The pharmaceutical industry has dozens of lawsuits from states coming after the record-setting $875 million government settlement against TAP Pharmaceutical Products for sales and marketing practices. The industry’s marketing generally has gotten so extreme that a growing number of doctors nationwide are refusing gifts to promote products. Congress is looking for a low-cost Medicare drug benefit, and internationally the industry still gets knocked for its insensitivity to the need for vaccines in the developing world.

So why should it care about an unhappy letter from the Blue Hill Memorial Hospital board of directors?

For this reason only: The excess charges for often purely redundant drugs, driven by profit and marketing demands, are raising protest not just from advocacy groups and not just around Washington, but locally, among people who watch health-care systems closely and knowledgeably. If the drug industry is looking for allies, it apparently is losing another, influential group.

The Blue Hill board makes two points in a May 24 letter to Del Persinger, president of Pharmaceutical Research and Manufacturers of America:

. “Relentless, excessive consumer-directed marketing of prescription medications” raise costs and force physicians to spend more and more time explaining to patients why certain drugs are not right for them.

. Phrma’s unwavering effort to stop states such as Maine from making prescription drugs more affordable is especially frustrating: “We find your obstructive legal maneuvering to be unconscionable.”

But the more important message is in the messengers themselves. Gardner W. Smith, MD, writes for the board: “We do not envision ourselves as wild-eyed radicals but rather as concerned members of the community. Our board is comprised of physicians, a retired clinical pharmacist, a former chief executive of a visiting nurse association, a former professor of surgery at a major academic medical center, attorneys, an investment banker, an independent school headmaster, marketing directors, a retired IBM executive, a university president and a retired insurance executive. We are community leaders who are well informed; we are consumers; we are investors and we have often been in leadership roles that require our understanding of national domestic issues.” Translation: Ignore us at your peril.

It is impossible to conclude that many other similarly qualified boards that examine drug-industry marketing, lobbying and legal obstructionism do not also find the same outrages. The Senate is expected to consider this summer a drug benefit for Medicare and drug lobbyists is working hard to ensure that the benefit does not also include price discounts. When they look for friends to support their position, they will justifiably find fewer and fewer people standing behind them.