The Minnesota House of Representatives Commerce and Labor Committee, and members of the Health and Human Services Policy Committee recently held a hearing titled: How Minnesota’s Reporting and Gift Laws Affect the Medical Community.
One physician giving testimony on the subject was Dr. Michael Gonzalez-Campoy, a resident of Sunfish Lake, MN, an endocrinologist and the Medical Director and Chief Executive Officer of the Minnesota Center for Obesity, Metabolism and Endocrinology. Dr. Gonzalez-Campoy noted in his introduction that his testimony would focus on three primary areas:
How the 1993 Minnesota reporting and gift laws (the 1993 laws) have caused tremendous harm to patients, medical education, clinical research and development, the physician-patient relationship, and physician-industry collaborative relationships, as well as other unintended consequence.
Why there is value to patients, medicine and society that comes from the working relationship between physicians and industry.
Why taking an extreme position against the physician-industry working relationship, and assigning to this relationship the label of a “conflict” has its genesis in a very small number of people, most of which derive significant personal gain from advancing this position.
THE WORK PRODUCT OF PHYSICIANS
The 1993 laws mandate reporting of some of the income that represents the work product of physicians. The law does not however call into question the ethical, moral or legal implications of the physician-industry working relationships, and they do not challenge that physicians should be paid for the work they do outside the patient-physician relationship.
NEGATIVE IMPLICATIONS OF THE 1993 LAWS AND REPORTING ON THEM
The 1993 laws mandate reporting to the Minnesota Board of Pharmacy payments to physicians for education, consulting, or research, coming from “a wholesale drug distributor” (i.e. pharmaceutical companies). At the same time, the laws did not mandate reporting of payments from colleges or universities, group practices, foundations, lawyers, HMOs, patients, legal firms or the government. As a result, Dr. Gonzalez-Campoy noted that the reporting mandates “a source of income that was somehow different from all other sources in the work product of physicians.” This begged the question of why “to report of one source of income for physicians, and not the others when all sources represents the legal, moral and ethical work product of physicians?
Another problem is that reporters use the data produced from the 1993 laws, and release it with the innuendo that it is inappropriate or illegitimate money paid to physicians by industry.
HARM TO MEDICAL EDUCATION
Physicians have the professional obligation to educate themselves and their peers. For example, Dr. Gonzalez-Campy himself is an expert in obesity and diabetes, he is on the cutting edge of clinical research, and he knows best how these new treatments are to be used.
WHO BENEFITS FROM THE 1993 LAWS, AND WHO DOES NOT?
Patients are hurt by preventing access to newer, better treatments, and using generics when newer alternative medications are better.
The taxpayers are hurt in Minnesota because the overutilization of generics frequently increases the global cost of care, and taxpayers end up paying more when patients lack access to appropriate medications, as decided with their physicians.
Doctors are hurt because the profession of medicine has been harmed by ignoring the value of the physician-industry working relationship and the constant attacks on its merits.
The academic medical centers are hurt because the media has tainted the image of academic physicians, when in reality they represent significant effort to carry on research or educate peers.
People who gain from criticizing this relationship include:
The media, who seek to sell papers by periodically using reported data
Politicians who see their name in the paper repeatedly (i.e. Senator Grassley)
Manufacturers of generic medications (the more generics prescribed, the better these companies are).
Pharmacy benefit management companies make profits by pushing cheap, generic drugs on patients, and by discouraging appropriate prescribing through formulary restrictions.
HMOs who get to pocket more of the health care dollars by denying patients the access to treatments physicians deem appropriate for them; and
TORT lawyers who work to advance the “conflict of interest agenda.”
THE VALUE OF THE PHYSICIAN-INDUSTRY COLLABORATIVE RELATIONSHIP
The partnership of physician and industry brings value to patients, and many doctors cannot practice without this partnership, nor can medicine advance. The reported income between such groups “represents the collective efforts of physicians and industry in the development and implementation of newer, better, safer treatments,” that improve patient care. Such progress over the past decade includes improving diabetes care, osteoporosis, pituitary disease, hypertension, and lipid disorders.
Knowing these facts, media can do a better job covering physician payments by including the benefits such relationships have to patients and the advancement of medicine that these payments represent.
This change in practice is critical for both physicians who receive such payments, and more importantly patients because when they here these stories, they modify effective treatment plans in response to sensationalist headlines.
To keep patients healthy, doctors must be the ones who decide what treatments are best for their patients through the objective education they receive from medical companies, industry research, and clinical studies.
MN HOUSE COMMERCE COMMITTEE -Testimony J. Michael Gonzales- 10-5-2009