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

Vermont Rutland Herald
By Peter Hirschfeld

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 Julie Brill.

Montpelier, Vermont is the smallest, most down-to-earth 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 Johnson, 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.

Johnson 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, Johnson 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,” Johnson 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.

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