LD4 to benefit physicians and patients

In recent days, two OpEd pieces have discussed LD 4, a bill intended to reduce health care costs by curbing the pharmaceutical industry’s aggressive marketing of expensive drugs. Dr. Lisa Marrache and Sharon Treat support the law “LD 4 a step in the right direction” (BDN, Dec 4). Tarren Bragdon’s piece, “A bad pill for health care reform in Maine” (BDN, Nov. 30) is very misleading. We would like to offer a third perspective.

Pharmaceutical companies want the public to believe that patient welfare, not shareholder happiness, is their primary motivator. However it can hardly be disputed that the most aggressive marketing is done for the newest, most expensive drugs, not necessarily the most effective ones. Most of approved Food and Drug Administration applications by the top companies in the last decade have been for “Me Too” drugs, which often sell better than proven medicines they are designed to replace. One such “blockbuster” drug alone can mean billions of dollars in revenue. The majority of truly novel treatments have been introduced by smaller companies that often cannot afford to employ large sales forces.

The pharmaceutical industry giants employ 90,000 sales representatives to promote the latest drugs. This sales force depends on data that will be restricted by LD4: the specific prescribing records of individual physicians. This data (which includes no patient-identifiers), has been described by drug reps as the “greatest tool in planning [the] approach to manipulating doctors.” It enables sales reps to individually tailor their product pitches.

We agree with Bragdon that “data and information drive everything from an appropriate diagnosis to understanding and administering the latest treatment options.” However, we dispute the notion that salespeople represent the best source of information for physicians. The material passed to doctors by pharmaceutical representatives (called “sales aid” by the industry) is often biased, minimizing side effects while overplaying benefits. Wouldn’t you prefer if your physician was not educated by those with a financial stake in the medicines described? We believe that patients derive much more benefit from their doctors keeping up to date with the scientific literature from unbiased sources.

One should not ignore the fact that the doctor-patient relationship is about more than prescription drugs. The New England Journal of Medicine article quoted by Bragdon indeed shows that children received less than half of indicated care, similar to what other studies have shown for adults. While this is alarming, less than one-fifth of “missed” care involved omitting medicines, the majority implicated interactions that required spending time with those children, something you cannot do while seeing a drug rep.

The Maine law LD 4 gives doctors the choice to opt out of having their prescriber information sold to the pharmaceutical industry. It does not prevent physicians from sharing this information with salespeople if they choose to go that route. We believe physicians and patients will benefit enormously from providing doctors this choice.

Benjamin Schaefer, M.D., works for Northeast Cardiology Associates in Bangor. Bethany Picker, M.D., is a faculty member at Central Maine Medical Center Family Medicine Residency in Lewiston. Both are board members of the National Physician Alliance.