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October 08, 2013

Massachusetts Hearing on Restricting Interactions with Physician and Industry: Modest Meals Should be Defined as those Served at Hospital Cafeterias

On Tuesday, October 1st, 2013, the Joint Committee on Public Health of the Massachusetts Legislature held a public hearing on a number of new bills relating to interactions between the medical products industry and physicians. We reviewed these bills in a recent article.

As a quick review, Tuesday's docket contained the following bills directly relevant to interactions between the medical products industry and physicians:

MA House Bill 2061, which proposed a complete ban on pharmaceutical advertisements in the Commonwealth of Massachusetts.

MA House Bill 2018 and its companion MA Senate Bill 1051, which add additional disclosure requirements on interactions between healthcare providers and the pharmaceutical industry, above and beyond the disclosure requirements already in place under both existing State statutes and the Physician Payment Sunshine Act. This bill also ties the definition of a modest meal to federal standards for the same and prohibits the provision of alcohol at informational exchanges.

MA Senate Bill 1052, which call for addition needless information for MA's existing disclosure requirements for physician-industry interactions in a manner which is largely duplicative of the Physician Payment Sunshine Act.

MA House Bill 2020 and its companion MA Senate Bill 1050, which propose State funding for an academic detailing program.

A collaborator of Policy and Medicine, David Barton from the Center for Medical Innovation at Brigham and Women's Hospital, attended the committee meeting. He observed that little spoken testimony was offered either for or against most of the aforementioned bills. In fact, only two individuals appeared to testify on these bills.

Semi-retired Harvard Medical School Pathologist David Korn, MD, testified in support of H2018 and S1051. As mentioned above, these bills focus on defining the value of a modest meal, with an incidental provision prohibiting the inclusion of alcohol at informational exchanges, and a broadening of the disclosure provisions in the existing MA gift ban statute related to meals. These disclosure provisions largely exceed those required under the Sunshine Act, and thus represent an added burden on interactions between physicians and industry. In contrast, the prohibition of alcohol and definition of a modest meal merely duplicate the federal standard in force under the Sunshine Act. Thus, the disclosure provision may have naturally have been the focus of Dr. Korn's testimony. Instead, he delivered a lecture on the evils of pharmaceutical marketing, the need to break the medical academe's "addicti[on] to medical product company gifting," and the genesis of various ethics codes. He lamented the repeal of the prohibition of meals from industry to doctors under the Massachusetts gift ban law and then suggested that a modest meal should be defined according to the contents of hospital cafeterias.

Following Dr. Korn's testimony, the committee heard testimony on the licensing of naturopathy and insurance reforms before returning to the topic of industry interactions with testimony from PhRMA's assistant general council John Murphy. Mr. Murphy ran through the arguments against each of the proposed bills relating to industry interactions rather quickly. Among his arguments were that the ban on pharmaceutical advertisement suggested in H2061 represents an unconstitutional suppression of commercial free speech and that many of the various disclosure rules suggested were duplicative of provisions within the physician payment sunshine act. At the end of his testimony, he mentioned that PhRMA had provided substantially more information through written testimony. This reference suggests that much of the material that the committee will use in deciding whether or not to pass these bills on to the house and senate has not been made publicly available at this time.


As we stated before it is unlikely that these bills are going anywhere this session of the legislature. It should be noted that the legislature is much more open to private meals at nice restaurants for their own benefit. There is no reason they should be more restrictive on private citizens such as physicians. So if they are smart they will not try to restrict physician meals to the cafeteria or perhaps they should try it out for week first.  Given how wonderful the food is at the hospital cafeteria it is no wonder out side meals have good attendance.


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