Works-in-progress: Globe looks at Massachusetts AMCs

This week started with an editorial in the Boston Globe about Massachusetts medical centers that have tackled conflict of interest, those that haven’t, and those that are working on it.

Bearcats in whitecoats

In keeping with the old maxim, “Friday news is good news,” the University of Cincinnati medical school announced new conflict of interest policies last Friday. According to this story in Business Courier of Cincinnati, industry support for UC research jumped a whopping 40 percent in 2007.

“We have to have an environment where the physicians are functioning free of the influence of the pharmaceutical industry in their patient care and prescribing, and anything short of that really doesn’t work,” said Dr. David Stern, dean of UC’s College of Medicine.

Granting Grassley’s wishes

USA Today looks at Sen. Charles Grassley (R-IA) recent entreaties to 15 drug makers, urging them to publish their educational grant spending as Eli Lilly began doing last year on a public website.  Pfizer has already announced its plans to make such information publicly available in the future.

“We’re all struggling with how much to reveal,” said Cathryn Clary, a vice president at Pfizer. “Stay tuned.”

Allan Coukell and David Rothman, both members of the Prescription Project, weigh in on Grassley’s investigations and the alignment of Lilly’s grants with its vested corporate interests.

Senators probe devicemaker payments

And Grassley’s cosponsor on the Physician Payments Sunshine Act, Sen. Herb Kohl, held a hearing Wednesday on medical device companies and payments they make to physicians.

Lot’s more in the St. Paul Pioneer Press, the Wall Street Journal (subscription required) and this terrific front row coverage in the BNA.

Evergreen state sends privacy bill to House

Last week, the Washington State Senate passed a bill that would ban the sale of prescription data for marketing purposes.  SB 6241, which would limit the practice commonly called data-mining, passed 26-22, and now faces the House vote, which must happen before March 8.

In follow-up coverage, this story appeared in the Tacoma News-Tribune, and Seattle Times columnist Nicole Brodeur called data-mining “nothing but a wider opening on our proverbial hospital gown.” Brodeur writes a great column, but leaves you with the odd sense you’re reading a high school playbill with her closing line: “She buys her drugs from Rusty.”

Alas poor Jarvik – the denouement

In what we hope is Act V of the Pfizer tragicomedy, the drug giant announced it’s pulling its Lipitor ads featuring Robert Jarvik, TV doc, rowing hopeful, and inventor of the artificial heart.  Be sure to read the WSJ Healthblog post on Jarvik’s post-ad plea for credibility, which reads a lot like an essay we had to write once: How I Spent my Summer Vacation.  But Jarvik adds a twist …. He’s talking about his summer vacations 45 years ago.

No shortage of coverage, so click away:

New York Times
Kaiser Network
Time
Bloomberg
ABC News
 

Hugs, not drugs

Here’s another blog-hug for pharma champion and law professor Paul Rubin, who penned this paean to Big Rx in Forbes earlier this month.  Essays and yeays praising Rubin’s “excellent column” aren’t hard to come by, but PostScript chose this one for its ridiculous conflict-of-interest disclosure at the end.  (Hey, it’s the longest one of those we’ve seen from a libertarian in awhile – even if it is tongue-in-cheek.)

And for an antidote to the Paul Rubin lovefest above, try Howard Brody’s take on health economists that don’t bother to factor in the health.

Clarence Thomas, meet the FDA

In the same week that Clarence Thomas’s two years of zipped lips during oral arguments made the news, Eye on the FDA blog noted the peculiar silence of the long-suffering drug agency under the continuing barrage of criticism.

Blogger Mark Senak, an industry consultant who helps companies get their affairs in order before going to the FDA, notes that the FDA website houses only two speeches from all of 2007, and one from 2008.  Not a lot, considering there are near-weekly reports on the FDA’s underfunded, underperforming track record. 

Medpin, or medicine for people in need, began in 1999 as a project of the Public Health Institute. During its eight-year tenure, Medpin worked with a broad group of California clinics, pharmacy schools, and health care foundations to get people appropriate medications in safety net settings. PostScript recently talked with Kathryn Saenz Duke, director of Medpin until it closed under funding challenges late last year. In the aftermath of the California showdown over health reform, PostScript asked Saenz Duke about what the defeat of universal coverage means for Californians who can’t afford their prescription drugs.

