What should a doctor consider when he is about to choose a drug treatment for an ill patient? Certainly, the drug's effectiveness and safety are key factors, and possibly the cost if a cheaper alternative works just as well. But doctors should not choose a particular drug because manufacturers gave them office supplies or promised them free trips, and they should not be influenced in their decisions by prescription benefit managers who get kickbacks to promote certain brands. Such questionable practices are common, however, and Americans should support an effort by the U.S. Department of Health and Human Services to put a stop to them.
HHS has published proposed guidelines that call for pharmaceutical manufacturers to end the practice of kickbacks and illegal remunerations and to develop a self-policing system that sets clear guidelines, trains employees and encourages whistle-blowers within the industry. We shouldn't be surprised to learn that drug makers and the medical profession have opposed the rules.
The kickbacks work in a variety of ways. Sometimes a drug company gives direct payments or discounts to prescription benefit managers so they will put one of the company's drugs on the preferred list. If that drug then gains market share, the kickback amount is increased. Some managers, who determine which drugs are covered by an insurance plan, are even paid to send letters to doctors promoting one drug over another. Such incentives are also used to persuade doctors to prescribe a brand-name drug over a generic, even if the cheaper drug has shown better results.
Sound unethical? Not to the pharmaceutical industry, which calls its activities "well-established practices," to be distinguished from "illegal kickbacks." But we fail to see the difference when decisions about prescribing drugs are based on financial reward rather than sound medical science.
Some doctors and hospitals are on the pharmaceutical gravy train, as well. They claim there is no conflict in letting drug companies pay for professional education programs or in accepting small gifts such as pens and note pads emblazoned with company logos. Perhaps some of those practices are not harmful, but the Massachusetts Medical Society raises a good point. "Is the physician who writes a prescription with a company's logo on the pen more likely to wire a prescription for that advertiser?" the society asked in a New York Times story.
In the current atmosphere of distrust of corporations, even the appearance of a conflict of interest should be avoided. Besides, if drug manufacturers were interested only in medical education, they could find a way to support it indirectly without any implication of a payoff.
The pharmaceutical industry's claim that it keeps prices down through its marketing ploys is ludicrous. John Rother, public policy director for AARP, answers that argument this way: "It's a form of corruption in our health care system. Getting it cleaned up has got to make it more competitive, ultimately."
The Bush administration's strong stand on the issue is welcomed. In other arenas, it has folded to corporate pressure and weakened rules that protect consumers.
Perhaps the administration recognizes that predatory pricing by drug companies is a growing threat to the economy and to many Americans. There is also a direct benefit to the government (which means taxpayers) to clean up those practices because rising drug prices increase the cost of Medicare and Medicaid.
Whatever its motives, the administration should be encouraged not to give up the fight. The new rules wouldn't clean up all that is wrong in the pharmaceutical industry, but they would end a practice that is uncomfortably close to bribery.
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