The senate in my home state of Massachusetts has passed legislation that would ban any payments or gifts made by pharmaceutical and medical device companies to healthcare practitioners, their families, medical facilities, and all staff at those facilities. If enacted into law, this bill would be the most far-reaching and toughest such legislation in the country — and would have serious negative side effects for CME andin the state and across the country. Draconian is the word I've heard when talking to people about this development.
Massachusetts, particularly Boston, is an enormously popular destination for medical conventions. Such a restrictive environment for exhibitors and sponsors could mean that healthcare societies would pull back from choosing Boston, says Gregg H. Talley, CAE, whose company manages. As Talley pointed out during his presentation at the Pharmaceutical Meeting Planners Forum, medical societies holding meetings in international destinations are already losing hundreds of thousands of dollars in revenue as exhibitors curtail their participation because of various countries' pharma prohibitions. (See story, page 26.)
The broadly written bill appears to lump CME in with other gifts and payments, and would therefore stifle commercial support, experts say. The Massachusetts Medical Society is pushing for a CME exemption. Since the ban applies to all honoraria and travel, medical educators would not be able to pay speakers from Massachusetts, says Thomas Sullivan, president, Rockpointe Corp., who advocates for CME issues on Capitol Hill. This, he says, would limit access to some of the bestin the country, such as physicians from Harvard Medical School, Massachusetts General Hospital, and Boston University Medical Campus.
In a smidgen of good news, the final version dropped the prison terms for violators, although the bill still includes a $5,000 fine for each infraction. “We're certainly delighted they eliminated the prison penalty. None of us wants to go to jail,” Bruce Auerbach, MD, president, MMS, told me. “But to have a $5,000 penalty because someone accidentally took a pen is excessive.”
Excessive and shortsighted. It's in nobody's best interest to create such a punitive atmosphere for healthcare practitioners or medical education. I believe that gifts and perks can and do influence doctors' decision-making, even if they don't acknowledge or realize it. But the solution to the intricate problem of physician/industry relationships is not as simple as “just say no.”
For instance, Barbara Barnes, MD, explained to me that her institution, the University of Pittsburgh School of Medicine, implemented a new industry relationship policy this February that prohibits any kind of personal gifts to physicians, including pens and notepads — but does allow teaching aids, such as placebo inhalers so physicians can demonstrate to patients how to use them properly. In developing this strategy, the organization sought feedback not only from healthcare practitioners and staff but also from patients. “We really tried to achieve some middle ground so that we don't have the unintended consequence of compromising patient care,” she says.
This is the kind of reasoned approach that can be productive and effective. When considering new policies at your organization or preparing a response to proposed legislation, it's important to hear from all the stakeholders, including patients, who are — or should be — the most important voice in the debate.