PS: What was your background before Medpin?  How did you get interested in prescription drug access issues? 

KSD: As a senior staffer on the California State Select Committee on AIDS in the 1980s, our committee worked with a broad spectrum of patients, advocates, and political groups to create new laws and policies, sometimes finding common ground and unexpected allies.  After the Senate, I joined a University of California research team looking at managed care’s impact on safety net providers. 

From there, I moved to the California Medical Association, where I met many doctors who felt caught between rapidly increasing direct-to-consumer drug advertising, formularies, and their relationship with patients.  All those experiences brought me in 1999 to the project that became Medicine for People in Need (Medpin).

PS: Is there a short version of what Medpin was, and what happened to it? 

KSD: Medpin’s first project was based on a cy pres litigation settlement in which all parties agreed to have an independent nonprofit organization distribute more than $170 million worth of diverse brand name drugs from 25 companies at no charge to recipients. 

We worked with 150 California public hospitals and community clinics caring for uninsured people, designed and operated a new, award-winning drug order and distribution system, and helped safety net providers fill 2,600,000 one-month medication supplies for indigent patients who might otherwise not have received those medications. 

Those were real achievements.  But we were also committed to bringing longer term benefits to safety net clinics.  We introduced many to the federal 340B discount program, promoted greater awareness and use of generic drugs, and helped the clinics better use drug companies’ patient assistance programs.  We sponsored California’s law allowing expanded use of 340B with community pharmacies, and created new working relationships among California’s large county indigent care systems, nonprofit community clinics, and faculty from California’s seven pharmacy schools.

PS: Will the needs Medpin met be met by something/someone else, or is that still unclear?

KSD: When the decision was made to close Medpin due to funding challenges, we were pleased to look back at how much of our past work has ongoing impact, and to know that many of the other nonprofits we have partnered with continue their work. 

But important work remains, and many of our former partners are facing their own funding difficulties.  

PS: Is the pharmaceutical industry doing its part to help patients in need? 

KSD: Medpin has always encouraged safety net providers to avoid confusing patient assistance programs with drug samples, which are part of drug companies’ marketing efforts.  It’s interesting that Medicare Part D’s infusion of federal funds into prescription drug spending has brought greater scrutiny to the design of patient assistance programs and their impact on that federal spending. 

This new legal attention is especially important for safety net providers, who feel pressure to accept much-needed financial help for many of their low-income patients, including from drug companies through patient assistance programs (and for some clinics, through drug samples).  There is tension between using this short term help vs. moving toward evidence-based prescribing that may favor lower cost, generic drugs that aren’t “free,” but can offer better overall value.  

PS: Is the government doing its part to help patients in need? Where’s the slack? 

KSD: Two existing federal programs immediately come to mind as needing more government attention and support:  Part D Low Income Subsidies, and “340B.”  (The 340B program helps uninsured and Medicaid patients by requiring significant purchase discounts for their safety net providers).

With this being such an exciting election year, maybe there’s a chance that policy leaders can engage people to think broadly about what government should be doing to help all of us improve our health, and particularly those in most need. 

PS: How did Medpin relate to pharmaceutical companies?

KSD: When I started with Medpin, I assumed we would eventually come together with PhRMA to identify and pursue some common interests, while agreeing to disagree on other matters. 

But I soon realized that PhRMA didn’t need or want to work with us. It’s more comfortable for them to purchase communications, outreach, or other assistance than to develop a relationship with an independent nonprofit like Medpin. 

Someone once commented to me that “Drug companies don’t understand and therefore don’t trust a nonprofit organization.”  At first I scoffed at this, but later came to see it as an insight into our experience with them.

We did interact with a few individual drug companies.  For instance, we gave several awards each year of the cy pres project to companies judged to have been most constructive in providing good products for uninsured patients. 

After that project ended, a few drug companies—most notably Merck and AstraZeneca—responded to our invitation for dialogue about continuing some portion of the work we had done together.  But these conversations did not progress, partly because Medpin decided to proceed only if a larger number of companies agreed to move ahead, and that never happened.

