Big PHarma, Conflicts of Interest, Undue Influence, “Freedom of Speech”

The drug industry does everything it can to influence physician’s and patient’s treatment decisions. They spend more on drug promotion than on drug research. They have innumerable physicians, research and practicing, on their payrolls–by offering grants, honorariae, or simply putting them on salary. And it works, it’s well documented that these conflicts of interest influence physician’s choices of treatment.

So it was not surprising to learn that these companies “data mine,” review records of prescriptions at pharmacies, to learn what doctors are prescribing and where to put their emphasis as they propagandize. What is surprising is the recent Supreme Court decision that it is unconstitutional to limit the right of drug companies access to these confidential records.

Concern about detailing has prompted at least 25 states to consider legislation to curtail it by restricting the transfer and use of physician-identifiable prescribing data.13 Laws passed in 3 states — Vermont, New Hampshire, and Maine — were swiftly challenged by PDIs and a trade association of pharmaceutical manufacturers.14-16 One of these challenges reached the nation’s highest court this year, and on June 23, the Supreme Court struck down Vermont’s statute by a vote of 6 to 3,17 holding that in practical effect, the law unconstitutionally restricted the speech of pharmaceutical companies and PDIs on the basis of the viewpoint it expressed. In this article, we review the Court’s reasoning and examine the implications of its holding.

What’s remarkable is that the Court views this a “freedom of speech” issue, once again elevating corporations to the level of citizenship. (As they did with political contributions)

The NEJM concluded:

The Sorrell decision impedes states’ efforts to curb detailing. Clever lawmakers may, however, be able to write their way around the Court’s ruling. The decision might also offer an unexpected dividend to opponents of data mining: the surrounding publicity might alert physicians to their right to opt out of sharing their prescribing information through the PDRP. Although the Supreme Court swept aside data-mining laws with the stroke of a pen, physicians who object to data sharing can escape it with the click of a mouse.

Medicynical Note: Our single minded Supreme Court appears to value the “citizenship” of corporations over individuals. Money appears to be a form of free speech whether in the form of political contributions or the ability to unduly influence prescribers in our non-system of health care. More American Exceptionalism.

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