Continued Education Critical to Ability of California Physicians to Treat Patients

Dr. Jonathan Katz
Practicing Neurologist in San Francisco

Legislation currently before the Assembly that is aimed at eliminating undue influence in pharmaceutical prescribing will instead hinder the education of California medical professionals and limit their access to critical information about new medicines and treatments.

The intent behind the legislation is to limit the promotional expenditures of the pharmaceutical industry, with the belief that this type of activity is somehow harmful to patient care.

However, SB 790 has the potential to severely limit important educational activities and create an unnecessary regulatory morass for physicians. Limiting communications between the life sciences industries and the treating community will have an unintended chilling effect on the exchange of information about new treatments. The bill could also limit peer educational events that are run by clinicians and happen to be sponsored by the biopharmaceutical industry.

Importantly, the legislation completely misses the point that physicians are not the deciders of medication costs. Physicians are motivated by doing what’s right for patients. We try to strike a balance between prescribing new therapies and limiting costs, but some specialists focus on diseases that have only one medication available to treat their patients. We are professionally compelled to make the right treatment decisions based on patient health. Promotional activity plays no role in those decisions.

The legislation goes too far in trying to come up with a catch-all solution – while supported by some generalists, it fails to take into account differences in the way different specialties practice. For example, in my highly specialized field of neuromuscular disease, we see patients with a number of rare and fatal diseases with complicated mechanisms, and often with only one medication available to treat. Expensive new medications may be highly effective compared to older therapies and the doctors are highly aware of cost-benefit issues. By contrast, internists have the choice of numerous common medications that do not offer major medical benefits.

Fortunately, medical progress has precipitated the introduction of several new treatments to the market. Having relationships with the companies that develop those treatments is most beneficial to patients. We work closely with companies in planning clinical trials and educational activities. Our offices serve as centers where multiple concerns can come together, including patients, physicians and industry. It is shortsighted to think that resources directed towards this type of communication are harmful – we all work together to create expectations of how treatments work and their value.

Improving healthcare, in general, will rely on all stakeholders working together. Ethical interactions between the pharmaceutical industry and the medical community are a critical part of improving patient care. They provide an opportunity to obtain valuable clinical and scientific information about new medications and treatment options.

Reducing educational resources by forming unneeded barriers to communication is not the answer.

For their part, manufacturers should focus more funds on education in order to promote fair, open discussion, and collaboration between members of the treating community. Other members of the community such as insurers and advocacy groups should also provide support for open, expert-led, dialogue.

SB 790 broadly and cavalierly approaches “gifts” to physicians. But conferring critical education is not a free “gift,” except to the patients whose health it helps improve. Any legislative attempt to address pharmaceutical “gifts” should be cautious not to limit the free exchange of necessary educational resources for physicians.

I urge California legislators to reject SB 790, which is unnecessary regulation that could have a detrimental impact on the health of Californians.

Dr. Jonathan Katz is a practicing neurologist in San Francisco.

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