This weekend’s Minneapolis Star Tribune highlighted today’s hearing in the Minnesota Legislature between a consumer-insurer coalition on one side and a coalition of physicians and drug companies on the other.
The article states that while “Americans dole out billions of dollars for prescription medications each year, drug makers are also doling out billions of dollars to influence the doctors who prescribe them.” Such a claim is problematic for many reasons, and ignores the fact that without such drugs, millions of Americans would not be as healthy or living as long.
The joint hearing of the Commerce and Labor and the Business, Industry and Jobs committees will begin debating three bills (which we mentioned previously). The bills are “designed to improve doctors’ prescribing skills, reduce the influence of pharmaceutical companies — and perhaps reduce overall drug spending by consumers.”
For example, one bill allows the state commissioner of Health, “along with the state Board of Phrmacy and the University of Minnesota’s medical and pharmacy schools, to develop a drug-education program for doctors, pharmacists and other health care professionals.” Essentially, this program would limit drug company representatives from talking to physicians about drugs that are clinically shown to be effective in favor of “evidence-based medicine.” The article claims that evidence-based medicine involves doctors who “make medical decisions based on unbiased scientific information rather than information from drug companies.”
Excluding truthful information from drug company representatives about research and clinical studies for brand name drugs, in favor of generic drugs, just to save money, hardly seems unbiased. Physicians must be able to hear all sources of information equally, and weigh the potential costs, risks and benefits of all drugs to save their patients foremost, not money.
Proponents of the bills feel that the drug industry’s spending of $7.2 billion a year on marketing to physicians, “compromises the quality of health care and inflating.” Various groups, such as the newly formed Minnesota Prescription Coalition, a diverse group that includes AARP Minnesota, insurers HealthPartners and Medica, labor unions, hospitals and consumer groups, supports the proposed legislation.
Review of their website shows that the Minnesota Prescription Coalition is primarily funded under through with Community Catalyst and the Prescription Project of Pew Charitable Trusts.
The Prescription Project based in Boston Massachusetts and their parent Community Catalyst are also the only contacts and lists none of the groups discussed in the press release. Including the cell phone contact information for Peter Wyckoff, National Consultant – Prescription Access and Quality Community Catalyst – The Pew Prescription Project (I guess he is lonely and wants to chat)
It is interesting to note that the insurance companies are showing their stripes as being against newer medications and treatments in an effort to get the focus off their overhead costs and onto the costs of treatments which in the end can lead to tremendous savings to society.
For example a patient who is treated with a medication to prevent a heart attack or treat a stroke, may live five to ten years longer than those who do not. In those post event years they can contribute back to society through taxes and productivity which is rarely if ever discussed in the cost analysis.
Supporters such as Peter Wyckoff, a coalition spokesman and employee of the Prescription Project, believe that the proposed bills will “save money in the long run and improve quality and safety in prescribing.”
Against the proposed legislation are various members of the health care profession including the pharmaceutical industry, doctors, and members of the Association of Clinical Researchers and Educators (ACRE). The article noted that ACRE recently co-sponsored a forum in Minnesota on “Restoring the Value of Collaborative Relationships in Medicine.”
One member of ACRE, Dr. J. Michael Gonzalez-Campoy, a Minneapolis endocrinologist, and past president of the Minnesota Medical Association told the Tribune that the “relationship between doctors and drug companies is often misunderstood by the public.” He further emphasized that doctors would not be able “practice medicine if it weren’t for pharmaceutical companies.”
ACRE also provided written testimony to the hearing outlining the harm that can happen to patients and medicine from the proposed bills including:
· “Generics all the time” is a false economy.
o Newer medications are more cost efficient in the long run. They represent an investment in future health.
· Medical care decisions should be made by physicians and patients together, not anyone else.
o Physicians, especially in greater Minnesota and large medical groups in metropolitan areas, deserve free access to all sources of medication information with no restrictions – not from the State, not from HMOs, not from the federal government.
· Excellent medical care is built on this exchange of information, and partnerships between physicians and industry are integral to it.
· ACRE believes that the collaborative relationships between physicians and industry are moral, ethical and legal, bring value to medicine and to patients, and result in excellent patient care.
· ACRE does not condone unethical behavior in medicine, the examples of which are exceedingly rare.
· ACRE affirms that the work product of physicians includes clinical research and education, and that physicians should be paid for the work they do.
· It is not up to the legislature to determine the contractual arrangements of physicians for the work they do.
Still, critics of industry-physician relationships believe that drug companies are only out to sell their product because they know doctors have “little time to comb through complicated clinical studies and journal articles, and crave “unbiased” information.”
In response to such claims, Marjorie Powell, senior assistant general counsel for the drug industry group PhRMA, noted that the proposed legislation is “overkill” because insurance companies already prescribe generics when they are available. She further emphasized that “two-thirds of all prescriptions filled in the U.S. are with generic drugs, so it’s not clear that an [education] program is of any value to physicians.” For Minnesota the generic prescription number is closer to 80%.
States such as Pennsylvania and New York have already “adopted similar education programs,” which have resulted in savings, according to Stephen Schondelmeyer, a University of Minnesota pharmacy professor who studies drug pricing. The article noted that these savings occur because the programs encourage the use of “cheaper generic drugs instead of more expensive brand-name medications.”
Dr. Gonzalez-Campoy noted however, that this type of saving is not necessarily a good thing because the “rising health care costs have focused the discussion away from the value of treatments to the cost of pills.” He further asserted that while ACRE is not against the use of generic medications, the organization supports the premise that physicians should be using “newer, better treatments when they are more appropriate for patients,” regardless of cost.
Also being debated at the hearing is legislation that will prohibit “pharmaceutical data-mining,” where “drug companies buy doctors’ prescribing records from a third party and use the data to target their marketing efforts with individual physicians.” While the creators of this bill believe it causes physicians to receive biased information, PhRMA’s Powell noted that “because pharmaceutical companies have the most current information about medicines, both new and existing, it’s very important that they get that information to the physicians who are actually prescribing the medicines.”
Ultimately, it should be noted by media sources and public officials that when considering the impact this legislation will have on patients and doctors, there must be a distinction between hiring physicians for consulting and customer education, and merely paying doctors to prescribe. The interactions between the drug industry and physicians are crucial for the health and livelihood of our patients, and without such exposure, how else will physicians know what to prescribe?