Stephen F. Hodgson, MD a Mayo Clinic endocrinologist in an editorial published in the Rochester Post-Bulletin argued that physicians are able to make their own judgments and against legislation introduced in Minnesota basically banning interaction between physicians and industry.
Bellow is the editorial in its entirety:
Rep. Tina Liebling's three bills, recently before the Minnesota Legislature (House Files 1640, 1641, 0491), include an attempt to take control of the information physicians receive concerning new drugs and medical devices, under the rationalization that physicians are duped into prescribing medical products that are unnecessary and expensive, and that medical care costs can be reduced by circumventing marketing pressures.
Rep. Liebling states that physicians are coerced by marketing techniques whose influences are so subtle that physicians can't recognize them, and that this creates a "conflict of interest" that erodes patient trust and drives up medical costs.
These legislative efforts ratchet up restrictions that prohibit marketing inducements felt to be corrupting to the weak-minded among us. No clear evidence is presented that a real systemic problem exists, or that previously enacted legislation has produced any reduction in the cost of medical products.
In her comments in the Post-Bulletin (see "Both Sides: We must limit influence of drug companies") Congresswoman Liebling implies that there is a subtle culture of corruption among Minnesota physicians, who actually are in all likelihood the most ethical and dedicated single group of individuals in the state. How could our Legislature so badly misunderstand the nature of the commitment that Minnesota's physicians have to their patients?
All physicians are trained to weigh scientific data and are well able to distinguish between science and hype. They are trained to use evidence — based information, to asses the quality of the data, to make clinical decisions accordingly, and to place the needs and interests of their patients first.
They are fully aware that pharmaceutical and medical device companies want them to prescribe their products but also know that all information transmitted from industry is, by law, required to be accurate and to conform to specific wording, and is regulated and approved by the Food and Drug Administration.
"Conflicts of interest," a term Rep. Leibling and others use to stigmatize normal overlapping interests, are a constant feature of every relationship, whether it's a physician receiving information from a pharmaceutical company or receiving a fee from a patient, a politician taking campaign contributions from a constituent or the tort bar, an academic medical center pandering to the Legislature on which it is dependent for funding, or an uninformed and biased reporter trying to satisfy reader interest or editorial goals.
Physicians recognize that overlapping interests derive from a multiplicity of incentives, often involve real and potential motivational differences and are an inevitable aspect of human interaction in all walks of life. More importantly, they know how to make appropriate decisions in this environment on behalf of their patients. To try to legislate conflicts of interest out of existence, though in keeping with an increasingly intrusive governmental regulatory zeal, is regressive and clearly illustrates the ultimate futility of government control over human thought and interaction. To attempt to legislate restrictions of this nature may also be a violation of the First Amendment to the Constitution.
The facts – evidence based – are that patients' trust in their physicians remains high and has not changed in spite of political and journalistic attempts to undermine it. Furthermore, a study by economist Dr. Frank Lichtenberg of Columbia University, carried out over two decades in 52 counties and controlled for demographic, social, and economic conditions, showed that new drug launches accounted for 40 percent — five months of every year — of the increased longevity observed over the period of study.
When we consider that human longevity has increased from 47 to 78 years over the past century, we cannot escape the conclusion that new drugs have played a major role.
Another roadblock in the process won't benefit anyone, and laundering information through academic medical centers like the University of Minnesota only introduces another set of biases and conflicts of interest to the equation, and slows access to new and effective products.
Rep. Leibling seems to conclude that new drugs and devices are too expensive and therefore are unnecessary, and assigns therapeutic decisions to a faceless government-appointed formulary committee that will never be able to asses the individual needs of patients. In fact, approved new medical products only exist because they are useful and sometimes lifesaving. In the long run, this short-sighted legislation will do harm to our patients by denying or delaying the availability of new drugs and medical devices and limiting the treatment options that patients and physicians can consider. In addition, the bureaucracy it establishes will only add to the cost of government.
Before another layer of intrusive legislation is enacted, it is reasonable for citizens to demand objective evidence that previously enacted legislation has unequivocally reduced costs or produced value, and that all legislation that does not meet its own objectives be rescinded. '
I urge Rep. Leibling, her colleagues, and those who support this legislation to let physicians do their job, and to seek real and effective ways to reduce the cost of medical care. For example, have our legislators considered the obvious money saving benefits of tort reform, or is the "conflict of interest" between the tort bar and politicians just too compelling?