn Tomei said the reporting bill she sponsored wouldn't require doctors to do anything. "I think they already have more than enough paperwork."

That seems to ring true in most states that have introduced legislation. "I think that the legislators get it," said Bernie Horn, policy director of the Washington, D.C.-based Center for Policy Alternatives and author of the model bill that most of the state legislation is patterned after. "Restricting the requirements to drug manufacturers is becoming fairly uniform."

Debating what laws are needed

Proponents of reporting laws argue that the requirements will help rein in excessive marketing practices that drive prescription drug prices. But the trade group Pharmaceutical Research and Manufacturers of America has opposed reporting bills.

PhRMA spokeswoman Wanda Moebius said the bills require companies to disclose trade secrets. She also said the laws aren't needed because PhRMA's Code of Conduct already prohibits the practices lawmakers are trying to curtail. And she said doctors have a responsibility to serve as gatekeepers. "They are the best judges of what to prescribe to which patients."

Dr. Angell, who also authored the book The Truth About the Drug Companies: How They Deceive Us and What to Do About It, disagreed and said reporting laws can only help.

"The pharmaceutical industry pours billions of dollars into 'educating' doctors to prescribe the newest, most expensive drugs, despite the usual lack of evidence that they offer anything better than the older, less expensive drugs already on the market," she said. "PhRMA's guidelines can easily be evaded by construing gifts, such as trips and meals, as educational, not promotional."

AMA guidelines on industry gifts were approved in 1990 and state that physicians should accept only gifts that have some benefit to patients, are of modest value and come with no strings attached.

If any of the states considering legislation adopt it, they would join Maine and Vermont in creating reporting laws.

Maine Medical Assn. Vice President and General Counsel Andrew MacLean said the association "helped shape" the version which passed in their state in 2003. The MMA made sure that the law wouldn't have a negative impact on continuing medical education. It also pushed for public reports to list only aggregate data and not statistics on individual doctors.

"We didn't want this type of law to result in physicians' names being splashed all over the newspapers," MacLean said.

John Santa, MD, the assistant director for health projects at the Center for Evidence-based Policy at Oregon Health & Sciences University in Portland, testified before the state Legislature in favor of Oregon's reporting measure. "Financial relationships with industry are not wrong," he said. "They're wrong when they're concealed and they make people wonder 'what did you do to get what you got?' "