Patients should feel confident that the drugs and medical devices prescribed by their doctor are what is best for their health, not something influenced, even subconsciously, by a nice meal or a free trip to a sunny resort that the doctor enjoyed.
That, in essence, is what is behind legislation expected to be introduced in the General Assembly this week. A final version of the proposal is still in the works, but the idea is to restore public confidence by greatly regulating the financial interactions between drug companies and medical device makers and doctors, a necessary step in the wake of highly publicized gifts to Dr. Mark G. Midei, the Baltimore cardiologist facing accusations of implanting hundreds of unnecessary stents.
In crafting the bill, Maryland lawmakers would be wise to follow the example of Vermont, which in 2009 passed legislation requiring drug and medical-device makers to publicly disclose all financial relationships with physicians and other health care providers in the state. In addition, it bans most industry gifts, including meals, travel and entertainment, to doctors, nurses, medical staff, pharmacists, health plan administrators and health care facilities.
Vermont's disclosure requirements let the public learn each year which doctors have been paid by the makers of the brand-name drugs they prescribed and how much money surgeons have received from the makers of devices such as stents, pacemakers and artificial knees. Payments for clinical research for products under review by the Food and Drug Administration are exempted from disclosure.
Knowing the financial relationship between a doctor and a medical manufacturer could be useful to patients. If, for example, the patients of Dr. Midei had known that he was being paid consulting fees and feted by Abbott Laboratories, makers of a coronary stent, they might have been more skeptical about whether they wanted him to put the device in their bodies.
Calls for reforms have been growing. A group of prominent physicians warned in a 2006 article in the Journal of the American Medical Association that voluntary guidelines by a drug industry group and professional associations have not stemmed abuses. They also said that studies have shown that even small gifts can influence behavior because of the recipients' desire to reciprocate. California, Maine, Massachusetts, Minnesota, West Virginia and the District of Columbia have passed laws that either ban or require disclosure of gifts from health care companies to doctors.
In 2009, Johns Hopkins tightened its rules for "interaction with industry," barring gifts and also banning drug and device representatives from patient care areas. In addition, Hopkins limited the paid consulting activities of physicians in its medical school, hospital and clinics.
Not all the interaction with industry is bad, especially at teaching hospitals where researchers work with industry to discover new products and bring them to market. In crafting their regulations, Hopkins officials tried to ban activities, such as lavish free meals, that were extraneous to educational or research work. Officials report that with a few minor revisions relating to part-time employees, the program has worked.
Earlier this winter, an attorney representing Dr. Midei dismissed accusations that a crab feast and pig roast Abbott Laboratories threw for the doctor at his home was inappropriate. Such wooing of physicians by medical manufacturers was a common business practice, the lawyer said.
It might be good for business, but it is bad medicine. Giveaways and sponsorships by manufacturers can distort the ways doctors care for patients. If Maryland wants to remain a leader in health care, its lawmakers need to join other states in ensuring that commercial interests don't taint medical decisions.