PS: Did Medpin work with patient advocacy groups? Considering that they are powerful consumer voices, but that some take funding from PhRMA members, what do you think their net effect has been on the conversation around prescribing and access?

KSD: Medpin’s focus has been on helping vulnerable patients by working with health care professionals in “safety net” settings.  We have promoted evidence-based prescribing through drug monographs, guidelines, and other materials we’ve developed with two pharmacy schools and our statewide group of safety net pharmacists and physicians. 

As for groups taking PhRMA funding, I believe that leaders from a number of “disease groups” are trying to think carefully about whether and how it’s possible to accept drug company funding while staying independent of pressure–however subtle or self-generated–to avoid ruffling their funders’ feathers.  Do I think there could be more self-examination on this issue?  Absolutely, yes.

PS: What does the defeat of California Health Reform mean for patients who can’t afford their prescription drugs and the community health clinics that serve them? 

KSD: Watching California’s recent health care reform efforts has been déjà vu for those of us who followed this state’s earlier drama over drug pricing.  We had several years of high-profile legislative efforts to address drug costs in California, followed by a confusing and expensive ($80 million) campaign in 2005 involving two drug discount program ballot initiatives. 

After voters failed to approve either measure, our Governor and legislative leaders enacted the bipartisan California Discount Prescription Drug Program in early 2006, which blended elements from both initiatives.  But that law failed to include any funding, and we’re waiting to see if anything comes from all the money and political negotiating invested these past years. 

Uninsured people will continue to need care and help on their drug costs from safety net providers.  There is some good news these days because a number of medications that used to be high priced are now available generically at much lower cost.  The bad news is that effective pharmaceutical care must be set within larger medical care and health promotion activities, and our state and national leaders are still trying to patch together financing and delivery system for those activities. 

Right now California’s public officials face a $16 billion budget deficit, so I don’t expect health reform here anytime soon.  

A final thought: Just as pharmaceutical care should be only one part of effective medical care, so should medical spending and attention be put into a larger framework of topics not typically considered medical or health-related. 

Recent writing by Michael Pollan, Steve Schroeder, Dick Jackson, and other thoughtful observers should move us all to pay more attention to our food, the built environment of our communities, tobacco use, and other factors whose combined power to help or hurt our health status is greater than the impact of medical care. 

How ironic it would be if we in the U.S. achieve access to appropriate medication at affordable prices for everyone, but see growing numbers of people eating fast food, smoking cigarettes, and living in communities designed more for cars than humans. I think sometimes we need to step back and at least acknowledge this bigger picture of “health.”

Good news for American Indians yesterday, as the U.S. Senate passed the Indian Health Care Improvement Act by an 83-10 margin.  A similar version must still get through two House committees before it makes it to the floor.

The act, S. 1200, would distribute $35 billion for American Indian health care through the Indian Health Service over 10 years, placing emphasis on building preventive care capacity. Reauthorization is long overdue: according to the Seattle Post-Intelligencer, the IHCIA was last authorized in 1992 (pre-Clinton health reform) and expired in 2000 (three years before the Iraq war began).   And speaking of war: If $35B sounds like a lot, remember it’s only a quarter of what the U.S. spent in Iraq in 2007 alone (source: Congressional Budget Office). 

This version of the IHCIA, which represents a 17 percent increase in funds, would reinstate many preventive health programs that were cut over the last decade as funding remained flat in the face of rapid inflation, and legally protect the appropriation from future cuts.

Here’s a story in the Seattle Post-Intelligencer about the bill, which includes these startling facts:

• infant mortality rate is 150 percent greater for Native Americans than  Caucasians. 
• Native Americans are 2.6 times more likely to be diagnosed with diabetes.
• life expectancy for Native Americans is nearly six years less than the rest of the U.S. population.
• Suicide rate for Native Americans is 2.5 times higher than the national average.
• Health care expenditures for Native Americans are less than half of what America spends for federal prisoners.

Startling stuff, and worth remembering when we talk about universal health care and reforming the American health care system.

