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What About Docs’ Side of Drug Kickbacks?

Insurance Commissioner Dave Jones’ pursuit of a whistle-blower lawsuit against Bristol-Myers Squibb, which allegedly offered kickbacks to physicians to increase its drug sales in California, raises a related question: What about all those physicians — 15,000 gifts have been reported between 1999 and 2005 — who took the bait?

That bait includes sports tickets, expensive meals, all-expense paid trips and honoraria for speakers who sometimes didn’t even show up.

While a code of conduct for physicians is not written in stone, the American Medical Association’s policies usually hold weight with its members. In essence, AMA’s guidelines say that individual gifts of minimal value are permissible as long as the gifts are related to the physician’s work. We’re talking pens and notepads. No gifts should be accepted if there are strings attached, according to AMA. In other words, don’t accept gifts in return for prescribing a manufacturer’s drugs.

The state Department of Insurance estimates health insurers in California spent $3.5 billion on drugs involved in the kickback scheme. The commissioner went so far as to say in last week’s press conference that BMS salespeople were “shaking down” physicians.

Rosanna Westmoreland, vice president of communications and marketing for the California Medical Association, said her group supports mandatory disclosure of financial relationships between physicians and pharmaceutical interests. In addition, CMA policy supports requiring pharmaceutical companies to report all payments including cash, gifts, travel entertainment, sports and lodging given to physicians. She calls these measures part of a “clear policy regarding conflict of interest rules for physicians.”

Four years ago, the San Mateo County Medical Association surveyed its members about the value of setting a policy for physician behavior related to accepting gifts from drug companies. It was voted down. Sue Malone, executive director of the medical association admitted that some physicians accept free lunches to appease their staffs.

“If the California Medical Association really wanted to put its foot down, it would mandate that its members do such and such; instead, it is only supporting disclosure,” she added.

The Pharmaceutical Research and Manufacturersof Americaenacted its own code governing the interactions betweenpharmaceutical company representatives and health care professionals. But the new code is voluntary for pharmaceutical manufacturers and physicians.

The lawsuit, brought by three former BMS employees in 2007, was sealed until last week when a judge granted the California Department of Insurance permission to make the case public. Commissioner Jones pointed to further evidence that physicians are still accepting kickbacks from BMS. 


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