Map of life expectancy at birth from Global Education Project.

Wednesday, February 28, 2007

Sorry Doc, you'll have to buy your own Yankees tickets

Those of you with a very long memory will remember that last year, a bunch of people with letters after their names proposed a new code of regulations to stop drug companies from bribing doctors. Well, talk is cheap, but the Pew Charitable Trust has put up real money, $6 million in fact (enough to keep the Iraq war going for an hour or so), to try to actually make it happen.

The Prescription Project is led by my old friend Rob Restruccia, but he didn't approve this message, it's just coming from me. The PP is going to campaign among "academic medical centers, professional medical societies and public and private payers to end conflicts of interest resulting from the $12 billion spent annually on pharmaceutical marketing."

This is a promising development. However, the only real clout behind it is moral persuasion. The drug companies certainly aren't going to cave voluntarily, and unfortunately one of the deep dark secrets about academic medical centers is that nobody is really in charge. Every department is a fiefdom. Similarly, nobody tells individual physicians or group practices what to do, no matter what ethical codes the medical societies propound. Insurers can try to make rules about what prescriptions doctors write, but they have no practical way of enforcing appropriate choices among alternatives, and they have no way of getting inside of doctor's offices and practices to stop them from taking bribes from drug dealers. I fear that without legislation - you know, that evil Big Government -- actually restricting drug company practices, this is going to be something of a cat herding exercise.

But we'll see. You go, Rob.

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