Bill would make drug firms disclose gifts to doctors

Washington -- Gifts to physicians such as free lunches from drug and medical device reps soon could be listed on a national database so patients can evaluate whether money might be affecting their doctors' prescribing.

The bipartisan Physician Payments Sunshine Act, introduced Sept. 6 in the Senate, would require drug and medical device manufacturers with $100 million or more in annual gross revenues to disclose names and office addresses of every doctor who gets a gift valued at more than $25. Drug samples and funding for clinical trials would be exempt. Failure to comply would trigger fines of up to $100,000 per violation.

"Whether it's dinner at a restaurant or tens of thousands of dollars or more in fees and travel, patients shouldn't be in the dark about whether their doctors are getting money from drug and device makers," said bill sponsor Sen. Chuck Grassley (R, Iowa), the top Republican on the Senate Finance Committee.

The American Medical Association has not adopted a policy on the legislation. The AMA's ethical guidelines prohibit doctors from accepting any gift of substantial value or with conditions attached. All gifts must primarily benefit patients or be related to a physician's work.

The bill won't change prescribing patterns but would hasten compliance with the AMA code, said Maine Medical Assn. Vice President Gordon H. Smith. "No physician wants to be seen as having received value from a pharmaceutical company and then prescribing their drugs," he stated.

States take action

A few states already have laws limiting industry gifts to doctors. The bill would not preempt these measures, said Senate Special Committee on Aging spokeswoman Ashley Glacel.

Maine passed its law in 2004, and after an administrative delay began compiling a registry of gifts exceeding $25 from drug companies on July 1, Smith said. Physician names will be confidential. The state will total the aggregate amount of gifts each quarter. It is too early to say how the law will affect doctors, Smith stated.

Vermont requires drug companies to report any gift valued at more than $25 but allows them to withhold names of recipients by declaring gifts a trade secret, said Vermont Assistant Attorney General Julie Brill. Her office collects the data and issues an annual report analyzing trends. It has made physicians much more aware of accepting gifts, she said.

"There has been a lot of good and healthy discussion in the prescribing community as to the gifts and their perceived and actual problems with accepting payments," Brill said.

The Vermont Psychiatric Assn. decided to revamp its ethical guidelines after the attorney general's 2007 report revealed that psychiatrists ranked first among specialists who accepted the most gifts, said VPA Executive Director Steve Larose. The report revealed that 11 Vermont psychiatrists received 22% of the overall $2.25 million in gifts given by drug companies to the state's physicians.

The VPA adopted the AMA's guidelines in April as a starting point and will finalize a policy in the next few months, Larose said.

Minnesota bans drug firms from giving physicians gifts valued at more than $50 and requires public disclosure of compensation that is more than $100. But few doctors even knew about the law until the Journal of the American Medical Association published an article reviewing Vermont's and Minnesota's laws in March, said Minnesota Medical Assn. President Richard Geier, MD.

Minnesota's law ignores the issue of physicians being involved in drug trials and marketing, Dr. Geier said. Physicians will not travel and give technical briefings about the effectiveness of drugs without being paid for it, he said.

California, West Virginia and the District of Columbia have nonpublic registries.