Signaling the increasing skepticism with which physicians eye drug companies, more than a dozen resolutions that would have curbed--and in some cases eliminated--the relationships between doctors and drug manufacturers floated through the AMA's recent convention.
At least 15 resolutions that addressed strained physician-pharmaceutical industry relations were voted on in diverse committees at the AMA's annual House of Delegates meeting, held June 17 through June 21 in Chicago.
Some of the milder resolutions passed as written. But the more strident challenges to drug industry sales practices were blunted by committees of an AMA that was criticized by delegates for taking millions of dollars from the drug industry, raising the question of exactly how much influence pharmaceutical companies have on the nation's physician organization.
The AMA's own financial report revealed that the pharmaceutical industry gave the association $625,000 to conduct an education campaign on how drug representatives can ethically buy physicians meals and pass along other incentives (see story, page 9).
In the end, however, delegates failed to get the votes to take a firm stand against detailing, junkets, direct-to-consumer advertising and physician profiling.
The issue isn't likely to go away--especially if some state medical societies, including Minnesota's, have their way.
The Minnesota delegation offered six of the 15 drug-related resolutions. A survey of members of the Minnesota Medical Association on drug industry practices prompted the flurry of activity. Four of the six Minnesota resolutions passed.
"We were satisfied with the reference committees' handling of these issues," says Anthony Jaspers, M.D., an alternate delegate and family practitioner from Lake Crystal, Minn. One of the resolutions that was defeated sought to ban the use of coupons in direct-to-consumer advertisements of prescription drugs. Two other resolutions dealt with DTC advertising. The most strident, from New Jersey, called for the AMA to seek an outright DTC ad ban.
"I'm realistic," Jaspers says. "The AMA can put pressure on the drug industry, but it is a free-market system. I hesitate to say the government should place restrictions to prevent the drug industry from doing any advertising, but one option is to tighten those guidelines. They're pushing the envelope right now."
The California Medical Association brought the most contentious resolution before the 530-plus house members: an obliquely worded resolution AMA leaders feared would cripple the marketability of the AMA's own Masterfile, a comprehensive list of information on physicians and medical students. The database includes physicians' names, addresses, practice specialties, Social Security numbers and Drug Enforcement Agency numbers. Drug companies use the list to target physicians for drug marketing. Drug companies also use numeric identifiers such as DEA numbers to profile physician prescribing patterns.
The California resolution called for the AMA to ensure that all sales of Masterfile data "protects the privacy and confidentiality interests of member and nonmember physicians."
The AMA estimated the financial impact would be $23.2 million if the resolution passed; the AMA's financial report shows the association made that much marketing physician data last year.
Committee debate on the Masterfile resolution was occasionally contentious and included implied accusations from the CMA that AMA officials buried the resolutions at the bottom of the agenda. Only a handful of diehard committee members remained when the resolution was brought up for initial presentation at 6:30 p.m. on the opening day.
Marie Kuffner, M.D., immediate past president of the CMA, said she was saddened at the late hour and the lack of delegates who remained in the room for the discussion.
The committee chair repeatedly apologized for the delay and said the resolutions' assignments were determined by the order in which they were submitted.
By the time it reached a floor vote June 19, the resolution had been heavily amended by the reference committee and sliced into six parts for separate debate and votes. By then, in a compromise attempt, the AMA's immediate past president, Thomas Reardon, M.D., had stipulated the AMA would no longer sell physician Social Security numbers, and California delegates had agreed to refer the resolution to the board of trustees for review.
"We made progress, but we still have a ways to go to reach our objective," says Jack Lewin, M.D., chief executive of the CMA. One of those goals is to better publicize the existing policy that allows physicians to bar the AMA from selling their information to anyone, a process called "opt out." The ultimate goal of the CMA is to require the AMA to receive permission to sell physician data, or "opt in."
If the AMA went to "opt in" immediately, "they would see a precipitous loss of income," Lewin says.
Reardon defended the practice of selling the list to drug companies, saying that much of the same data is publicly available elsewhere and that drug companies don't need the list to profile doctors' prescribing habits. Prescription information used for profiling comes from pharmacies, Reardon says.
In December, at an interim meeting in Orlando, Fla., the House of Delegates amended a resolution calling for the AMA to seek federal legislation to end the practice of profiling physicians' prescription writing habits. Instead, the delegates passed a weaker resolution asking the AMA to study "legally appropriate means" to end drug company profiling of physicians.
In June, a resolution from Michigan to "seek legislation that would make it illegal for pharmacies to release physician prescribing pattern information to pharmaceutical companies" received "unanimous testimony at committee level in favor" but was not recommended for passage by the committee leaders, who cited the pending work on the similar December resolution.
Reardon, however, suggested that work would come to naught. "Unfortunately, there is not much we can do vis-a-vis profiling because the information is available from so many other places," he says.