A TEST OF POLITICAL WILL by John McDonough

It’s a health policy truism: one person’s waste is another person’s paycheck. And it’s vividly playing out in the debate over proposed ban on drug and device maker gifts to physicians in Senate President Therese Murray’s cost control legislation. It’s not just the lobbyists and the drug reps (we estimate 2,000 to 3,000 just in Massachusetts), it’s the pharmaceutical “bling” makers and distributors, it’s the caterers, it’s friends and relatives of the above. A veritable industry devoted to the subtle and not-so-subtle seduction of physicians. All of them contacting their legislators to oppose the ban.

So the proposed gift ban poses an important and timely question – does Massachusetts possess the political will to address wasteful rising costs when a well-heeled lobby protests? If we can’t address this blatant waste, what waste can we address?

There are savings to be realized from the gift ban. Nearly $4.5 billion was spent on prescriptions in Massachusetts in 2006, an ever-rising number. Between 2000 and 2005, drug spending rose 500 percent, one-third the result of marketing practices, including gifts to providers. The promotions trigger rising costs as gifts promote the newest, highest-cost drugs for which there are often cheaper, safer and more effective alternatives.

For consumers, businesses, and the state, the gift ban is a win, win - lower costs and better quality. And it’s drawing harsh, unrelenting industry criticism, threats, scare tactics and misrepresentations.

They say the gift ban will result in a scarcity of education about drugs for providers. Untrue. Nothing in the ban prohibits drug reps from providing information to providers, just no gifts.
They say drug companies will no longer be able to employ physicians to do research. Also untrue. Drug companies may continue to hire and contract with providers to do work, such as research, for reasonable compensation.

They say providers should be held to the same standard as legislators because legislators can take gifts. Not true. Lobbyists are prohibited under Massachusetts law from giving anything of value to a lawmaker. Not a stick of gum, not a cup of coffee. Sen. Stan Rosenberg and I wrote that law back in 1994 – let’s hold the drug industry to the same ethical standard as lawmakers.

“Shared responsibility” is as appropriate for health reform phase II as it is for phase I. We expect the health care industry to eliminate sources of waste and inefficiency. Already, UMass Memorial Hospital and Boston Medical Center have halted inappropriate marketing practices within their walls. It’s time for the rest of the hospital and physician community to follow suit.

The gift ban is one of the few easier steps we can take to address rising medical costs. And if we can’t do this, it’s hard to see how we’ll summon the political will for the harder cost control challenges yet to come.

John McDonough
Executive Director, Health Care for All