The Health Care Gift Ban

In 2008, Massachusetts passed a law prohibiting gifts by drug and device companies to doctors. I voted for the ban then. There is currently pending a proposal to repeal the ban and thoughtful people have approached me in support of repealing it. After revisiting the issue, I continue to support the ban. I will listen carefully to the arguments on the floor, but I expect to vote against repeal.

I have great respect for the pharmaceutical and device industries. Many of us owe our lives or health to the advances of modern medicine. Many of these advances have emerged from corporate research and many of them have been disseminated by the very marketing practices that the law prohibits. The hospitals and medical schools and related companies of Massachusetts are among our most important economic engines and we have to be very concerned about their vitality.

On the other hand, rising health care costs are our biggest financial problem and the law responds to concerns and evidence that gifts from drug companies at several levels bias patient care in unhelpful ways.

• At the lowest level, trinkets and convenience meals bestowed by drug companies on health care providers may create bias in favor of new product use. Some find the idea that something as small as a meal could bias a physician as silly and insulting. Considerable evidence and most human experience suggests the contrary — gifts at any level create a sense of duty to reciprocate. A prescription choice among similar drugs is not always a big choice and it makes sense that it would be easy to influence physicians with gifts; physicians are human like the rest of us.
• At the medium level, more significant meals and time away has the benefit of creating an opportunity for physicians to talk to drug developers, but must inevitably create a stronger duty of reciprocity.
• At the top level, there have been credible stories of senior physicians embracing new drugs and devices and driving their institutions to sanction the new drugs and devices in direct return for important research funding.

I am concerned about the effects of the ban on:

• Restaurant businesses. Drug companies used to spend a lot of money buying breakfast, lunch and dinner for physicians and other health care workers. I don’t doubt that there has been an impact, although the recession is probably a larger impact.
• The convention business. Massachusetts will lose some convention business as a result of the ban, but, as for restaurants, surely the recession is a larger issue.
• Informal interaction between physicians and drug companies. I totally support the idea that drug companies should want to talk to physicians. That’s intrinsically healthy. My instinct though is that, after a period of adjustment, physicians and drug companies will find ways to talk that raise less concern for inappropriate influence than company-paid dinners.

I’ve been approached in an organized way by advocates on both sides of this issue and I have considered their arguments carefully. But I am most influenced by the roughly ten contacts about this issue that I initiated with physicians. They all felt that the ban responded to a real problem and most felt that it should be preserved unchanged.

So, that’s where I am for now! More input welcomed.