Let Go of Your Hats: A Good Health Bill Will Not Pass In California
Has it been only a few days since I advised readers to “hold on to your hats: a good health bill might actually pass in California”? Although it got through the Senate at the end of May, the Assembly Health Committee killed it unanimously. My previous post responded to a critical examination of the bill by David Lazarus of the Los Angeles Times.
SB-1096 would have allowed pharmacies to perodically send mailings to patients, reminding them about their medicines. As Mr. Lazarus pointed out, this would actually be funded by the brand-name drug makers, who would recruit the mailing company and pay the costs. Needless to say, this is what disturbed the legislators and people who somehow think that it is an invasion of privacy for drug makers to know who is using their products – especiallly because the law provided an “opt out” rather than an “opt in”.
Mr. Lazarus celebrated the bill’s defeat in today’s column, quoting Republican Assemblyman Alan Nakanishi, MD, as favoring “opt in”; but Democratic Assemblywoman Mary Salas dismissing any bill “about opening the door for the pharmaceuticals. The pharmaceuticals want to be able to communicate directly with patients.”
Well, ain’t that a horrible crime! I suppose it’s true that patients using the most profitable drugs will get the most frequent and convincing “reminders” in the mail, as claimed by Jeff Krinsk, a San Diego attorney with a business interest in stopping the bill.
But so what? As I discussed in the previous post, non-adherence to prescription therapy is rampant, and if the profit motive will increase adherence, so much the better. And what about those politicians who are upset that drug makers advertise directly to consumers via TV and print ads? Wouldn’t they be happier to see more targetted communications?
I spoke the other day with a physician who strongly opposed the bill, and is no doubt cheering its defeat. He was concerned about the doctor-patient relationship. Well, fair enough, but if the physician is treating the patient properly, why is he afraid of a pharmacy mailing a letter? Actually, most doctors I know shun responsibility for what patients do, which is appropriate because doctors don’t and can’t control patients’ behavior once they’ve left the office.
Plus, we are talking about information here, and it’s not obvious to me that the information, morally, is the sole property of the doctor and/or patient and/or pharmacy. Are they really telling us that the firm which put its investors’ capital at risk to create this intellectual property should be uniquely forbidden by the state from knowing who is using its products?
And what about post-marketing surveillance – observing and measuring side effects of a new medicine that had not been detected in pre-approval trials? That “process” (and I use the term very loosely) is a mess (largely due to inadequate incentives), and it seems to me that the drug makers could be in a better situation to address this, if they had better information about how their medicines were used in the population.
On the other hand, patients do have a right to privacy, and I fear that if they are forced to “opt out”, pharmacies induced by drug makers to keep them “opted in” to mailings will not be overly forthcoming about the choice to opt out.
Perhaps the law could allow a pharmacy or drug maker to require a deliberate “opt in” or “opt out” before dispensing a prescription. Of course, that might have the unintended consequence of unnecessary bureaucracy and patients refusing to make either choice, so not getting their meds.
Perhaps there is no perfect answer. What else is new?