Bill seeks to limit pharmaceutical company influence

Every year, drug companies spend billions of dollars trying to convince doctors to push their products.

Every year, drug companies spend billions of dollars trying to convince doctors to push their products. While no one’s sure exactly how well it works, people are concerned. “It’s a huge problem,” Jeannine Conway, assistant professor in the College of Pharmacy at the University of Minnesota, said. “The drug companies have really infiltrated lots of areas of how we get information.” A bill in the state Legislature seeks to limit the influence of pharmaceutical companies by recruiting a team of independent health care experts to present doctors with unbiased, scientific-based information about various treatment options. If the bill is passed, the University’s medical and pharmacy schools will be charged with sorting out the details in collaboration with the state commissioner of health and the Board of Pharmacy. Such programs, called academic detailing, have sprouted in at least eight other states as well as Australia, Canada, the United Kingdom and the Netherlands. “The attempt is not to come in and take away individual freedom, it’s to make sure doctors have good information so they can make the best decisions,” said Rep. Tina Liebling, DFL-Rochester, author of the bill’s House version. “And that they’re as objective as possible and not influenced by people who make money from treatments.” The bill was suggested to Liebling by the Minnesota Prescription Coalition, an expansive group that includes AARP Minnesota, labor unions, consumer groups, insurance companies and several hospitals, including Hennepin County Medical Center and Children’s Hospitals and Clinics of Minnesota. The group claims that drug companies devoted $12 billion — more than half of their promotional spending in 2008 — to physicians. Jerry Avorn, a professor at Harvard Medical School, helped establish academic detailing programs in Massachusetts, Pennsylvania and Washington, D.C., in 2005. Having specially trained pharmacists, nurses and physicians teaching doctors about treatment options means less reliance on ads or representatives from drug companies, he said. Having been a primary care physician for many years, Avorn said doctors are often too busy to learn about medications and get most of their information from ads. “There’s really not a lot of time when you can come home at night and curl up with 20 medical journals and teach yourself everything you need to know,” he said. But not everybody thinks the program is a good idea. “The basic premise that there’s a conflict of interest when physicians and industry work together for the common good is one that I think is flawed,” said Michael Gonzales-Campoy, an Eagan-based endocrinologist and past president of the Minnesota Medical Association. The legislation would devastate medical education, as ideas that originate at universities need the marketing arm of the pharmaceutical industry in order to develop, Gonzales-Campoy said. “They disseminate information about new treatments very, very well,” he said. “That brings value to patients in a way that the government can’t.” University pharmaceutical economics professor Stephen Schondelmeyer, who studies prescription drug costs and policies, spoke in support of the bill at a joint committee meeting that began debate on this and two similar bills. Oftentimes, drug manufactures know more about their products than the public, leading to ineffective or dangerous drugs remaining on the market, he said. Examples include antidepressants, recently found to be akin to placebos in patients with mild forms of the disorder, and the high-profile removal of Vioxx from the market — a drug believed to have caused about 100,000 heart attacks in users — long after its maker knew about the dangers associated with it. “The drug company knew more than they were telling, yet they kept promoting the drug actively for a number of years,” Schondelmeyer said before the committees, “even after they knew it might be causing more harm than good.” Despite the continued problems, Conway said she’s concerned about how such a detailing program would work. “With the current economy and the hiring pause, everyone has a full plate,” she said. “Who would take this on? I have no idea.” Leibling said she expects a long road ahead for the bill, on which discussion has yet to begin. She introduced it alongside two others, one of which would tighten restrictions on gifts doctors can receive from drug companies. The other would ban drug companies from obtaining doctors’ prescribing records for marketing purposes. All three bills were introduced last year as well, yet none made it through their respective committees. “Sometimes it can take more than one year for something to really happen,” she said. “It takes that long for people to understand such a complicated issue.” Money is a barrier too, Liebling said, as the detailing program would be funded in part by additional fees on the pharmaceutical industry, something she’s not sure the governor would approve of. Avorn said his program more than pays for itself through improved patient outcomes and reduced drug expenditures. Drug companies are good at disclosing the good things about their products, but they don’t always tell the whole story, Schondelmeyer said. “Doctors are very smart and wise people,” he said, “but sometimes we can be fooled by the marketing.”