opinion

As Minnesota and the nation struggle to deliver high-quality health care more efficiently, one area in need of further reform is the way medications are marketed, prescribed and used.

Advancements in pharmaceutical technology over the last 100 years have saved or improved millions of lives. However, as with many useful medications, there have also been serious side effects, such as the use of medications for the creation of illegal drugs; widespread abuse of prescription drugs; doctor shopping; the environmental impacts of pharmaceutical disposal, and the subtle, yet ultimately unhealthy marketing-industry practices that have grown around pharmaceutical use.

Minnesota has led the way in combating these consequences, as one of the first states to implement safeguards for the sale of over-the counter cold medicines that contained pseudoephedrine used to make illegal methamphetamines. Recently, Minnesota launched a statewide database that will track prescriptions for Vicodin, OxyContin and other addictive pain medications that, much to the concern of law enforcement agencies, are showing up on the streets. The state also is exploring the impact of pharmaceuticals that end up in the water supply.

One of those bills, SF 1044, places restrictions on the marketing practices of pharmaceutical manufacturers. Today, when you fill a prescription, the data from that transaction enters a database that is sold by the American Medical Association to data-mining firms. These firms, in turn, identify doctors by their prescription-writing tendencies and sell this valuable information to pharmaceutical companies. This information helps the pharmaceutical companies target doctors and tailor marketing efforts in order to shift those doctors into patent-protected products, many of which have only marginal benefits over the replaced drugs.

This practice is good for the drug companies but bad for the consumer. It contributes to the ever-rising cost of prescription medications and the overprescribing of expensive brand-name medicines.

A companion bill, SF 895, provides prescribers with objective information on medications based upon evidence-based science. Those providing this information would be doctors, nurses and pharmacists, not employed by any pharmaceutical company. Having a consultant team available to provide balanced information will help medical professionals make better decisions for their patients based on the most effective treatment, rather than the business interest of a private entity. This is one effective measure we can implement to stem the tide of deaths due to adverse reactions to pharmaceuticals, which runs into the tens of thousands each year.

In 1993, Minnesota was one of the first states to prohibit pharmaceutical companies from bestowing expensive gifts and other forms of compensation on health care professionals. However, the language has remained vague, and many companies have found ways around the law. The third bill in this package, SF 1237, strengthens the law already in place.

It is important to note that these bills have received support from the Minnesota Medical Association, from several local health plans and from many hospitals. Anyone who has listened to direct-to-consumer television ads for the latest and greatest drug to hit the market knows that the list of possible adverse reactions can far outweigh the benefits. We also know that there have been instances of widespread sales of medications that have led to many deaths, despite inside knowledge of the dangers.

It is critical that prescribing doctors are convinced by the evidence and are not swayed by a persuasive representative armed with information about prescribing habits.

John Doll, DFL-Burnsville, and Kathy Sheran, DFL-Mankato, are members of the Minnesota Senate. Doll is the author of SF 1044. Sheran is the author of SF 895.