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Healthy Skepticism Library item: 12173

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: news

Stewart N.
Catania's Bill Would Regulate Pharmaceutical Salespeople
Washington Post 2007 Dec 9C11

Full text:

The District could become the first jurisdiction in the country to license pharmaceutical sales representatives, a move a council member says would help protect doctors and patients from disreputable agents who help drive up the costs of prescription drugs.

The drug industry says the move is unnecessary because it overlaps with federal laws.

The D.C. Council is set to vote Tuesday on member David A. Catania’s SafeRx Act, which would also ban pharmaceutical manufacturers from using doctors’ prescription data for marketing purposes without the doctors’ knowledge.

At issue, Catania (I-At Large) and his allies say, is an industry whose representatives can mislead doctors and patients into buying the most expensive drugs on the market, shunning reasonably priced generics or drugs that could be just as effective. Because the agents’ salaries are dependent on sales, they sometimes give the wrong impressions about drugs and present themselves as medical professionals, Catania said.

Other professions are licensed, Catania said — why not pharmaceutical sales? “If it is good enough for cosmetologists, it ought to be good enough for the pharmaceutical company,” he said.

Under the bill, a pharmacy board would be formed and would create a code of ethics for salespeople and license them. The “detailers,” as representatives are known in the industry, would have to be college graduates and would be prohibited from using titles that could lead doctors to think they are licensed to practice medicine, pharmacy, nursing or in other health fields.

If such a bill passes, it could open the door for states to try to create similar legislation, say people on both sides of the debate. In recent weeks, the District has become a battleground for those who have targeted the pharmaceutical industry in hopes of reining in drug prices and securing stronger local regulations.

The industry is embroiled in court cases in New Hampshire, Maine and Vermont over recently passed state laws meant to curb companies’ “data mining,” the practice of reviewing doctors’ prescriptions without their knowledge and targeting them with aggressive marketing.

The Pharmaceutical Research and Manufacturers of America has countered efforts to regulate drug companies, saying that the Federal Drug Administration and the American Medical Association have laws and policies to scrutinize them.

“The D.C. government should not be trying to insert itself into an arena that is already well covered nationwide by federal agencies,” Ken Johnson, a senior vice president of the association, said in a statement. “We should avoid the confusion of a patchwork quilt of local laws.”

Marjorie Powell, senior assistant general counsel for the association, said in an interview that Catania’s bill is “a misuse of the District’s resources.”

“It’s sort of a solution in search of a problem,” she said.

About 3,000 to 4,000 sales representatives work in the D.C. region and cast a wide net outside the area, Powell said. “They typically work in D.C. and in Maryland and Virginia, Delaware and Pennsylvania. Should they be licensed in all of those jurisdictions?” she asked. “It’s going to be a fairly huge administrative process.”

She said that the average sales representative receives training two to three times a year and “typically has a background in science, medicine or pharmacy.”

Catania said federal agencies do not have the resources to closely monitor the multibillion-dollar trade. “If we put a chink in that armor, I think it will shake the pharmaceutical industry to its core,” he said. “This is about patient safety, having decisions made based on science and efficacy, not money.”

Catania and advocates of the bill say patients’ health can be threatened by salespeople who provide false information about prescription drugs.

Catania, chairman of the council’s health committee, has been lobbying colleagues for support, pushing the bill out of committee with a 3 to 2 vote and altering it to accommodate concerns. But pharmaceutical lobbyists have been right on his heels, enlisting David Wilmot, a local lawyer who knows the political landscape.

Wilmot and some council members, including Marion Barry (D-Ward 8), have questioned whether Catania’s bill would really protect patients or whether it is a pet project for the lawmaker, who was recently elected chairman of the National Legislative Association on Prescription Drug Prices. Formed in 2000, the group of state legislators is building a reputation for taking on the pharmaceutical industry.

The debate is open on the 13-member council, with no majority on either side of the issue. Although both have claimed the support of Muriel Bowser (D-Ward 4), she said she is undecided. “I’m waiting to see some amendments,” she said.

The problem with the legislation, some council members have said, is that it is several bills in one — and they have to agree with each part to pass it.

Barry, one of the dissenting voters on the health committee, said he doubts the bill would have any effect on the city’s status as having some of the highest rates of several chronic diseases in the nation. “We’ve got the biggest AIDS epidemic in the country,” he said. “Spend time working on that.”

Barry is particularly critical of the legislation’s licensing rules. “If you regulate detailers, so what?” he asked. “The doctors don’t need to be protected from detailers.”

Christopher McCoy disagrees. McCoy, a physician in internal medicine in Minnesota, is a member of the prescription privacy committee of the National Physicians Alliance. The group of doctors, formed two years ago, does not accept money from pharmaceutical companies.

There has been controversy recently over doctors receiving money from drug companies for speaking engagements and other activities, which critics say influences doctors’ prescription choices.

“Our self-confidence makes us believe we are immune to marketing,” McCoy said. “Why would the drug companies spend $12 billion if it didn’t work?”

The industry actually spends an average of $25 billion a year on marketing, and 60 percent of that is for pharmaceutical samples, Powell said. Last year, it also spent $55.2 billion on research and development of new medicines, she said.

McCoy said his group is most worried about data mining. “They have more information than we do. Most doctors I talk to are offended by this,” he said.

A U.S. District judge blocked New Hampshire this year from enforcing its law prohibiting data mining on the grounds that it restricts commercial free speech. State Rep. Cindy Rosenwald (D) said the state is appealing.

“There’s no question that using doctors’ prescriptions to fine-tune your marketing plan has an impact on drug sales,” she said. “There’s no other industry that has such detailed information of their customers without their permission.”

Powell said data mining has benefits for patients because sales representatives can learn more about which drugs doctors are prescribing and better inform them of their effects.


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