Though much attention was focused on national reforms this spring, several states made moves toward greater transparency in the pharmaceutical industry, and toward curbing the industry’s marketing influence on prescribing. Connecticut passed a law requiring companies to create codes of ethics at least as strong as the PhRMA code, and Vermont and Colorado expanded transparency efforts.

This week, Connecticut Governor Jodi Rell signed a bill into law that requires all pharmaceutical and medical device companies that do business in Connecticut to write a code of ethics that meets, at minimum, the PhRMA code and submit it to the state.

“After four years, Connecticut passed important pharmaceutical provisions into law,” advocate Jean Rexford said. She heads the Connecticut Center for Patient Safety, which pushed for passage of the law and similar bills in the past. “Pharmaceutical companies will be required to write a code of ethics, submit it to our Attorney General’s office and if that code is not followed, there will be a $5,000 fine under our Unfair Trade Practices Act.  We had a great coalition working on this—Connecticut AARP and Consumers Union activists generated thousands of emails.  But it’s our Attorney General’s office and Representative Ritter and Senator Harris who deserve the most credit.  It took years but we finally got there.  Over those four years I have seen a change: accountability and transparency are now understood to be an important part of health care reform.”

In May, the Colorado legislature sent a bill to the governor that would require Colorado to post payments disclosed through the federal Sunshine Act on its state website. Gov. Ritter indicated this week that he intends to sign the bill.

“The availability of information to consumers on pharmaceutical payments to physicians allows consumers to have conversations with their doctors and to draw their own conclusions on conflicts of interest,” said Lynn Parry, a physician who heads the Colorado Prescription Coalition, which supported the bill. “These conversations have to include any person who can be affected by industry relationships.”

Vermont also clarified and expanded its existing transparency and gift restriction law, explaining that small food and drink given at a conference is permitted, and requiring that drug samples, including their recipient and amount, be disclosed in 2012. This disclosure mimics the provision that samples be disclosed to the federal government beginning in 2012 recently passed as part of the Patient Protection and Affordable Care Act. Read more about some drugmakers’ recent samples reporting to Congress at the Wall Street Journal.

–Kate Petersen, PostScript blogger

Boston Globe coverage of the progress of the Massachusetts health cost containment and quality bill, which was debated in the House yesterday, runneth over –

The gist

The letters

Lisa Kaplan Howe, Health Care for All

Brian Hurley, American Medical Student Association

The outcome

Now the omnibus bill (56 sections!) goes to conference, where the Sen. President’s version including a complete gift ban, disclosure and academic detailing should keep things interesting.

Singing the PhRMA Code Blues

This week, the head of a Kaiser Permanente’s physician network, the largest of its kind in the U.S., spoke out against the revised PhRMA code in the pages of the San Francisco Chronicle, calling it “nothing more than window dressing,” and “a weak, transparent move by an industry that is pretending to take strong action.”

Dr. Pearl, CEO and executive director of The Permanente Medical Group, a 6000-physician network that serves 3.3 million patients in northern California and abides its own pharmfree code, said that instead of relying on the profit-driven drug industry to police itself, physicians must collectively take responsibility for limiting the influence of pharmaceutical marketing on the medicine they practice, writing that “we cannot abdicate our responsibility as professionals – whose duty is to put patients’ interest first – by relying on the industry that benefits from those inducements to self-regulate.”

Rx realignment

Times of London columnist Carl Mortished says that in a convergence unseen in ElectionLand in recent years, both presumptive U.S. presidential candidates have angled to take on big Pharma: Obama has talked about allowing Medicare to negotiate drug prices, and both he and McCain have been seen stumping drug reimportation, which has had banana-peel traction under the current administration.

Though the Times online headline, “Barack Obama and John McCain go to war with Big Pharma” probably overstates things a bit, the article takes a good look at how U.S. politics may feed and shape bigger Western pharma trends.

Legislative affairs

As part of his continuing inquiry into medical conflicts of interest and financial ties to the pharmaceutical industry, Sen. Chuck Grassley (R-IA) has asked the American Psychiatric Association to submit to him its financial statements, citing concern that the degree of support the specialty society receives from commercial interests is causing field-wide bias.

Here’s coverage in the New York Times, and an opinion piece in the Boston Globe by former New England Journal of Medicine editor Dr. Arnold S. Relman discussing the proper source of incentives in academic research.

And in the San Francisco Chronicle, Dr. Lawrence Diller, a UCSF-affiliated pediatrician writes:

“The Fortune 500 drug companies, by their sheer economic clout, have become the single most dominant influence in our health care system. The ambiguities of children’s mental health and illness make child psychiatry the most vulnerable branch of medicine open to such influence.”

Maple Leaf Rag

The Canadians have found us! Proof in the pages of this month’s Canadian Medical Association Journal.  Thanks, Canada. We’ll watch hockey this year, promise.

And these last two are from the Wall Street Journal Healthblog. The first told us more than we knew about PhRMA chief Billy Tauzin and his history on the Hill, and the second – well, though the Healthblog wasn’t first to pick it up, we liked the desk-cowering image: Turns out injury-by-spacecraft has its own diagnostic code.

Lends a whole new meaning to Universal health care.

Yesterday, The Boston Globe reported that Fidelity Investments will pay $8 million to settle charges that traders improperly accepted gifts from brokers seeking their business.  The SEC investigation revealed that traders for the Boston-based company received an estimated $1.6 million in gifts (including sports tickets and some very strange bacchanalia involving dwarves) between 2002 and 2004. Some of the 13 traders involved are still under investigation by the SEC, and Fidelity has admitted no wrongdoing in the settlement.

The Globe excerpts several email from brokers who were gifting, including this one to a Fidelity trader in March 2003: “Your prompt response will be rewarded w/ Celtic playoff seats. Thanks for caring.”  According to The Globe, “the SEC said Fidelity traders failed to seek the best stock trades on behalf of its mutual fund customers because their choice of brokers was influenced by gifts.”

Different verse, same refrain.  Gifts influences behavior, whether you’re prescribing Zocor or selling shares of Merck.  And in both cases, the costs of those compromised decisions fall to a party that, well, wasn’t invited to the party…or the Celtics game…or the golf trip.  While the guardians of our health and our finances jockey for favor and market share, it seems we patients and investors are left to pick up the tab, and swallow the pill.

And speaking of gifts…

 A relevant editorial appeared in the Hartford Courant today about the dim prospects for two bills that address the gifts-for-prescribing regulatory waltz industry has been doing around federal anti-kickback rules.  Last year’s bill, which never got voted on, would have required pharmaceutical companies to disclose all gifts to docs and other health care providers or face a hefty fine. This year’s, also DOA, would ban quid pro quos (which the federal anti-kickback statute already does), gifts for physicians personal use, pharma-physician consulting deals without specific deliverables, but would allow small business-use gifts (like post-its) and samples to continue. 

Both bills were proposed by Connecticut AG Richard Blumenthal and supported by the Connecticut Center for Patient Safety.

The Wall Street Journal health blog puts the Courant editorial in the context of several other state and federal bills being considered to rein in the gifting of doctors – including Massachusetts, where Senate President Therese Murray introduced a health care bill this week that would, if passed, become the first complete ban on industry gifts to physicians in the country.