Bill seeks to limit drug companies’ influence

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By NANCY HICKS / Lincoln Journal Star

Omaha physician Roger Kobayashi knows the seductive practices of drug reps, who try to win converts to their company’s drugs with the gifts they give.

Through the years, he’s been the “recipient of pharmaceutical attention,” including free meals, concerts at Carnegie Hall and research grants.

Pharmaceutical companies have paid him to speak in Europe and Hawaii. They’ve taken him golfing, to sporting events. He’s even had “dynamic, blue-eyed blondes cozy up to a wrinkled old prune like me,” the doctor said in written testimony to the Legislature’s Health and Human Services.

The gifts have gotten much more expensive than the leather doctor bag filled with equipment that Eli Lilly wanted to give all incoming freshman when he started medical school 37 years ago.

Kobayashi no longer sees drug reps. He has refused to give lectures for drug companies and has stopped doing “research” that was conducted primarily to position a company’s product.

But it hasn’t been easy. Because drug reps are able to get information about physician’s prescribing habits, he is still the target of pharmaceutical salespeople who want to change his prescribing habits.

Kobayashi says he learned about the specifics of this practice years ago when a company accidentally sent him its “dossier” on a group of physicians’ prescribing practices and how influential these physicians were.

The Omaha doctor, an immunologist and allergist, spoke in support of a bill (LB451) that would prohibit pharmacies from selling data to drug companies showing what doctors were prescribing.

Kobayashi described the practice as “abuse of physician confidentiality and privacy,” and said it is used as a tool for companies to target doctors who are not prescribing their drugs. It has been used to influence doctors to prescribe medicines that patients might not need, he told the committee.

But much of his testimony could have been used to support another bill (LB675) that would require pharmaceutical companies to report all gifts above $25 to doctors and hospitals.

Both bills were supported by the AARP of Nebraska as ways to curb rising drug costs. Both were opposed by the Pharmaceutical Research and Manufacturers of America, representing the pharmaceutical industry.

The information-gathering measure would allow senators to find out how much drug companies spend to wine and dine the state’s doctors, trying to influence their prescription habits.

It’s a lot of money if Nebraska is similar to Vermont, which has gathered this kind of data for several years. Pharmaceutical companies spent more than $1.45 million in 2005 on the top 100 recipients in Vermont. The companies spent more than $2.1 million in the state that year, including $204,800 on food, according to information provided by AARP Nebraska.

But company reps are an important educational link to doctors, according to an industry lobbyist. They assure that physicians get the latest, most accurate information, said Tara Ryan, representing the Pharmaceutical Research and Manufacturers of America. The industry also has a voluntary code guiding ethical relationships between industry reps and doctors, Ryan said.

The data on what doctors are prescribing is necessary so companies can target safety messages to physicians who are most likely are using specific drugs, she said.

The data can also be required under FDA risk management plans where companies are required to monitor prescribing practices for specific drugs, she said in opposition to the bill banning release of physician prescription data.

Ryan also pointed out that physicians can ask that their prescription information not be given to pharmaceutical companies under an opt-out program through the American Medical Association. “A mechanism is in place for doctors who don’t want to be inundated with calls,” she said.

Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.