MN State’s drug law goes to Congress

06/27/2007

The law calling for disclosure of drug company payments to doctors draws national attention.


By Kevin Diaz,
Star Tribune
June 27, 2007


WASHINGTON -- Drug company payments to Minnesota doctors came under a national microscope Wednesday as members of Congress heard pleas for a national registry based on a landmark state disclosure law.

Payment records from Minnesota, the only state that makes them public by name, show more than $22 million in pharmaceutical company payments spread among at least 2,388 doctors between 2002 and 2004.

The disclosures have helped shine a light on the flow of money from drug companies to doctors who write prescriptions and sometimes help study experimental medicines -- in some cases, doctors with documented legal and ethical lapses.

The findings, published locally as well as in the Journal of the American Medical Association and the New York Times, are considered to be a small slice of a national phenomenon.

"Without the data collected through the Minnesota gift disclosure law, we would not have the weeklong series of front-page articles in the New York Times detailing payments to doctors and questionable or unsafe prescribing patterns linked to those doctors," said Sharon Treat, a state legislator from Maine and head of the National Legislative Association on Prescription Drug Prices.

Treat, testifying before a Senate panel on aging, appeared with Dr. Peter Lurie, of Public Citizen, a consumer advocacy group that was the first to probe the Minnesota data two years ago. The law has been on the books since 1993.

Gaps in state laws

While praising Minnesota's public disclosure law, which is spawning similar laws across the nation, Lurie said it remains too difficult for citizens and interested parties to learn where all the money is going, and for what purpose.

"What we really need is a national law," Lurie said. "We have state laws, but they are riddled with holes."

Nationally, marketing and promotion efforts were valued by the pharmaceutical industry at $25.3 billion in 2003.

While Minnesota names specific doctors, it provides for no regular summary reports to state legislators, as some other states do. "A model statute would require both," Lurie said.

Minnesota also has no separate reporting requirement for each payment, making it harder to determine whether the money is for educational purposes, speaking fees, free drug samples or other purposes.

In some cases, Lurie's group found Minnesota disclosure forms that had sat in boxes for up to a decade, he said, "gathering dust and never being analyzed."

Cody Wiberg, executive director of the Minnesota Board of Pharmacy, which maintains the records, said in an interview that his office has been working on scanning the data into electronic files so it can be posted on the Internet in a couple of weeks. Legal clearance to go forward with the project came from the Minnesota attorney general's office just last week, he said.

It remains unclear whether Congress will create a similar national registry.

"We would like to do this as quickly as we can," said Sen. Herb Kohl, D-Wis., chairman of the Senate Special Committee on Aging. "Disclosure is really important."

But Kohl has set no timeline for action, and he has yet to introduce a registry bill in the Senate.

Doctors, drug firms opposed

Sen. Norm Coleman, R-Minn., a member of the aging committee, skipped the hearing to attend a briefing on Iraq and Iran, according to his spokesman. In a written statement, Coleman termed himself "proud of Minnesota's foresight in starting to address the issue of inappropriate relationships between physicians and pharmaceutical companies."

But the idea of a national registry has met with little enthusiasm from the American Medical Association (AMA) and the Pharmaceutical Research and Manufacturers of America (PhRMA). The drug and health products industry, which made nearly $20 million in campaign contributions to federal candidates last year, defends pharmaceutical marketing efforts as an essential part of educating doctors on the drugs they prescribe.

"That is the purpose of what is known as pharmaceutical marketing or promotion," said Marjorie Powell, PhRMA's senior assistant general counsel. "So that physicians know when to use and when not to use a medicine."

Robert Sade, chairman of the AMA's Council on Ethical and Judicial Affairs, testified that while "giving of gifts reflects a customary social practice," doctors are bound by a code of ethics that ensures that "physicians must not place their own financial interests above the interests of their patients."

Sade said the AMA has not considered a nationwide disclosure law on payments, saying that Minnesota's experience is "too incomplete to make a decision."

Powell said there would have to be "full consideration" of what information should be included, such as free drug samples.

Advocates for greater transparency argue that the public ought to know about the payments, whether or not doctors think they are legitimate. "If doctors aren't ashamed of this, then they shouldn't object," Lurie said.