American College of Physicians: Advocacy in Action: Tackling Pharmaceutical Issues Head-On

ACP member shares the physician's perspective at legislative forum in Texas

Dr. Fred Campbell has spent way too much time trying to convince patients to take his advice about the potential benefits and risks of certain prescription medications.

As he described it, patients often come in armed with information from direct-to-consumer drug advertising and take this as the Holy Grail. "Direct-to-consumer advertising interferes with the physician-patient relationship," he said. "Patients will never believe me over these commercials."

That's one of the many reasons that Campbell, an internist in private practice in San Antonio, Texas, joined forces with U.S. Rep. Lloyd Doggett (D-Texas) at a forum the congressman sponsored in August on prescription drug pricing and other pharmaceutical concerns. The overarching goal of the forum was to foster discussion and put a face on these issues.

"It was a wonderful forum," Campbell said. "We filled an assembly hall with more than 200 people, and it lasted two hours on a Saturday morning." Other legislators, patients, patient advocates and insurance company representatives attended the forum and swapped stories.

For instance, Campbell shared the story of a patient who'd had a coronary artery stent implanted but, a year later, was reluctant to stop Plavix (clopidogrel) because she was confused by a "direct to patient" ad warning her not to. "I had to convince her of the evidence-based risk of future Plavix use and unproven benefit, at some length, due to seemingly contradictory statements from the ad," Campbell said.

Such instances, more typical than rare, have made him favor a ban on direct-to-consumer drug ads, Campbell said. The American College of Physicians supports restrictions on this type of advertising, describing it as "an inappropriate practice." ACP policy says that, "lacking a legislative ban on direct-to-consumer advertising, the U.S. Food and Drug Administration should play a strong role in ensuring the accuracy and clarity of information provided to the public through direct-to-consumer advertising."

On the issue of prescription drug pricing, Doggett said that "physician voices are especially important regarding prescription price gouging."

"With a long history of both effective health care advocacy and professional service, Dr. Fred Campbell described to our Forum the enormous impact of spiraling pharmaceutical prices upon patients and physicians," the congressman said. "I commend Dr. Campbell and ACP for making access to reasonably priced medications a key part of their legislative agenda."

"Government-approved monopolies are demanding prices that far exceed what is required to afford a substantial profit plus the costs of drug research and development," Doggett said. "The EpiPen is only the most recent of many outrageous examples." The price for the emergency auto-injector used by people with allergies rose from less than $100 to more than $600 in roughly the past decade.

Forum participants urged the Centers for Medicare and Medicaid Services to negotiate drug prices directly.

Other issues broached at the forum included calls against evergreening of patent extensions, pay-for-delay deals in which a pharmaceutical company pays a generic producer to delay market entry of a lower-priced competing product, single-sourced generics and adverse formulary practices. "Single-sourced generics that are older can sometimes fall into a situation where they will only be produced by one company for the purposes of profit," Campbell said.

Campbell said he also called for more transparency in research. "If a drug extends life by days, weeks or months, we need to know about associated side effects, such as vomiting or inability to walk," he said. "Quality of life is as important as quantity."

Doggett said he would be encouraging his legislative colleagues to hold similar forums in their districts. To ACP members, he said he would "welcome messages from physicians across the country (email Lloyd.Doggett@mail.house.gov) and hopes these will also be shared with your local member of Congress."

For his part, Campbell sees much work yet to be done. "There are ongoing advocacy efforts at the state and federal level," he said, "and we will continue to work hard at the grassroots level."