Vermont is one of only several states which require pharmaceutical
companies to disclose money paid to influence doctor's prescribing
practices. The New York Times reported on June 27, 2007 Psychiatrists
Top List in Drug Maker Gifts: "drug company payments to psychiatrists
in the state (Vermont) more than doubled last year (2006), to an
average of $45,692 each from $20,835 in 2005. Antipsychotic medicines
are among the largest expenses for the stateÂ’s Medicaid program."
The below article shows that one year later Vermont psychiatrists are
raking in even more from pharma: "Eleven psychiatrists received a
total of almost $630,000, or about 20 percent of combined marketing
expenditures in the state, the study found. That amounts to about
$57,000 per psychiatrist, on average."

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Letter to the editor:
http://www.rutlandherald.com/apps/pbcs.dll/section?category=SERVICES07

Vermont Rutland Herald

Report: Drug makers spent $3M in state in 2007

By Peter Hirschfeld
Jul 9, 2008

MONTPELIER — Pharmaceutical manufacturers are using their vast
marketing budgets to influence the types of medications prescribed by
Vermont doctors, Attorney General Bill Sorrell said Tuesday.

The pharmaceutical industry spent $3 million last year to promote its
products in Vermont, according to a report from the Office of the
Attorney General. The marketing expenditures, up by 33 percent over
Fiscal Year 2006, represent the highest single-year spending since the
state began tracking data in 2003.

"This report shows, once again, that the pharmaceutical industry has
too much influence over the practice of medicine in Vermont," Sorrell
said in a statement. "It is particularly troubling that the industry
is paying large sums of money to influence prescribing practices
involving psychiatric drugs."

Drug makers paid out more money to psychiatrists last year than any
other type of doctor in Vermont. And four of the five most heavily
marketed drugs are used to treat either attention deficit
hyperactivity disorder or depression, the report found.

"When you start looking at the particular types of payments being
made, the heavy weight toward psychiatrists as well as psychiatric
drugs, it does become particularly troubling," said Assistant Attorney
General Julie Brill.

Montpelier, Vermont is the smallest state capital in all the United
States.
With a population under 10,000, Montpelier Vermont is a typical small
New
England town that just happens to be the state capital.

Ken Johnson, senior vice president for the Pharmaceutical Research and
Manufacturers of America, called Vermont's report "misleading" and
said the data "serve only to misconstrue the value of interactions
between pharmaceutical research companies and health care
professionals."

In 2003, Vermont became the first state in the country to require drug
manufacturers to disclose the gifts, payments, travel reimbursements
and other financial donations to doctors and others in the field.

Johnson said in an e-mail Tuesday that such expenditures are used to
inform and educate physicians on new medications entering the
marketplace. Any legislation that might discourage those interactions,
Johnson said, does a disservice to patients.

"The current statute in Vermont does not acknowledge that meetings
with technically trained pharmaceutical research company
representatives — many of whom are health care professionals
themselves — are one of several important ways for physicians to
receive the information they need to make sure medicines are used
properly and patients are safely and effectively treated," Johnson
said.

According to Brill, drug companies have concentrated the bulk of their
marketing budgets on only a small group of physicians.

"We have seen more money being spent and we have seen that money
concentrated in fewer people and concentrated in fewer practice
areas," Brill said. "Part of that is manufacturers are focused on
thought leaders — people influential in the prescribing community
either because they're conducting studies or they're people who are
well-respected in their fields."

Eleven psychiatrists received a total of almost $630,000, or about 20
percent of combined marketing expenditures in the state, the study
found. That amounts to about $57,000 per psychiatrist, on average.

Physicians specializing in cardiovascular disease received the second
largest aggregate amount, with two doctors splitting a total of more
than $300,000. Laws protecting trade secrets prevent the Office of the
Attorney General from disclosing the names of specific physicians
receiving payments.

Brill said the data offers no insight on whether marketing budgets
directly influence prescribing behavior.

"We don't have any definitive information on it yet, but some people
certainly believe that to be the case," Brill said.

This report marked the first year that Vermont required manufacturers
to disclose which drugs were being marketed. She said the state will
use that information in a future study to determine whether
prescription rates rise alongside marketing budgets.

Ken Libertoff, executive director of the Vermont Association for
Mental Health, said he worries that financial incentives are playing a
role in doctors' prescribing behaviors.

"This report confirms that there's been an enormous intrusion of
pharmaceutical marketing and pharmaceutical gifts to physicians
throughout the state," Libertoff said. "Â… The mixture of marketing and
money and medicine is a formula for disaster, and we think that this
report confirms concerns about whether consumers and patients are
receiving the best care and the best practice."

While recognizing the potential benefits of psychotropic medications
for certain mental health patients, Libertoff said drug makers may use
financial incentives to conceal or downplay adverse side effects.

"What we would consider huge financial payments have basically
polluted health care," Libertoff said.

Libertoff said that in order for Vermont physicians to "reclaim their
high status as patient-centered health care providers," they must
refuse to take any gifts or payments from the pharmaceutical industry.

He called on industry leaders, including the Vermont Medical Society
and Vermont Psychiatric Association, to fashion an official policy
calling on doctors to decline any future payments.

Link to article:
http://www.rutlandherald.com/apps/pbcs.dll/article?AID=/20080709/NEWS03/80709038...