Sunday, March 16, 2008

Time To Stop Small-Time Legal Bribery Of Doctors

For years, it hasn't been such an uncommon sight to keep a doctor appointment in the early afternoon and see leftover pizza, or Chinese takeout, or such, around the joint. Then, a pharmaceutical salesperson emerges from the back, a walking drugstore with a big valise, after making a "sale." This person has apparently treated everybody in the clinic to lunch. (And then, written it off on the taxes as a business expense.) There are free drug samples galore, and lots of Cialis pens and coffee mugs; but it's understood that prescriptions will be written along with distribution of those samples.

I've witnessed this firsthand, and so has my wife. It's under $100 worth of perks, so it's currently accepted practice (pardon my choice of words). Not every doctor accepts these small perks, but they are legal. And, this kind of unethical coziness between the medical profession and drug companies is one facet, among many, of the U.S. health-care debacle.

The Senate has a bill, the Physician Payment Sunshine Act (S. 2029), currently in the Finance Committee. It would, according to The Associated Press: "...create a database disclosing the names and addresses of doctors who receive gifts or payments. It would also include pharmaceutical company names and the value of the gift or payment."

More specific information is on The bill would:

... amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP.

Sadly, this bill has been mired in committee since September, despite support from medical ethics groups. AP reported, tersely: "Drug companies oppose the act."

What are the "pro" arguments? I'll quote more from the AP story, which was not merely about doctors accepting perks. It was about doctors acting as actual shills, giving testimonials to peers for new drugs, under corporate sponsorship for damned good pay:

Pharmaceutical companies argue that doctors are an essential part of educating colleagues as new drugs are developed. ...

To summarize, their argument is: How can doctors know about new medicines, their potential side effects, their proper use, and so forth, unless they hear it from experienced peers? But, to have the symposiums sponsored by the drug companies, who are paying the doctors who are giving testimonials, seems like a pretty big ethical conflict of interest.

More from AP: PhRMA (the drug industry's lobbying arm) adopted voluntary rules in 2002 that limit the value of gifts to $100 or less and says that all forms of free entertainment, including sporting events, are inappropriate.

All very nice, but I'm offended by even seeing these reps feeding my doctor and his staff fully loaded pizza, beef broccoli and moo goo gai pan, and a lot of sales bullshit. The bill that's bogged down in the Senate committee isn't nearly strong enough. This is legal bribery, even if it's on a small scale. And I realize that any action won't have more than a tiny effect on the American health-care morass.

But on principle alone, it should be banned. And, any effect it has might work toward curbing what is clearly the chronic overmedication of the American people.