Pharma’s Cold Reception in Minnesota
The Minneapolis-St. Paul Star Tribune reports that SMDC Health System has banned all items containing any firm’s logo on the premises. (http://www.startribune.com/lifestyle/health/13881951.html) This applies primarily to pharmaceutical companies and the abundant number of trinkets, such as notepad, pens, pencils, and the rest. Several years ago, Minnesota was one of a small number of states that encouraged state employees to purchase their medications through online pharmacies and distribution houses located in Canada (i.e., drug reimportation). At the time, this was interesting because it represented something of a sanctioned black market, where the federal government was (and continues) to be opposed to reimportation, while a number of states and localities supported the practice due to cost savings. SMDC Health System believes such gratis advertising influences prescribing patterns by their physicians, and the system projects a cost savings in excess of $100,000 through the elimination of inappropriate prescribing.
The Supreme Court, however, has ruled that advertising constitutes free speech and, in the case of health care, the distribution of information. Industry representatives have labeled this new policy as “unfortunate,” but they have not indicated an interest in pursuing the issue in court — as yet. In this case, the industry can hardly bite the hand that feeds them if not being fed. If the practice becomes commonplace, however, it will be interesting to note the positions taken by both sides.
More interesting, is the question of whether there are any unintended consequences with such a practice. It is fully understood by the hospital system that this is likely to incur a reduction in industry support, especially since the new rule reduces access by pharmaceutical sales reps seeking to meet with system practitioners. The health system maintains that there are more appropriate sources of information available to practitioners (such as journal articles and attendance at continuing medical education events) and argues that the information typically provided by sales representatives is skewed to favor the products sold by the represented company.
Potential Unintended Consequences:
A couple of years ago, study results indicating that if a physician were to read one germane journal article per day, that practitioner would be behind by five years before the end of the first year. To the extent that physicians rely on sales representatives for some portion of their professional information, the unintended consequence may be less well-informed practitioners. If the no-logo practice expands, the industry may be less inclined to sponsor continuing medical education conferences, which currently constitute one significant source of medical information for practitioners. Taken to its natural extreme, the inability of the industry to effectively market their products would have the effect of undermining research and development investment. A partial or incremental step in that direction would include a reduction in R&D spending for treatment of low frequency diagnoses and those likely to generate lower profitability – such as medications for treatable conditions, where the goal is to reduce the side effects of drugs currently on the market.
None of this is guaranteed to take place, and, at this early point in the practice of banning logos and other marketing materials, there is no indication that a trend exists along these lines. Moreover, it is certainly not my intent to support the pharmaceutical industry or to oppose what may be an effective approach to reducing the rising cost of health care. Instead, this represents an opportunity to anticipate the unintended consequences – as Edward Tenner recommends in “Why Things Bite Back: Technology and the Revenge of Unintended Consequences.”