The devil, they say, is in the details.  So we were interested to see the tripartite approach the University of New Mexico recently took when it came to weaning itself off industry grub (Go Lobos!)

The University of New Mexico Health Sciences Center recently passed a comprehensive set of vendor relation policies that ban gifts, restrict industry involvement in Continuing Medical Education, require faculty disclosure of all relevant financial interests, and prohibit those with such interests from serving on committees making drug and device purchasing decisions.  When it comes to the food, the guidelines give departments until 2011 to turn back those sandwich platters, relying on a third less industry meal support each year.

“Beginning January, 2011, meals funded by PHCI can not be provided on the UNM HSC campus. In the transition, departments and divisions will reduce their dependence on PHCI funding by at least 33% in each of the three years. ”

This may be a good strategy for a school that wants to ease faculty/resident to the BYO plan (after all, everyone knows that a third a loaf is better than none), or wishes to give departments adequate time to restock the fridge without the help of pharma.

Meals, which have been steadfastly provided by pharmaceutical companies at many institutions since the dawn of time, are a sticking point for many medical centers working through these issues, because they have become such a comfortable part of the scenery, and seem to many at the table to be the least insidious (and certainly the tastiest) form of pharmaceutical companies’ largesse.

Institutions have come at this differently: Some medical centers have budgeted carefully to replace lost pharma food, while others have gone cold turkey, reasoning that doctors can begin bringing their own lunch (a practice we’ve been doing faithfully since the fourth grade).

Bottom line: If UNM can increase long-term buy-in and compliance among its clinicians and faculty with such a transitional meal-plan, we’re all for it.

The Senate Special Committee on Aging holds a hearing today on marketing by medical device companies. The hearing concerns the business practices of five companies involved in a $311 million settlement with the U.S. government last year over kickback allegations.  The companies have been called to testify.

The disclosure mandated by the settlement, and the findings (40 surgeons received more than $1 million each from device makers last year alone), bear on the proposed Physician Payments Sunshine Act, which would require all pharmaceutical and medical device makers to report gifts to physicians on a biannual basis, which would be published in a public online database.  Committee Chair Sen. Herb Kohl (D-WI) is an original co-sponsor of the Sunshine Act.

Here’s a good article by the St. Paul Pioneer-Press about the hearing.

If you are on or near the Hill , stop by and show your support for transparency in medical marketing.

The Wheres and Whens:

Senate Special Committee on Aging

Wednesday, Feb. 27, 10:30 AM

Dirksen Building 628
 

On Monday, The Boston Globe ran this editorial, “A line between docs and drugs,” as the third part of a series called Priced out of Care. 

The editorial, which features the work of the Prescription Project with local academic medical centers to build conflict-of-interest policies, highlights strong policies at UMass Memorial Medical Center and Boston Medical Center, while noting the work-in-progress status of a guideline process at Tufts-New England Medical Center and at Partners.

Off the labeled path

Late last week, the FDA proposed new guidelines on off-label marketing, a follow up to a more nebulous ‘guidance’ it issued in December. The rule change-up would allow drug companies to begin distributing medical journal articles on drugs for off-label uses, providing they are peer-reviewed publications with a legit editorial board.

Under current (but lapsed) FDA rules, manufacturers are not permitted to promote drugs for off-label indications, those for which the drug has not been approved. Critics of the move say it will give drug reps the green light to do more marketing with less therapeutic evidence.

Now the FDA is soliciting public comment on the proposed guidelines, and plans to make a formal ruling in 60 days.

PostScript previously considered last year’s guidance here.

Up, up, and away

In other cheery drug news, pharmaceutical makers have raised the wholesale price of the 50 top-selling brand name drugs at roughly twice the rate of inflation in 2007.

The Wall Street Journal reported it, but the Wall Street Journal Healthblog did too (and it’s free.)

Gilded lilies, magic wands, AMSA, and equipoise…

This story has it all. As part of a comprehensive feature on the medical school’s new policies, RxP associate director David Rothman talks to PittMed, the magazine of University of Pittsburgh School of Medicine, calling Pitt’s new policies on medical conflict of interest “outstanding.”

