Got an email first thing this morning from PhRMA, the association for the drug manufacturers. It follows stories that have appeared this week about the annual report on spending by drug companies on marketing and education -- money paid primarily to Vermont doctors. Drug manufacturers spent $3.1 million in Vermont during a 12-month period that ended a year ago. That doesn't count free samples, drug rebates or scholarships to educational programs.

Anyway, the email declared that PhRMA (Pharmaceutical Research and Manufacturers of America) had revised its "code on interactions with health care professionals." The new code takes effect in January.

PhRMA doesn't like Vermont's disclosure law. Ken Johnson, senior vice president, said in a statement issued earlier in the week that it discouraged important interaction between doctors and pharmaceutical representatives -- collaboration and education. This morning's email elaborates on his argument. "Providing physicians with up-to-date, accurate information about the medicines they prescribe clearly improves patient care and advances health care in general. Pharmaceutical research companies that discover and develop new medicines are the most knowledgeable about their products and are in the best position to inform health care professional about a wide range of topics related to these medicines, including new treatment options, appropriate dosing, emerging safety development and potential interactions with other drugs."

Ken Libertoff, executive director of the Vermont Association for Mental Health, worries that drug companies promote sales to enhance the bottom line more than educate. That's why he objects to doctors taking drug money and is calling for a statewide weaning -- by individual docs, hospitals, the medical school, and advocacy groups. His own organization went cold turkey a year ago. The Vermont Medical Society takes no drug dollars and neither does the Vermont Psychiatric Association -- but Vermont doctors do accept the dollars.

So in the wake of stories about the increasing amount of money being spent in Vermont on "marketing" and Libertoff's call to "just say no," PhRMA sends this email with its new responsible marketing guidelines.

1. No more promotional items such as pens, mugs and other "reminder objects" with company logos. Such items, although of minimal value, "may foster misperceptions that company interactions with health care professional are not based on informing them about medical and scientific issues."
2. No more free lunch, meaning no restaurant meals, but companies can help pay for occasional meals at the offices of health professionals in conjunction with informational presentations. Further, the code says companies shouldn't provide any entertainment or recreational benefits to health care professionals.
3. Companies are supposed to ensure their staff know the rules of ethical conduct and PhRMA suggests they check up periodically.
4. PhRMA asks companies to promise to abide by the code and have their top officials certify each year that they are.

My, the times they are a changin'.

Libertoff called the drug companies giants, but it looks like people like him and Vermont's disclosure law have put some pebbles in the giants' shoes. The last line of PhRMA's email identifies the "blister" that's developing. The changes in the code and the drug companies' "acceptance" of proposed federal legislation shining a light on physician payments "reflect PhRMA's position that appropriate transparency in relationships with health care professionals can help build and maintain patient trust in the health care system." There is it -- the looming problem -- patient or public trust.

So, is Libertoff right? Should docs swear off all drug company dollars?Or is the PhRMA spokesman right that who better to talk about a drug than a representative of the company who developed it? Or a local doctor who has had some experience with a medication? (hence the speaker fee)

-- Nancy Remsen