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A move by New Jersey to become the first state in the US to regulate the relationship of doctors to drug companies is sparking a debate over the best way to counter the power of Big Pharma.
Last month, NJ Attorney General Anne Milgram released a 22-page report limiting the gifts doctors can accept from drug companies -- among other things saying they can no longer accept free lunches, gifts worth more than $200 (US) and banning them from putting their name on ghostwritten articles. It also calls for tighter controls on doctors' financial disclosure and limits on drug companies paying for doctor retraining.
All are methods used by drug companies to market their products to the doctors who write the prescriptions. New Jersey has one of the highest concentrations of drug companies in the U.S.
The Medical Society of New Jersey, however, says doctors should not be targeted.
Spokesman Daniel Klim said the task force's time could have been better spent on other issues.
"We don't believe that pharmaceutical gifts influence medical decision-making as much as, say, a patient's insurance plan," he said. Klim said that physicians follow a code of ethics and that real conflicts were rare.
"I think in any industry you could find negativity," he said.
Milgram defended the report, saying the state has greater jurisdiction over doctors. "It really is, at the end of the day, each individual doctor's conflict of interest as much as it is the industry's."
Other states, such as Massachusetts and Vermont, put the reporting onus on industry instead of physicians.
Daniel Hoffman, president of the consulting firm Pharmaceutical Business Research Associates in Glenmoore, Pa., supported the restrictions, saying small gifts lead to bigger benefits, such as free education courses.
"It's sort of the opening gambit to a one-hand-washes-the-other relationship that I think has to be broken, to which this kind of ban can be useful," he said.
Industry groups agreed with Klim, however.
Dave Knowlton, president of the nonprofit New Jersey Health Care Quality Institute, said the state should be wary of putting new regulations on doctors who already have too many hoops to jump through.
"I really think that we should be diligent about saying, 'Let's not put another hassle on them unless we really think there's a need for it,' " he said.
Knowlton was on the task force and said he was frustrated that he and other members were left out of much of the process.
He wanted proof that the regulations were needed, arguing that many of the abuses of years past had been remedied through voluntary actions by manufacturers and federal regulations controlling such things as payments to physicians during drug and product trials.
The US federal government is working on regulations governing the drug companies, but Milgram said action is needed now: "To me, the argument of 'please just wait [for a federal plan]' isn't fair to the consumer, because people go to the doctor's every day."
The report makes 22 recommendations in all.
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