Drug company payments to doctors still hard to access despite disclosure laws

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:655
  1. Fred Charatan
  1. Florida

    An attempt to use disclosure laws passed by two US states to discover the sums of money paid by drug companies to doctors found the relevant information was of limited quality and hard to access.

    The US states of California, Maine, West Virginia, Vermont, Minnesota, and the District of Columbia have laws mandating disclosure of payments made to doctors by drug companies. In two of these states, Vermont and Minnesota, payment disclosures are meant to be publicly available.

    The Vermont law, enacted in 2001, requires drug companies to disclose any gift or payment of $25 (£13; €19) or more to doctors, hospitals, nursing homes, pharmacists, or health insurers for the purpose of marketing their products. The only state with a similar law is Minnesota, which in 1993 prohibited companies from giving gifts valued at more than $50 to doctors or other healthcare providers. The law also requires disclosures of payments of $100 or more, excluding pharmaceutical samples, publications, and educational materials.

    A six member team led by Joseph Ross of Mount Sinai School of Medicine in New York investigated the disclosure laws in Vermont and Minnesota.

    The team examined the Vermont data from 1 July 2002 to 30 June 2004 and the Minnesota data from 1 January 2002 through to 31 December 2004. Their results were published in JAMA, the journal of the American Medical Association (2007;297:1216-23).

    Getting key information required a lawsuit in Vermont and photocopying individual disclosure forms in Minnesota, the researchers reported.

    “In Vermont, 61 percent of payments were not released to the public, because pharmaceutical companies designated them as trade secrets, and 75 percent of publicly disclosed payments were missing information necessary to identify the recipient,” the researchers wrote.

    “The hoops that we had to jump through to get the data in each state is enough to show that these laws aren't really working,” said Dr Ross.

    Most payments studied were related to education, research, meals, and personal visits with doctors to promote new drugs.

    In their article, the authors concluded that the Vermont and Minnesota laws requiring disclosure of payments do not provide access to payment information for the public, and are of limited quality once accessed. However, substantial numbers of payments of $100 were made to doctors by drug companies.

    These results highlight the need for better enforcement of existing laws, and should help others craft better ones elsewhere, say the researchers.

    Marjorie Powell, a lawyer for the Pharmaceutical Research and Manufacturers of America, defended the companies' rights to declare some payments trade secrets, to keep competitors from learning about drugs under development.

    A JAMA editorial in the same issue (pp 1255-7) entitled “Sunshine laws and the pharmaceutical industry” by Troyen Brennan of Aetna, Hartford, Connecticut, and Michelle Mello, of the Harvard School of Public Health, says, “Their primary commitment is to create shareholder value, not maintain an altruistic commitment to patients . . . but at some point the leadership of the pharmaceutical industry and their boards of directors must begin to recognize that growing public and professional mistrust could substantially detract from that value.”

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