The reporting in this piece is as layered as the towering sandwich on the first page, canvassing students, researchers like Rothman, medical school faculty, and surveying work being done at the state and federal level to limit the influence of pharmaceutical marketing on prescribing and medical education.

Be sure to read the interview with UPSM Dean Arthur Levine at the end of the feature story with the intriguing subhead, “The Dean Contemplates Tchotchkes…”

Washington state senate passes prescription privacy bill

This week, Washington State Senate passed a bill that would ban the sale of prescription data for marketing purposes. SB 6241, which would limit the practice commonly called data-mining, passed 26-22, and now faces the House vote, which must happen before March 8.

“This vote today tells me that our legislators agree that the doctor-patient relationship should be private and that includes prescriptions,” said Rupin Thakkar, an Edmonds-based pediatrician and co-chair of the Washington Coalition for Prescribing Integrity.

Check out this news release from the Healthy Washington Coalition, a member group of the WCPI, which includes the Washington State Medical Association and the King County Medical Society.

Conflict 101

Here’s a trio of opinion pieces in the Tennessean by the editorial board, a University ofTennessee business ethicist, and Steven Gabbe MD, dean of medicine at Vanderbilt on the conflict of interest guidelines the medical school introduced earlier this year.

“If we are going to teach medical students…about their obligations as a professional,” writes Gabbe, “we must make sure their teachers are modeling the behavior we are teaching.”

Some students at Des Moines University balked at a recent visit by PhRMA prez Bill Tauzin, who took the podium on campus this week the Partnership to Fight Chronic Disease.

The students smelled a fox-henhouse arrangement, since pharmaceutical companies are often major sources of financial backing for patient advocacy and disease groups.

Loose ends

Here’s a slightly-belated think piece by writer Dan Greenberg, author of “Science for Sale: The Perils, Rewards, and Delusions of Campus Capitalism.”

Greenberg, who has spent a good deal of pages on the issue of corporate funding in academic research, looks at the recent JAMA survey of academic medical centers we posted on here, and he pulls few to zero punches.

The Royalty Treatment 

This survey in JAMA on institutional conflicts of interest at medical schools got some pick up, including these stories Reuters, Inside Higher Ed, Kaiser Daily Health Policy Report. 

We blogged on a related editorial by RxP’s David Rothman earlier this week, but be sure to check out this post from Howard Brody, who asks where’s the proof of damage these conflicts can cause? (then provides his own). 

Brody is also skeptical about how much water policies carry for such a complex and deep-rooted issue as institutional conflicts of interest: “It is not clear to me what one can do about institutional COI when the forces working on the average medical school are aligned as they are today,” Brody writes.

Pharma Freebies: Hot or not? 

Businessweek ran its answer to the dueling-talking-heads-on-cable-news-networks with this pro-con, “Halt the Pharma Freebies?” in Duh-Duh-Duh…The Debate Room! Prescription Project advisory boardmember Phillip Pizzo MD, the Dean of the Stanford University School of Medicine goes column-to-column with Ken Johnson of PhRMA.  Luckily, the text is more interesting than the average Anderson Cooper/Wolf Blitzer exchange.    

Dear Mr. Stupak: This Star-Ledger piece looks at the recent flurry of Congressional inquiries into the marketing and safety practices of big pharmaceutical companies.  Right now, Pfizer, Eli Lilly, Merck, Schering-Plough and GlaxoSmithKline have all become compulsory pen pals with the House Committee on Energy and Commerce and the Senate Finance Committee lately. 

We’re biased, but we tend to believe/hope that these inquiries may yield more than the baseball hearings, or Arlen Specter’s heroic efforts to preserve the sanctity of American Football for future generations.    But if it seems like Congress can’t seem to stop talking to the drugmakers or the athletes, consider this: A new survey shows that prescription drugs may be on their way to surpassing baseball as the new American past time. Stand aside, Roger Clemens.  It’s Robert Jarvik’s turn to shine. In the Pitt, not their stomach 

Here’s a good story in the Pittsburgh Post-Gazette on the first felt effects of the University of Pittsburgh Medical Center’s new conflict of interest policies, which go into effect today.

