The bill, S.45, would allow doctors and other providers to eat food paid for by pharmaceutical companies, as long as the food is offered to many people in the context of a large conference and is not advertising a specific drug or device.
Currently, health care providers are prohibited from eating such food — or accepting virtually any gift from pharmaceutical companies other than drug samples or academic literature — because of a gift ban the Legislature passed in 2009 that was widely considered the toughest in the nation.
“The law is also the first (in the nation) to ban all free meals, long a favorite gift in marketing to doctors,” The New York Times reported. “The law also closes a loophole in previous regulations that had allowed companies to keep specific expenses private by claiming them as trade secrets.”
The Vermont Medical Society, which represents doctors across the state, spearheaded S.45. The society has said the current law makes it too hard for doctors to have meals when they attend conferences to receive continuing medical education credits.
Jessa Barnard, the lobbyist for the Vermont Medical Society, said doctors will often attend conferences sponsored by professional medical organizations, where a pharmaceutical company has sponsored a session and placed a buffet table with sandwiches in the back.
Barnard said the pharmaceutical company will often ban Vermont doctors from attending the session because there is food in the back of the room. If the food is only in the room for a period of time, the company often keeps them out of the room during that period, she said, causing the Vermonters to miss part of the session.
However, those same pharmaceutical companies will often sponsor iPhone charging stations, coffee booths or food booths at the conferences, according to Barnard. The doctors can accept food or coffee from the booths, but not in a room where a session is going on, she said.
“It’s really an issue of access to continuing medical education for our members,” Barnard said. She called S.45 a “tweak” in the law that is similar to other changes that have passed the Legislature in the past several years.
The Senate Health and Welfare Committee supported S.45 unanimously and took testimony from the Vermont Medical Society, which cited unnamed doctors the society said have been forced to take taxis from their hotels to get food during conferences. One doctor’s anonymous testimony was read aloud on the Senate floor.
The bill has since passed the Senate and will be taken up this week by the House Health Care Committee. If the committee approves the bill, it would go to the full House.
Ken Libertoff, a retired mental health advocate who helped pass that law nearly 10 years ago, has come out of retirement in part to oppose S.45. He said the bill may have good intentions but that it rolls back an intentional part of the gift ban while disparaging doctors who support the ban.
“I think that most doctors appreciate the fact that we are the state that set the national standard for having distance and a firewall between the work of physicians and the pharmaceutical and medical device industry,” Libertoff said.
He said he hopes the Legislature and the House Health Care Committee hear from doctors who support the current version of the pharmaceutical gifts law as well as from those who say the current law makes it too difficult to attend conferences.
Dr. Scott Waterman, a psychiatrist and professor emeritus at the University of Vermont College of Medicine, said: “Although there is somewhat understandable tendency to see (meals) in a different category than other types of gifts, they’re not.”
“The sense of gratitude — allegiance, owing something, what have you — that comes from giving and accepting gifts is equally applicable to meals,” Waterman said. “So in every reasonable sense of the word, they’re gifts. They’re inducements to listen to representatives of the industry.”
Waterman said doctors can get continuing medical education credits without accepting food from pharmaceutical companies. He said academic departments at the UVM Medical Center give weekly presentations that provide the credits.
Waterman said doctors can also get the credits through conferences sponsored by scientific and professional organizations, rather than pharmaceutical companies. Doctors who live too far from an academic medical center can get continuing medical education credits online, he said.
“For the previous two decades (before the 2009 law), I had witnessed the deleterious impact pharmaceutical marketing – often in the guise of … accredited educational programs – had on my profession,” Steingard wrote. “Many drugs were over promoted and their benefits were inflated. This was done through marketing that was disguised as education.”
“The current bill suggests that the new provisions will apply only to presentations that include significant educational content. This reflects a naïve understanding of drug company marketing tactics; pharmaceutical companies are adept at disguising promotion as education.”
She pointed to a journalist’s book, “Our Daily Meds,” which exposed how the maker of OxyContin marketed the drug — which is blamed for causing the nation’s opioid epidemic — through academic physicians and accredited continuing medical education meetings.
“It has been my observation that many doctors believe their education and intelligence protects them from bias,” Steingard wrote. “They believe they can ‘see through’ the marketing. Cognitive psychology – and experience – tells us otherwise.”
Barnard, from the Vermont Medical Society, said the organization does not get any money from pharmaceutical companies and has a policy not to accept gifts from the companies if the gift would affect clinical decisions.
“The medical community has changed a lot, and maybe at one time what’s sort of seen as this cozy relationship between prescribers and the pharmaceutical industry has really changed,” she said.
