Whether or not pharmaceutical companies are allowed to provide meals to doctors is a big deal. Some believe that providing food to physicians would influence their decision on whether or not they prescribed their drugs. Others strongly disagree. But how much it too much? Should there be a limit on how extravagant the meal? Is there a way to track such expenses?
The controversy dates back to 2008 when the State of Massachusetts actually thought it was a big enough deal that they implemented a state ban, being the first state to do so. But, now in a recent turn of events the law has been appealed and now the industry is allowed to provide “modest” meals.
The change allows medical industry companies to pay for “modest meals and refreshments” for doctors and other health professionals in connection with educational presentations that are not certified by the Accreditation Council for Continuing Medical Education. The presentations must happen “in a venue and manner conducive to informational communication,” the new law says.
Restaurateurs, pharmaceutical companies and device-makers had lobbied for the repeal, which was included in the state’s $32.5 billion 2013 budget enacted in July.
“This narrow change will afford health care providers some flexibility to be educated on new clinically relevant products and allow them to stay informed on advancements in pharmaceuticals and medical devices that benefit patients and lower our health care costs,” Massachusetts Gov. Deval Patrick wrote in a letter announcing his decision to undo the meal ban.
But, not only is there a restriction on the meals being modest, they will also have to file paperwork claiming that they provided it.
Drug- and device-makers that provide meals will have to file quarterly reports with the state health department saying where the non-CME presentation took place, what medicines or devices were discussed at the meeting and how much was spent per participant. Also, it will be up to the health department to define through a rule-making process what counts as “modest” food and drinks.
Other gifts from industry are still banned, and payments to physicians of more than $10 will have to be reported under the sunshine provisions of the Affordable Care Act. Industry payments to physicians will be collected starting in 2013 for inclusion in a nationwide public database.
Critics of the 2008 state gift ban were thrilled for the change.
“The Massachusetts Legislature and the governor finally figured out — despite the incessant pleading of the anti-industry activists who instigated the statute — that telling doctors where they can have meals, and the redundant reporting of who pays doctors what, are detrimental to medical education and innovation and do not reduce the cost of health care,” said Thomas P. Stossel, MD, director of the Translational Medicine Division at Brigham and Women’s Hospital in Boston.
“They could, and should have, junked the whole law,” added Dr. Stossel, co-founder of the Assn. of Clinical Researchers and Educators, which is critical of restrictions on physician-industry collaboration. “In the meantime, other states and academic health centers that have contemplated or enacted such regulations should take notice.”
Not everyone in medicine is pleased with the change. A coalition of nearly 100 medical students, residents and academic physicians wrote legislative leaders and the governor in a bid to retain the state’s gift ban in its entirety.
“It’s really about the trust that’s at the heart of doctor-patient relationships,” said David Tian, a fourth-year medical student at Harvard Medical School in Boston. He chairs the American Medical Student Assn.’s PharmFree campaign that grades medical schools’ conflict-of-interest policies. “We know that patients are concerned that doctors are too influenced by industry.”
But, why does it seem that this is a big deal?
Apparently, A Consumer Reports National Research Center poll of 1,154 Americans in May 2010 found that 69% said drugmakers hold too much sway over physicians’ prescribing.
“This change creates ambiguity about what’s allowed and what’s not allowed,” Tian said. “We think we owe patients the clarity and the peace of mind of knowing that doctors in Massachusetts aren’t receiving gifts or meals from industry — period.”
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