Our hero is one Robert Bishop, a caterer near campus whose pharma accounts are going to go way down (20 percent of his weekly business), but who luckily has a gymnastics studio that is not affected by the COI policies…   That’s not all, though. Apparently UPMC, in a bind about the controversial issues of samples, elected for physicians in its network to decide whether they would continue to receive free drug samples – and 45 percent will.   Also, this insight: “The number of academic medical centers imposing such restrictions is growing every year, one pharmaceutical company, AstraZeneca, said in a statement.”

Newsday, Sunshine This Newsday story from Sunday looks at the Physician Payments Sunshine Act, and a bill banning physician gifts and prescriber data-mining that is being considered in the New York State Assembly now.   

Reform by another name The Carlat Psychiatry Blog isn’t sure that MGH Psychiatry Academy’s new policy – keep taking industry money, stop talking about it – really adds up to ‘CME reform’ it’s billed as.   

1-800-FEEL-BAD 

And Consumers Union is petitioning the FDA to include a 1-800 number and website where consumers can report side effects on every pharma commercial that runs on TV.  The FDA already requires companies to include it in print ads, but who reads anymore?  Check it out at Consumers Union website, www.prescriptionforchange.org.

A new study in the Journal of the American Medical Association found that academic medical centers have been slow – or slower than hoped – in addressing institutional conflicts of interest (ICOI) in a formal way. The gist – of 125 medical schools surveyed in 2006, 86 responded, and only 30 of those had a policy to address ICOI, which include things such as royalties, equity holdings, or other financial stakes held by researchers or institutional officials. The authors are researchers at Massachusetts General Hospital and the Association of American Medical Colleges.

In this accompanying editorial, Dr. David Rothman (who heads up the Institute on Medicine as a Profession and is the associate director of the Prescription Project), says no one should be shocked that academic medical centers are fertile ground for institutional COI – indeed, we made them that way with Bayh-Dole, and the FDA’s Critical Path Initiative, which encourage academic-industry collaboration on pharmaceuticals and whose “unintended consequences have been to blur the distinctions between academic and commercial entities, and to make ICOI much more pervasive.”

When it comes to narrative oomph, individual conflicts of interest often seem to pack a little more punch, because it’s about one physician or prescriber taking a personal check, making a decision to go to dinner with the drug reps, or to accept a consulting job, or to travel attend an out-of-town conference on industry’s dime.  Royalties, equity, IRB firewalls – it all sounds a little, well, cold. 

But Rothman rightly reminds us that institutional COI can have equally pernicious effects – lethal ones, even, as in the case of Jessie Gelsinger, who died in 1999 from participating in experimental gene-therapy trial and the University of Pennsylvania.  As Rothman points out, no one knows whether Gelsinger would have survived if Penn and the principal investigator conducting the research didn’t have big claims to any patents and profits that came out of the therapy.  But, as the bioethicists say much better than we can, it sure didn’t look good.

With a finger in the air, Rothman feels the winds of regulation a-blowin’, perhaps a little stronger than the winds of institutional change are.  Let’s face it, neither Congress nor university medical centers sport a Jack-be-nimble, Jack-be-quick reputation. But we’re glad that he also singles out a handful of medical centers that have bucked the image of the institution as a slow-moving giant.

There also seems to be a vacuum in professional society leadership, a sector that could provide positive leadership for institutions out ahead of government regulation or the policy-from-scratch approach some schools have taken.  Instead, Rothman finds that “neither the Association of American Universities nor the Association of American Medical Colleges has issued a model policy.” 

So now we wait – for other institutions to address conflicts of interest, for the AAMC to release its much-expected new conflict of interest policies this spring, and for the day when medical journals, who get all that ad revenue, let us read the important articles for free.

This week, drug giant Merck is out $671 million in combined settlements in one whopper of a health care fraud case.  Prosecutors for the states and federal government alleged that the maker of Vioxx and Zocor overcharged 49 states and the District of Columbia for four popular drugs, and bribed doctors to prescribe them with kickbacks disguised as consulting fees.

Read AP coverage here.

Row Row Row…Whose boat?

