Vermont AG: Pharmaceutical Industry has too much Influence Over the Practice of Medicine

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Vermont is one of only several states which require pharmaceutical

companies to disclose money paid to influence doctor's prescribing

practices. The New York Times reported on June 27, 2007 Psychiatrists

Top List in Drug Maker Gifts: " drug company payments to psychiatrists in

the state (Vermont) more than doubled last year (2006), to an average of

$45,692 each from $20,835 in 2005. Antipsychotic medicines are among the

largest expenses for the state's Medicaid program. "

The below article shows that one year later Vermont psychiatrists are

raking in even more from pharma: " Eleven psychiatrists received a total

of almost $630,000, or about 20 percent of combined marketing

expenditures in the state, the study found. That amounts to about

$57,000 per psychiatrist, on average. "

Letter to the editor:

http://www.rutlandherald.com/apps/pbcs.dll/section?category=SERVICES07

Vermont Rutland Herald

Report: Drug makers spent $3M in state in 2007

By Hirschfeld

Jul 9, 2008

MONTPELIER - Pharmaceutical manufacturers are using their vast marketing

budgets to influence the types of medications prescribed by Vermont

doctors, Attorney General Bill Sorrell said Tuesday.

The pharmaceutical industry spent $3 million last year to promote its

products in Vermont, according to a report from the Office of the

Attorney General. The marketing expenditures, up by 33 percent over

Fiscal Year 2006, represent the highest single-year spending since the

state began tracking data in 2003.

" This report shows, once again, that the pharmaceutical industry has too

much influence over the practice of medicine in Vermont, " Sorrell said

in a statement. " It is particularly troubling that the industry is

paying large sums of money to influence prescribing practices involving

psychiatric drugs. "

Drug makers paid out more money to psychiatrists last year than any

other type of doctor in Vermont. And four of the five most heavily

marketed drugs are used to treat either attention deficit hyperactivity

disorder or depression, the report found.

" When you start looking at the particular types of payments being made,

the heavy weight toward psychiatrists as well as psychiatric drugs, it

does become particularly troubling, " said Assistant Attorney General

Brill.

Montpelier, Vermont is the smallest state capital in all the United

States.

With a population under 10,000, Montpelier Vermont is a typical small

New

England town that just happens to be the state capital.

Ken , senior vice president for the Pharmaceutical Research and

Manufacturers of America, called Vermont's report " misleading " and said

the data " serve only to misconstrue the value of interactions between

pharmaceutical research companies and health care professionals. "

In 2003, Vermont became the first state in the country to require drug

manufacturers to disclose the gifts, payments, travel reimbursements and

other financial donations to doctors and others in the field.

said in an e-mail Tuesday that such expenditures are used to

inform and educate physicians on new medications entering the

marketplace. Any legislation that might discourage those interactions,

said, does a disservice to patients.

" The current statute in Vermont does not acknowledge that meetings with

technically trained pharmaceutical research company representatives -

many of whom are health care professionals themselves - are one of

several important ways for physicians to receive the information they

need to make sure medicines are used properly and patients are safely

and effectively treated, " said.

According to Brill, drug companies have concentrated the bulk of their

marketing budgets on only a small group of physicians.

" We have seen more money being spent and we have seen that money

concentrated in fewer people and concentrated in fewer practice areas, "

Brill said. " Part of that is manufacturers are focused on thought

leaders - people influential in the prescribing community either because

they're conducting studies or they're people who are well-respected in

their fields. "

Eleven psychiatrists received a total of almost $630,000, or about 20

percent of combined marketing expenditures in the state, the study

found. That amounts to about $57,000 per psychiatrist, on average.

Physicians specializing in cardiovascular disease received the second

largest aggregate amount, with two doctors splitting a total of more

than $300,000. Laws protecting trade secrets prevent the Office of the

Attorney General from disclosing the names of specific physicians

receiving payments.

Brill said the data offers no insight on whether marketing budgets

directly influence prescribing behavior.

" We don't have any definitive information on it yet, but some people

certainly believe that to be the case, " Brill said.

This report marked the first year that Vermont required manufacturers to

disclose which drugs were being marketed. She said the state will use

that information in a future study to determine whether prescription

rates rise alongside marketing budgets.

Ken Libertoff, executive director of the Vermont Association for Mental

Health, said he worries that financial incentives are playing a role in

doctors' prescribing behaviors.

" This report confirms that there's been an enormous intrusion of

pharmaceutical marketing and pharmaceutical gifts to physicians

throughout the state, " Libertoff said. " . The mixture of marketing and

money and medicine is a formula for disaster, and we think that this

report confirms concerns about whether consumers and patients are

receiving the best care and the best practice. "

While recognizing the potential benefits of psychotropic medications for

certain mental health patients, Libertoff said drug makers may use

financial incentives to conceal or downplay adverse side effects.

" What we would consider huge financial payments have basically polluted

health care, " Libertoff said.

Libertoff said that in order for Vermont physicians to " reclaim their

high status as patient-centered health care providers, " they must refuse

to take any gifts or payments from the pharmaceutical industry.

He called on industry leaders, including the Vermont Medical Society and

Vermont Psychiatric Association, to fashion an official policy calling

on doctors to decline any future payments.

Link to article:

http://www.rutlandherald.com/apps/pbcs.dll/article?AID=/20080709/NEWS03/

807090381/1004/NEWS03

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