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Healthy Skepticism Library item: 13994

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

Brody H.
PhRMA Code in Action in Massachusetts: Behind the Scenes
Hooked: Ethics, Medicine, and Pharma (blog) 2008 Jul 18

Full text:

In recent posts I tried to analyze the content of the new PhRMA code of ethics on interactions with physicians, and to suggest just how serious the industry might be—or not—in offering this voluntary move toward partial reform. More recent events suggest that if you wish to put a cynical spin on things, you may be our guest.

As the Boston Globe reported:

First, some background. Massachusetts is trying to implement its new plan to cover everyone in the state by a mandatory insurance rule, and to make insurance affordable, by finding more ways to cut health costs. The mammoth bill, containing numerous health care cost containment provisions, passed the Massachusetts Senate with a ban on pharmaceutical company gifts and meals to physicians; a requirement that payments for consulting and speaking be reported on a public website; and a ban on companies buying physician prescribing information.

The House, by contrast, deleted the ban on gifts and the sunshine reporting provision. Initially they left intact the ban on prescribing information, but a later amendment delayed the start of that rule for a year.

Why did the House delete these measures that had been acceptable to the Senate, and that promised to hold down drug costs (at least in theory) by limiting the companies’ ability to market the highest-priced, brand-name drugs? According to the Globe’s coverage, a critical feature of the descent of hordes of Pharma lobbyists on the Capitol was the argument that with the new code of ethics, PhRMA had promised to behave itself, and so there was no need to pass legislation. Specifically, the new version of the bill that passed the House replaced the bans with the simple requirement that drug companies adopt a “marketing code of conduct”—i.e., the PhRMA code.

Now, it just so happens that a state law would have real teeth in it, and the PhRMA code of conduct, at least according to its critics, is largely toothless—and if it is followed by the companies in a way comparable to its predecessors, it would be almost completely toothless. So it is a great sucess for industry lobbying if they can parlay the appearance of the code of conduct into the overturning or avoidance of legislative action. The Democratic state Senator who first proposed the ban on gifts in Massachusetts, Mark C. Montigny, specifically credited the industry lobbying effort with the reversal of the bans.

If you hold the cynical perspective that seems to be to be most realistic at present, we can look for renewed efforts at both the state and national levels to try to weaken any legislation that cramps the industry’s marketing style, with the new excuse that the legislation is not needed because PhRMA has seen the light and repented its sins in the form of the new marketing code. And that would seem to suggest the critical “why now” of the code in the first place.


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909