We admit, in the shadow of bribery, fake-rowing seems like a little white lie, but it’s one that may have turned into big bucks for Pfizer, the maker of Lipitor.   A month ago, Dr. Robert Jarvik, the Lipitor frontman that gives millions of primetime viewers the heebie-jeebies during commercial breaks every night, was outed for never having actually practiced medicine.

Now, courtesy of some digging by two Michigan House Democrats, it turns out Jarvik doesn’t row, either, as he’s seen doing in a recent Lipitor commercial (even though his stunt double’s on the team.)

Congress must decide whether the American public was more fooled by Jarvik’s doctorness or his rowing prowess, and why back in 1997 permitting pharma to run TV ads seemed like such a good idea.

Check out the PAL blog’s ideas for Jarvik’s replacement.

Industry-free CME at Sloan-Kettering: a case study

The Carlat Psychiatry Blog found this article in Medical Meetings Magazine on how Sloan-Kettering Memorial Cancer Center in New York cut industry out of its CME curriculum.

Some seemingly simple steps were taken to make up for the 25 percent of industry funding the center turned back:  Conference organizers used more cancer experts already in-house, moved the meetings from hotels to the conference center on campus, cut out catered lunch, and reduced advertising in mailers and medical journals. According to officials at the world-renowned cancer hospital, response has been positive and attendance steady. 

Vanderbilt gets on gift-ban bandwagon

Vanderbilt University Medical Center has banned gifts from pharmaceutical and devicemakers, an announcement that comes in the wake of news that the vice chancellor of health affairs was appointed to the board of Merck.

According to the Fairview Observer, the policy does not affect researchers, only clinicians, and there is no provision for oversight or penalties.

[Yeah, but who wants to anger Commodore Cornelius?]

Between the lines

Gooznews had his reading glasses on for this one:  a sentence in a New York Times story about spine device researchers who invest in the technologies they test.  Count me in, says Goozner, among the “few [who] would argue that doctors should never be allowed to invest in new technologies.”

“Why draw the line at research?” Goozner writes. “Is it okay that the doctor prescribing a particular drug has a huge hunk of his or her retirement portfolio in the stock of the company that makes that drug?”

What Would Nightingale Do?

Without much formal conflict-of-interest training or guidelines, nurses are prime targets and perhaps the next frontier for pharmaceutical detailing, according to this new article in PLoS Medicine.

Portrait Gallery

A nice profile on RxP ally, AMSA PharmFree coordinator, and Tar Heel of the Week Anthony Fleg appeared this week in the Chapel Hill News and Observer.

And the New Jersey Business Journal interviews state Attorney General Anne Milgram.  There are ten questions, but they all fall under the general category : “Why you gotta be so mean to pharma?”

State Round-up

This Charleston Gazette piece looks at the debate around a law recently passed in the West Virginia legislature that would require pharmaceutical companies to disclose all gifts to physicians to a state-wide board.

Pharmalot reports that New York State Senator Tom Morahan has asked the state health commissioner to look into a report that NY Medicaid spent $82.8 million on psych drugs for kids in 2006, many of which were off-label.

The Vermont legislature still stands behind the prescription data confidentiality law it passed last spring, according to a vote on a motion to repeal the embattled law at the state house this week.

Vermont was sued by health information companies who sell the data and awaits a trial in May.  A similar 2006

New Hampshire law was overturned by a district court judge and awaits decision by the  U.S. Court of Appeals.

From the Oops department… Covetous reporters, critics of pharma and all those ever bested by office culture had a good laugh this week after the leak of top secret documents related to Eli Lilly’s high-stakes Zyprexa negotiations to a lucky New York Times reporter was linked back to an error by a Lilly lawyer who used the auto-fill in his email headings one too many times. The docs were supposed to go to Bradford Berenson, Esq., but the unintended recipient was none other than Times pharmaceutical reporter Alex Berenson. Pharmalot has more here.

From the Let the Good Times Roll department…

Comes a good post from the New Orleans-based National Physicians Alliance doc, alias KidShrink, who made a point of speaking up and saying ‘not cool’ to a pharmaceutical Rep-Elf stuffing physician mailboxes with branded trinkets. Queen of England and King cake, all in one post.