Kickback by any other name requires full disclosure, even in medical field

If a pharmaceutical rep takes your doctor out to dinner, do you really care?

If a pharmaceutical rep pays your doctor millions in "rebates" for prescribing a particular drug, you probably do care. You might want to know if your doctor is paid more than $100,000 by drug manufacturers for giving lectures on the company's drug.

But how would you know?

AARP proposed a state law that might have provided some answers.

In its original form, Assembly Bill 128 would have required annual public reporting of gifts, fees, payments or other economic benefits with an aggregate value of more than $1,000 given to a doctor by a drug company. You would be able to check out whether the doctor who just prescribed a particular drug had a financial incentive.

But in the past few weeks, this bill has gone from gutsy to gutless.

In case you think this isn't a real problem, a comprehensive May 9 New York Times piece on doctors prescribing drugs for anemia said Amgen Inc. and Johnson & Johnson have paid doctors hundreds of millions a year as "rebates" when they prescribe anemia drugs made by the two companies. Amgen produces Aranesp and Epogen, and Johnson & Johnson produces Procrit.

Elsewhere, the payments would be called kickbacks. In the world of medicine, rebates are legal payments.

Working from documents provided by a whistle-blower, The New York Times cited a cancer clinic in the Pacific Northwest at which six doctors received $2.7 million from Amgen in one year. The six doctors had prescribed $9 million worth of Amgen's anemia drugs.

Although it's illegal for drug companies to pay doctors to prescribe certain medicines, it's legal for companies to rebate part of the price the doctors pay for drugs administered to patients.

Perhaps those doctors would have prescribed those medicines without the financial incentive. But wouldn't you feel better knowing what their reasons were? Is it the best drug or the most lucrative?

AB128, introduced Feb. 20, is still in the Assembly. It passed out of the Commerce and Labor Committee with one amendment pulling out much of its substance. It was referred to Ways and Means, where another amendment pulled out most of the rest.

The original bill would have required the drug companies to file an annual report with the Nevada attorney general listing gifts or economic benefits provided to doctors, pharmacists, health care facility administrators or anyone else authorized to prescribe or dispense prescription drugs. The company would have to detail the "value, nature and purpose" of the economic benefits, which would be posted on a Web site.

There were exemptions for product samples, clinical studies and speaking fees or underwritten costs of educational or scientific conferences.

It was unclear whether the rebates The New York Times reported would have had to be reported under any version of the bill. The bill's primary sponsor, Assemblyman Marcus Conklin, D-Las Vegas, refused repeated requests over seven days for an interview, apparently still sulking over a previous column. (Get over it, Marcus. You're a big boy. Act like it.)

Barry Gold, director of communications for AARP, said the consumer protection bill is similar to bills sought by AARP in other states. So far, only Minnesota has a full-disclosure bill that requires public reporting of all drug company payments to physicians, including payments for lectures. Less rigorous reporting laws passed in Vermont.

The way the Nevada bill now reads is "an incremental step," Gold said diplomatically.

This marks the second time the drug companies have squashed public reporting of their gifts and payments to doctors. Another Conklin bill, AB66, was killed in the Senate in 2005.

The original AB128 was a good disclosure bill. Calling the current version a consumer protection bill would be a big stretch. There's no way to find out what your doctor may or may not have taken from the drug companies, because that's no longer reported.

Perhaps disclosure of financial incentives to doctors would have reduced some of the drug company's costs because doctors wouldn't want their names on such a list. (Just like legislators don't like showing up on reports as taking comps from lobbyists during the session.) Perhaps drug makers would have passed on that savings to consumers.

OK, I'm a dreamer.

Jane Ann Morrison's column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call 383-0275.