It’s that time of year again: conference season. Well, at least for oncology. The annual meeting of the American Society of Clinical Oncology is coming up in early June. The book of abstracts has been distributed, Wall Street trading on the information has begun, and oncologists the world over are figuring out how to be in two places at once, with so many overlapping sessions of interest. And everyone is asking that all important question: Will doctors from Vermont (or Massachusetts or Minnesota) be allowed to eat the cookies in the exhibit hall?
For several years now, states have been passing laws that ban doctors from accepting gifts of any kind from pharmaceutical companies. Many states set the limit at $50 (anything below that is fair game). Some states require doctors to disclose any gifts they’ve accepted. Other states forbid doctors to accept anything at all, including something as seemingly minor as a pen or a cup of coffee.
The laws mainly appear to be a reaction against the gift-giving aspect of detailing. A 2007 survey published in the New England Journal of Medicine reported that among 3,167 physician respondents, 83% had received food gifts at work as part of their interactions with industry representatives. A survey by Marketech Inc. found that among 83 pharmaceutical companies, the average spending limit per individual healthcare professional was $1,561.
The backlash against this practice means that in some states, pharmaceutical companies have to disclose what they’ve spent on physicians in a central, state-run database (so that, theoretically, anyone can look up how much money pharmaceutical companies have spent on his/her doctor). Sometimes, it means that industry reps need to follow state-issued guidelines about what is and isn’t allowed during physician interactions. Other times, it has led to companies setting their own per-physician spending limit. (On my last check, Bristol-Myers Squibb had a $1,500 limit, though that may have changed.) And other times, it means seeing signs like this:
Bayer says that the same sign will be up again this year.
Of course, we can all see a reason for laws that curb lavish spending on physicians. The issue has been studied extensively by many medical and medical ethics journals. Even negligible gifts, it appears, can lead to bias. And admittedly, some of the exhibit booths treats are quite delicious. (Genentech’s chocolate-covered shortbread cookies from a few years back come to mind, though I have also seen people — serious oncologists, many of whom have traveled far to get to the conference — lined up for crepes and bottomless cappuccinos .) The ASCO exhibit hall has become much more anemic in recent years. Any gifts have to be educational in nature (though I think we all known how stretchable the term “educational” is), and the sense of disregard, of wooing doctors with swag, of constructing lavish back-lit fountains at the exhibit hall booth in the hope of …. what? hypnotizing a doctor into prescribing your drug? … are – well, if not gone, certainly dampened down.
Still – if your doctor had a treat from an exhibit hall booth at a medical conference, would you worry about his or her objectivity in choosing what drug to prescribe for you? In other words, does drinking the coffee mean he or she has been “drinking the coffee”? Does there come a point where the ban has gone beyond reason and into a bit of hair-splitting insanity? Are the laws honest, or are some of them the result of political posturing? Most importantly, does stopping a doctor from taking a Hershey kiss from a bowl at a company’s booth actually stop the process that we’re all worried about? Does it pull the problem out from its roots, or is it simply tugging at the leaves?