Measure Targets Gifts to Doctors

Prescription drug makers who give doctors millions of dollars’ worth of gifts each year -- from Chinese food to free travel -- would be forced to publicly list them under a bill pending in the Legislature.

California is one of several states questioning a culture of gift-giving that some doctors and consumer advocates call pervasive and potentially corrupting.

With dinners, theater tickets, even free tanks of gas, lawmakers say, drug company sales representatives try to win the attention of the people who write more than $155 billion worth of prescriptions a year nationally.

Under Assembly Bill 103 by Assemblywoman Sarah Reyes (D-Fresno), drug manufacturers would have to report to the state Board of Pharmacy gifts worth more than $25 to doctors, pharmacists, hospital administrators or anyone else authorized to write prescriptions.

Drug samples -- often used by hospitals and doctors to help poor patients -- would be exempt. Violators could be fined $10,000.

Reyes said she is trying to accomplish several things: to let patients know why a doctor might be pushing a certain prescription, to discourage doctors from taking gifts and to bring down the cost of prescription drugs.

Drug companies complain that the proposed law would force them to disclose trade secrets.

“No other industry that has a partnership with the state would be required to disclose the kind of information that would damage its ability to develop confidential marketing strategies,” Merrill Jacobs, a lobbyist for the Pharmaceutical Research and Manufacturers of America, wrote to Reyes last month.

Jacobs called her bill unnecessary, saying the industry has adopted voluntary guidelines that warn drug company representatives against paying doctors to attend conferences or giving them personal items, such as flowers, artwork or sports tickets.

“With the guidelines now in place,” he wrote, “what problem is the bill trying to correct?”

Reyes said that, even if it is true that pharmaceutical companies have voluntary policies against giving gifts, they should welcome a disclosure law.

“If they all have a gentlemen’s agreement to not do these extravagant trips, then this will keep them honest,” she said.

Connecticut, Maryland and Washington are considering similar laws. Vermont passed the nation’s first and only mandatory gift disclosure law for drug manufacturers last year.

Lawmakers are targeting the gift-giving as the cost of prescription drugs becomes a heavier burden for government programs that insure the poor and elderly.

Retail spending on prescription drugs has jumped 17% to 19% each year since 1997, according to the nonprofit National Institute for Health Care Management. The average price of a prescription rose 10% from 2000 to 2001, from $45.27 to $49.84.

“We don’t know why the drug someone’s been taking for years has suddenly gone up 200%, 300%,” said Judy Clibborn, a Democratic member of the Washington state House of Representatives and author of a bill to require drug makers to disclose gifts worth $50 or more.

“If we start to get a handle on what’s really happening, then we can answer those questions.”

Clibborn argued that disclosure also helps protect the drug manufacturers because their generosity to doctors may be exaggerated.

“There have been lots of allegations and people tell stories,” she said, “but nobody really knows what’s true.”

A March 2002 national survey published by the Henry J. Kaiser Family Foundation found that 61% of doctors reported having received meals, tickets to events or free travel from the drug industry.

Nearly the same percentage of doctors -- 59% -- said they found the information from industry representatives “somewhat useful.”

The figures don’t surprise New York City internist Bob Goodman. He banned drug company representatives from his clinic and launched a Web site -- www.nofreelunch.org -- to encourage colleagues to do the same.

Doctors don’t need to rely on the companies for information about drugs because unbiased information is readily available, he said.

“If they were aware that patients or the public knew about this, they’d be much less likely to do it,” Goodman said.

“At the very least,” he said, things like lobster dinners, payments for attending conferences and golf fees “gives a perception of a conflict of interest.”

Doctors often become so accustomed to drug company generosity, he said, that they feel entitled to it. His campaign appears to rankle some doctors.

“Someone wants to do something for us for a change and we need to be protected from it because we can’t think for ourselves,” one doctor wrote in a letter Goodman posted on his Web site. “You’ve had your fun playing in the sand castle, so wreck it for everyone else.”

Other letters come from drug “reps” who also seek an end to the free lunches.

“Believe me,” one wrote, “I do not like being a UPS delivery person, office stock person, caterer, social chairman or party organizer.... I strive to offer credible, and unbiased information about how my products can benefit patients.”

Pharmaceutical companies spent $16 billion promoting drugs in 2001, including professional journal advertising, according to IMS Health, a market research company that analyzes the pharmaceutical industry.

As concern grows about prescription drug prices, the federal government also has gotten involved. In October, the Department of Health and Human Services proposed regulations restricting pharmaceutical industry giveaways. The guidelines warn the companies that they risk violating federal anti-kickback statutes.

Reyes’ bill faces a battle in the Legislature, where drug manufacturers also have scattered gifts.

For example, Pfizer Inc., maker of the drugs Zoloft and Celebrex, spread more than $68,000 among state politicians last year. The company hosted a dinner for several Republican lawmakers in December that each reported as being worth $261. GlaxoSmithKline donated a total of $143,000 last year, and Eli Lilly & Co. and its political action committee gave more than $110,000 to a wide range of politicians. Those three drug companies spent a combined $1.3 million lobbying the Legislature last year. Reyes’ bill is expected to get its first vote in the Assembly Health Committee later this month.