Med students protest as Massachusetts relaxes pharma gift ban

What should doctors be able to accept from drug companies--and what should drug companies be allowed to offer? Over the past several years, there's been plenty of debate about these questions. And not without reason: Congress uncovered big payments to academic researchers. Medical students lobbied against pharma giveaways. Drugmakers started disclosing their gifts to doctors and financial relationships with them (often because government settlements required them to). And last but not least, those government settlements often covered allegations of kickbacks, junkets, and other inducements to sway physicians toward off-label prescribing.

The whole debate was encapsulated in one issue: the Massachusetts gift ban. Citing fears that pharma was unduly influencing doctors, the state's legislature outlawed drug company gifts completely and imposed fines of up to $5,000. And critics pounced. Restaurants that had hosted pharma dinners lamented lost sales. Hotels and visitors' bureaus said the ban would keep conventions away. And at pharma confabs everywhere, drug company booths displayed signs warning Massachusetts doctors away from free coffee and ballpoint pens.

Some legislators tried to roll back the provision last year, but were thwarted at the last minute by supporters of the law. And the law does have its supporters; in fact, as Gov. Deval Patrick prepared last week to sign a new state budget that included a provision weakening the gift ban, he addressed a group of med students, physician trainees and doctors who had petitioned to keep it intact.

To Patrick, allowing drugmakers to pay for "modest" meals as part of product-information sessions would be a "narrow change" to the law--and necessary for companies to educate docs about new drugs, according to a letter obtained by the Boston Globe. The governor said that the Massachusetts change would put state law in line with PhRMA's national code of conduct, which 58 drugmakers have pledged to live by. Apparently, Patrick considered this alignment to be desirable.

The petitioners didn't. "The national PhRMA code, while it is beneficial and sets the floor for these standards, we know we can do better," Brown University med student Reshma Ramachandran told the Globe. Harvard med student David Tian put it more bluntly: "We just don't want doctors to receive what are effectively bribes from companies," he told the newspaper.

The American Medical Students Association has successfully lobbied elsewhere; partly because of its efforts, academic medical centers, medical schools, and associated clinics have established new conflict of interest policies. Some are quite restrictive. A few even require pharma reps to deliver samples to a central intake location, rather than to doctors' offices. Does the Massachusetts change signal a pendulum swing in the opposite direction? Let us know what you think.

- read the Globe coverage

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