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Doctors' lobby, drugmaker cash linked

The maker of a generic drug reveals financial connections between the FMA and drugmakers who profit from a law the lobby seeks to protect.

By JO BECKER

© St. Petersburg Times, published March 24, 2000


TALLAHASSEE -- The powerful organization that represents Florida doctors has been one of the most vocal opponents of a proposal to remove state barriers to certain generic drugs, saying it could endanger patient safety.

What the Florida Medical Association has not publicly told state lawmakers considering the hotly debated proposal is that it receives money from name-brand drug manufacturers who stand to lose millions if the bill becomes law.

The incoming president of the FMA told reporters last week that no such ties exist.

But faced with information compiled by Barr Laboratories, one of the generic drug companies fighting to remove the barriers, current FMA president Dr. Mathis Becker admitted Thursday that the FMA does rely on donations from major drug manufacturers.

He said the typical donation is between $5,000 and $15,000 but could not be more specific. He said the money mainly goes into the group's foundation and is used to pay for things such as educational programs, conferences and helping drug-addicted doctors recover.

Becker insisted that the donations have played no role in the FMA's position, and called Barr Laboratories' tactics "reprehensible."

"This is just a red herring," Becker said.

At issue is a list, called the negative formulary, of 11 widely used prescription drugs. For all other drugs, pharmacists are required to offer consumers a cheaper, generic substitute. But the state considers these 11 drugs too dangerous and has prohibited generic substitution.

Most states leave such decisions to the federal Food and Drug Administration, which uses extensive criteria to determine if the brand name and generic drugs are medically equivalent. Florida is one of just six states to maintain such a list, although 13 other states and the Department of Veterans Affairs have some restrictions on generic drug substitutions.

The battle over whether to keep the list has been waged mainly between the drug giant Du Pont Merck, the manufacturer of a blood-thinning drug called Coumadin, which is on the list, and Barr Laboratories, which makes a generic version of Coumadin and wants in on Du Pont's near monopoly in Florida.

According to Barr, there are 3-million Coumadin users in Florida. State Senate analysts estimate that each user could save about $48 per year by switching to the generic version.

Du Pont Merck and the FMA have argued that doctors need to be informed of a switch to a generic because Coumadin is in a special class of drugs in which small dosage variations can be harmful; with Coumadin, too small a dose can lead to a stroke, while too large a dose can cause bleeding. The FMA argues that any savings would be eaten up by additional tests that would be needed if a switch is made.

Generic-drug companies, backed by advocates for the elderly such as the Silver Haired Legislature and the AARP, have suggested that the list does nothing more than protect the market share of the major drug manufacturers.

On Thursday, Barr added a new twist to the debate, saying that ties between the FMA and Du Pont Merck "call into question the impartiality of these "champions of the consumer.' "

Among Barr's contentions:

Du Pont and other major drug manufactures contribute money to the FMA, a point which Becker confirmed.

A special FMA journal mailed to all FMA members this month on osteoporosis was sponsored by Merck, a point which Becker also confirmed.

The Florida Coalition for Patient Safety, a group that opposes getting rid of the list, is partly funded by Du Pont Pharmaceuticals. The coalition confirmed that Du Pont did pay for a recent poll that shows 75 percent of Floridians support keeping the list.

Du Pont, Merck, Bristol-Myers Squibb, GlaxoWellcome, Schering-Plough, Pfizer, Eli Lilly and Wyeth Ayerst are participating members of the FMA's Corporate Affairs Board. According to Barr, five of the 11 products on Florida's negative drug formulary are among products sold by five of those companies for annual sales of $3-billion.

Becker said he did not have time to address each point raised by Barr. John Sowinski, a spokesman for the Florida Coalition for Patient Safety and a Du Pont employee, pointed to another survey conducted by the FMA that showed that 90 percent of Florida doctors support keeping the list.

"They are trying to impugn the integrity of the FMA, but there are doctors out there that practice medicine every day, and they view the negative formulary as being good state policy," he said. "All we're saying is that doctors should be in the loop."

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