Maryland lawmakers are considering clamping down on the fancy meals, theater tickets and expensive trips lavished on doctors by pharmaceutical companies trying to persuade health care professionals to prescribe their medications.
"The system bothers me," said Del. Charles R. Boutin, a Harford County Republican. "Everyone involved may have been trapped in a cycle of competitive action."
Boutin is the sponsor of a bill that would prevent physicians, nurse practitioners and pharmacists from accepting gifts worth more than $50 from pharmaceutical companies. Those who violate the proposed law could be reprimanded, or have their licenses suspended or revoked.
The measure is needed, Boutin and others say, because the "freebies" dished out by drug manufacturers seeking a market share are out of control, with damaging consequences.
"We would like to see doctors make prescribing decisions based on the best interests of their patients," said Benjamin P. Peck, legislative representative of Public Citizen's Congress Watch in Washington, which tracks health care issues. "The interest of the drug reps is that doctors prescribe the newest -not necessarily safer - [and] generally more expensive drugs that make them the most money."
Many of the largest U.S. drug companies - including Merck and Co., Pfizer, Bristol-Myers Squibb and Schering-Plough - spend more than twice as much on marketing, advertising and administration as on research and development, according to a July 2001 report by Families USA, a nonprofit group that advocates affordable health care.
But lobbyists for doctors and drug companies in Maryland say new regulations are unnecessary because guidelines created by national groups and corporations are working to curb the problem.
The money that drug companies spend on entertainment for doctors "is no different than in any other kind of sales force," said J. William Pitcher, a lobbyist for the Pharmaceutical Researchers and Manufacturers of America.
Drug companies are spending less on meals, trips and other gifts, Pitcher said, as concern over the issue has grown. "They're stopping that. They're changing," he said.
Boutin, however, disagrees. "We're talking Tiger Woods golf clubs," he said. "We're talking trips to Tahiti."
Pamela Metz Kasemeyer, a lobbyist for MedChi, the Maryland State Medical Society, said the American Medical Association has published guidelines covering gifts from drug companies, so further restrictions are unnecessary.
But Del. Dan K. Morhaim, a Sinai Hospital emergency room physician, concedes that a public perception problem exists.
"There's no real need to have a public concern that doctors are influenced by pharmaceutical companies," said the Baltimore County Democrat. "It ought to be clear you are just getting information, and are not unduly influenced."
Morhaim said he avoids giveaways because "I don't want to be in that position."
Federal regulators are tackling the problem from a different angle. The U.S. Department of Health and Human Services proposed rules late last year prohibiting drug companies from offering financial incentives to health professionals to prescribe or recommend drugs. Manufacturers are fighting the rules.
Boutin's bill would allow doctors to receive money for grants, education and training - which all sides agree can be important in helping professionals learn of the benefits and risks of new products. The $50 limit on gifts would not apply to free samples of drugs that manufacturers often give to doctors for them to distribute to their patients.
His bill was heard last week by the House Health and Government Operations Committee, which is considering several related bills. One measure, by Del. Eric M. Bromwell, a Baltimore County Democrat, would require drug companies to disclose to the state the gifts they provide doctors - similar to reporting standards for General Assembly lobbyists.
Morhaim and others on the committee say the measures are not likely to pass this year, given well-organized opposition and the fact that this is the first year the bills have been introduced. Frequently, such contentious bills take several tries to pass the Assembly.
If his legislation doesn't pass, Boutin says he might propose creating a commission to study the issue.