Investing in Life Sciences while Restricting the Industry Sales force

Tension between two bills that affect the life sciences industry may come to a head this week. One bill that details a one billion dollar investment in life sciences is expected to be released from a conference committee any day now. The other, a health care cost containment bill, has become increasingly controversial because it would ban gifts to doctors from sales reps for pharmaceutical and device manufacturing firms. W-B-U-R’S Martha Bebinger explains what's at stake.

BEBINGER: The gift ban includes pens and water bottles stamped with a drug name you can’t pronounce. It would also end the platters of sandwiches and the tens of thousands of dollars that fund continuing medical education for physicians in Massachusetts.

RICHARD MOORE: If their products require very generous gifts just to sell them, then there must be a deficiency in the product.

BEBINGER: Senator Richard Moore is a co-sponsor of the bill that would ban gifts to physicians as part of package of health care cost control measures.

MOORE: The drug companies have to re-evaluate how they push their product. It has a significant impact on prescribing practices and on the cost of health care. So I think whether they consider it friendly or not, it’s friendly to the patients and the taxpayers and that’s our primary concern.

BEBINGER: The pharmaceutical industry says it’s insulting to suggest that a meal or a pen push doctors to prescribe one drug over another. But Massachusetts Biotechnology Council Vice President John Heffernan says there’s no disagreement about how his members feel about a gift ban.

JOHN HEFFERNAN: This legislation would make MA the least friendly state to the bio-pharmaceutical industry in the country.

BEBINGER: How does banning a lunch or a pen, how does that make us the least friendly state in the country?

HEFFERNAN: It’s really not that simple. The legislation is extremely far reaching and it’s very hurtful to the industry.

MARK LEUCHTENBERGER: What could come next out of legislature that has such a level of distrust of biotech and PhRMA that they won’t let federal legislation and won’t let the PhRMA code speak for itself as we do.

BEBINGER: Mark Leuchtenberger chairs the Biotech Council and is CEO at Targanta Therapeutics. He says industry leaders, especially those outside Massachusetts, are asking that what’s could be next question at the same time State House leaders finalize a 1 billion dollar life sciences bill they hope to parade at a major conference.

LEUCHTENBERGER: It is a dichotomy. And believe me with BIO, the national convention, in San Diego next week. Knowing my California colleagues, they are watching this and waiting to crow about it. It will be a classic California vs. Massachusetts and they will have the upper hand in this argument as they try to encourage investment out there as opposed to here.

BEBINGER: In the Senate, where the bill that includes the gift ban passed unanimously, leaders say it’s foolish to suggest that it undermines the one billion dollar life science investment. But the Patrick administration and the House, are taking the industry’s frustration seriously. Housing and Economic Development Secretary Dan O’Connell says the state must make sure there is no conflict.

DAN O’CONNELL: I think how the gift ban is crafted is most important. The goal is a laudable one, but we also must be sensitive to bio-pharma and their sales needs and making users familiar with their products.

BEBINGER: House Speaker Sal DiMasi says he too wants to make sure that the ban does not interfere with doctors learning about the latest drugs or medical devices. He’s appointed 5 committee chairs, including Representative Michael Rodrigues, to look at ways to exclude educational materials from the ban.

MICHAEL RODRIGUES: Many times anatomical models that are very expensive are presented to physicians so that physicians can instruct patients on the effects of a particular disease or how to implement a medical device. That’s all stuff that we don’t want to prevent happening, we should encourage.

BEBINGER: Minnesota is the only state that already restricts gifts. It does not apply to journals or tools about the specific drug or medical device…(textbooks, PDAs, online subscriptions ior other gifts not directly related to the product are not allowed). In Massachusetts, lawmakers say this gift ban is the only piece of the broad health care cost containment bill they are hearing about. And they aren’t just hearing from the doctors and drug reps in their district…it’s also the catering companies and customized trinket makers who might lose significant accounts. Another part of the bill aimed at limiting the pharmaceutical industry’s influence has been largely ignored. It would set up a team of "academic detailers." They are independent drug and medical device researchers, paid by the state who would travel the physician circuit just like sales reps. Jerry Avorn, a professor at Harvard Medical School, started this as an alternative to the pharmaceutical sales force 25 years ago.

AVORN: Somebody comes into your office and says if you have 15-20 mins. I will summarize the best available information on how to manage hypertension, cholesterol, diabetes. It’s a real service that doctors would have to spend hundreds of hours in the library to get that same quality of information.
BEBINGER: With lunch or without?
AVORN: Well, we actually had a soul searching about the lunch. We originally started out by saying, we’re not going to do any bribes, we’re not going to give any freebies. And then some of the doctors said, I’d really love to talk to you but the only time I have is during my lunch hour, can you bring me a sandwich. So we crossed the line and said yes, we’ll spring for a pizza or a sub sandwich but not for a meal at Anthony’s Pier 4.

BEBINGER: Avorn says his program, in other states, either breaks even or saves a dollar for every one spent. Supporters of the gift ban say it would also save money. Former Health Care for All Director John McDonough says gifts help drug reps buy good will and persuade physicians to try a newer, more expensive drug.

JOHN MCDONOUGH: The gifts end up inflating the cost of health care. They’re not the only culprit, they are many, many culprits. It’s hard to imagine if we can’t face up to this one, how we will face up to some of the more difficult ones down the road.

BEBINGER: Pharmaceutical industry leaders say a ban would raise costs because physicians would be less likely to take time to learn about new, effective treatments. Regulators in Minnesota says there is no hard evidence that their gift restrictions have either saved money or changed the way doctors prescribe drugs.