The California Assembly is currently considering a bill, Senate Bill 790, which would put in place severe restrictions around gifts or other financial benefits that pharmaceutical companies can give to medical professionals as part of marketing activities.
Not only will the bill limit physician access to important information about new treatments, but it also insults the integrity of every physician practicing in California and is a threat to the patient-physician relationship, which is the heart of effective health care.
My personal experiences with pharmaceutical companies, like those of many of my colleagues, have been positive and productive. Before I will even consider writing a prescription for a new drug, I ask the manufacturer to provide me much-needed education and research conducted about the treatment. Their research scientists have spent full business days with my staff and me answering our questions and educating us firsthand about their drug. After listening and giving serious consideration to the risks and benefits of a drug, I have, on at least two occasions in the past, flat-out told the pharmaceutical company that I was not interested. That is why I have the “MD” after my name. My medical degree – and education, training and lifetime of experience – demand that I make decisions about treatment and prescription medication just as I make every other medical decision: thoughtfully and meticulously, and with only the best interest of the patient in mind.
SB790 comes on the heels of an article published in the Journal of the American Medical Association which found that physicians who worked for hospitals that restricted pharmaceutical industry marketing also prescribed fewer brand name medications, a conclusion as predictable as it is unhelpful. Physicians in such circumstances are themselves already conflicted – they are paid by hospitals and given bonuses for spending fewer dollars. In fact, their computers often won’t even allow those physicians to prescribe some medications, which ties their hands and limits treatment options for patients.
Since when did American medicine not allow for physician judgment and patient choice? Doesn’t it make more sense to educate patients about their options and then allow them, in conjunction with their physicians, to make the choice about what’s best for their own care? Isn’t that precisely what physicians are paid to do?
But SB790 is not about patient trust or choice. Instead, it could limit access to information about new treatments or medical best practices that physicians and other medical professionals use to successfully treat patients. In so doing, the legislation could have far-reaching unintended consequences for California patient health.
That is because physicians do not limit their ongoing education to reading journal articles. Good physicians read academic literature about advancements in treatment, but also learn from peer educational events run by clinicians and other experts, and, importantly, from sharing best practices and real-life experiences with other physicians. I still go to the hospital for lunch, and I assure you it isn’t about the food (especially since they stopped serving chicken wings). It is about the banter and exchange of ideas with other physicians at the table about interesting patients or challenging patient care issues.
SB790 is not about “gifts” from the pharmaceutical industry. It is about the preservation of physician autonomy and patient choice. Legislators are demonstrating their own lack of fortitude if they assume physicians could be so easily persuaded by a tuna sandwich. I urge legislators to vote no on SB790.
Marcy Zwelling-Aamot, M.D., is a board member of the American Academy of Private Physicians and the Chair of the National Physicians’ Council for Healthcare Policy.