Doctors groups said the practice of drug companies and medical device manufacturers trying to influence doctors with gifts, payments and free food is still a problem, but much less so than 10 to 20 years ago, when the practice was more widespread.

However, there’s no way to statistically validate a trend because the federal data only go back to August 2013. The Affordable Care Act – approved in 2010 – mandated transparency in such transactions.

A wide range of companies are subject to the reporting requirement, including the manufacturers of widely used drugs such as Eliquis, a blood thinner, Humira, a diabetes drug, and Synthroid, a thyroid drug. Medical devices covered in the database range from replacement joints and hospital beds to computer software and surgical tools.

Nationwide, payments to doctors from drug companies or medical device companies totaled $6.25 billion to 810,000 doctors since August 2013. In Maine, from 2013-15, such payments for all drugs and devices totaled $11.9 million.

Payments in Maine to doctors by drug companies selling opioids more than doubled from 2014 to 2015, from $21,654 to $42,550 in 2015 at the same time the opioid crisis worsened.

Gordon Smith, executive vice president of the Maine Medical Association, which represents doctors before the Legislature, said he knows from talking to doctors that the practice was more common years ago, when the free food flowed and doctors were more likely to go on all-expenses-paid junkets to warm places in the winter.

Smith said as more doctors and health systems become aware of the largesse by pharmaceutical reps – and how it could compromise prescribing patterns – health networks started clamping down on the practice.

Within the past decade or so, major health organizations such as Maine Medical Center, Eastern Maine Medical Center, MaineGeneral Medical Center in Augusta and others have banned or tightly controlled visits by pharmaceutical reps.

John Porter, spokesman for MaineHealth, the parent company of Maine Med, said the policy in place at Maine Med-affiliated practices strictly bans all gifts and free food by pharmaceutical representatives, and also prohibits doctors from accepting consulting or speaking fees from drug companies.

“We became aware of this as a concern in the industry several years ago, and we have taken appropriate steps to address this issue,” Porter said.

In Maine, most doctors are in a hospital network, and there are few independent physicians.

Porter said while the policy only affects Maine Med-affiliated practices, he believes it or a similar policy has been adopted at many MaineHealth hospitals and physician practices.

But Dr. Eric Campbell, a Harvard Medical School ethics professor who has studied the issue, said without data from years ago, it’s difficult to know whether these efforts have really been curbed. And Campbell said just because a policy is in place doesn’t mean doctors are following the policy.

Smith said even though he believes the practice has been reduced, it frustrates him to hear that opioid industry representatives are spreading messages counter to what the Maine Medical Association is trying to promote about opioids. The association is trying to persuade doctors to minimize opioid prescribing, especially for chronic pain.

Smith said the transparency mandated by the ACA on these transactions is helpful. Patients can look up their doctor at the propublica.org website.

“Your patients have the right to know that you’re not on the take and that the only thing you have in mind when prescribing for them is their health,” Smith said.

 

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