MMS Testimony In Support of House 2080 An Act to Promote
Economic Development in the Commonwealth, and in Opposition to S
515, An Act Making Technical Corrections to Health Care
Practitioner and Pharmaceutical and Medical Manufacture
Conduct
Before the Joint Committee on Health Care
Financing
The Massachusetts Medical Society supports changes in the
current pharmaceutical gift ban which would apply to meals. We have
attached the MMS policy on gifts from industry, which states in
relevant part,
"Any gifts accepted by physicians individually should primarily
entail a benefit to patients and should not be of substantial
value. Accordingly, textbooks, modest meals, and other gifts are
appropriate if they serve a genuine educational function."
The current ban allows modest meals in some settings but not all
settings and therefore we support efforts to allow meals to be
provided in restaurants, function rooms and other facilities. Our
reading of H 2080 is that it would not affect mandatory disclosure
of meals with a value of over $50 provided to physicians by
industry. Thus data will be available to judge whether meals are in
fact "modest" or not. We feel this bill is a reasonable
approach.
We oppose Senate 515 because it prohibits the provision of
anything of value by pharmaceutical company representatives to any
health care provider, their employees or their families. While this
ban includes the language "knowingly and willfully" it does not tie
the gift to business practices in any way. The total ban makes no
exception for legitimate educational materials. Prohibitions on
soliciting gifts would prevent a physician from asking a
manufacturer for even peer reviewed or FDA approved information on
their products. This approach is beyond what is necessary or
reasonable.
The American Medical Association policy on gifts from industry
has been adopted by the MMS's House of Delegates. It is offered
here to help inform legislators on national and local views.
Gifts to Physicians from Industry
That the Massachusetts Medical Society (MMS) endorses as
an opinion the American Medical Association Council on Ethical and
Judicial Affairs Opinion 8.061 and Clarification, ―Gifts to
Physicians from Industry,‖ issued June 1992, which reads:
Many gifts given to physicians by companies in the
pharmaceutical, device, and medical equipment industries serve an
important and socially beneficial function. For example, companies
have long provided funds for educational seminars and conferences.
However, there has been growing concern about certain gifts from
industry to physicians. Some gifts that reflect customary practices
of industry may not be consistent with the Principles of Medical
Ethics. To avoid the acceptance of inappropriate gifts, physicians
should observe the following guidelines:
(1) Any gifts accepted by physicians individually should
primarily entail a benefit to patients and should not be of
substantial value. Accordingly, textbooks, modest meals, and other
gifts are appropriate if they serve a genuine educational function.
Cash payments should not be accepted. The use of drug samples for
personal or family use is permissible as long as these practices do
not interfere with patient access to drug samples. It would not be
acceptable for non-retired physicians to request free
pharmaceuticals for personal use or use by family members.
(2) Individual gifts of minimal value are permissible as long as
the gifts are related to the physician's work (e.g., pens and
notepads).
(3) The Council on Ethical and Judicial Affairs defines a
legitimate ―conference‖ or ―meeting‖ as any activity, held at an
appropriate location, where (a) the gathering is primarily
dedicated, in both time and effort, to promoting objective
scientific and educational activities and discourse (one or more
educational presentation(s) should be the highlight of the
gathering), and (b) the main incentive for bringing attendees
together is to further their knowledge on the topic(s) being
presented. An appropriate disclosure of financial support or
conflict of interest should be made.
(4) Subsidies to underwrite the costs of continuing medical
education conferences or professional meetings can contribute to
the improvement of patient care and therefore are permissible.
Since the giving of a
subsidy directly to a physician by a company's representative may
create a relationship that could influence the use of the company's
products, any subsidy should be accepted by the conference's
sponsor who in turn can use the money to reduce the conference's
registration fee. Payments to defray the costs of a conference
should not be accepted directly from the company by the physicians
attending the conference.
(5) Subsidies from industry should not be accepted directly or
indirectly to pay for the costs of travel, lodging, or other
personal expenses of physicians attending conferences or meetings,
nor should subsidies be
MMS Policy Compendium 35 accepted to compensate for the physicians'
time. Subsidies for hospitality should not be accepted outside of
modest meals or social events held as a part of a conference or
meeting. It is appropriate for faculty at conferences or meetings
to accept reasonable honoraria and to accept reimbursement for
reasonable travel, lodging, and meal expenses. It is also
appropriate for consultants who provide genuine services to receive
reasonable compensation and to accept reimbursement for reasonable
travel, lodging, and meal expenses. Token consulting or advisory
arrangements cannot be used to justify the compensation of
physicians for their time or their travel, lodging, and other
out-of-pocket expenses.
(6) Scholarship or other special funds to permit medical
students, residents, and fellows to attend carefully selected
educational conferences may be permissible as long as the selection
of students, residents, or fellows who will receive the funds is
made by the academic or training institution. Carefully selected
educational conferences are generally defined as the major
educational, scientific or policy-making meetings of national,
regional or specialty medical associations.
(7) No gifts should be accepted if there are strings attached.
For example, physicians should not accept gifts if they are given
in relation to the physician's prescribing practices. In addition,
when companies underwrite medical conferences or lectures other
than their own, responsibility for and control over the selection
of content, faculty, educational methods, and materials should
belong to the organizers of the conferences or lectures. (II)
Issued June 1992 based on the report ―Gifts to Physicians from
Industry,‖ adopted December 1990 (JAMA. 1991; 265: 501 and Food and
Drug Law Journal. 2001; 56: 27-40); Updated June 1996 and June
1998.
