These Gifts Are Bad for Our Health

"I think the public would be outraged if it knew the extent of the industry's influence in prescribing decisions," says Shumlin. "We hoped to force industry to show the extent of these practices, and hoped to embarrass doctors into changing their own practices." Hoping that these changes in practice would help stem the rising costs of prescription drugs, 23 states have since considered, and a handful have adopted, similar legislation.

So far, however, industry has exploited loopholes in the Vermont legislation to avoid full public disclosure. For instance, the law says that gifts under $25 or grants for "research" need not be reported. And even when those gifts are reported to the government, the disclosure can be withheld from the public if the industry designates its own reports as "trade secrets." And the reports of gifts are made to the state attorney general's office, which doesn't keep a public database with real-life physicians' names and gift descriptions.

Instead, the attorney general issues annual overviews. In the May 2005 report, the most recent, the industry reported about $3.11 million in gifts in Vermont. None of the state's 2,200 doctors are named.

Nancy Chard, a Vermont state senator on the conference committee that forged the legislation, says, "Doctors' names should be out there. But the bill got toned down to a point where it's just a happy memory. I'm proud of having done it, but it's not a viable piece of legislation. There are so damn many bad guys in this thing."

Worried that Congress might spoil the party, some organizations have begun self-regulation. The American Medical Association and the pharmaceutical industry issued a set of voluntary guidelines on gifts. For instance, gifts should be under $100 in value unless they are payments as part of a formal consulting relationship. This gesture, and $91 million in campaign contributions the two industries made during the 2004 election cycle, have been enough to keep Congress out of this dogfight.

Given the amount spent on marketing per physician, it's clear that many gifts are not within the AMA guidelines. In Vermont, many reported payments to individual physicians ran into the thousands of dollars. "I'll tell you one thing," says Chard. "There are still plenty of [pharmaceutical] dinners going on at the local fancy restaurants."

"It's unconscionable that they're spending $3 million on trinkets here in Vermont when my patients can't afford to pay for the medications to treat their high blood pressure," says Benjamin Littenberg, director of general internal medicine at the University of Vermont. Littenberg accepts no gifts, no drug detailers and no materials from drug companies or their sales reps. (He's also never written a single prescription for Vioxx.)

Legislators in Vermont started with the simple idea that the billions of dollars industry hands to physicians should be public knowledge. And there are some simple ways to fix the rules the law established.

· Remove trade secret exemptions that subvert the entire point of the law. Allowing a drug company to decide what is a trade secret is like permitting John McEnroe to make his own line calls.

· Require disclosure of the identities of gift recipients. Imagine if all political contributions had to be disclosed, but the public never learned who received them.