When ethics rules get in the way of patient care

Melissa Jones, a nurse educator with Alosa Health, explains opioid prescribing guidelines at a doctor’s office in Elizabeth, Pa.
Melissa Jones, a nurse educator with Alosa Health, explains opioid prescribing guidelines at a doctor’s office in Elizabeth, Pa. Associated Press

For California physicians and physician’s assistants, professional education does not stop at graduation from medical school or a PA program. The most effective and engaged medical professionals will learn throughout their careers from the experiences of their peers, clinicians and other medical experts.

Unfortunately, legislation before the state Assembly may unnecessarily curtail that education and inadvertently harm California patients.

Senate Bill 790, which goes before the Assembly Health Committee on Tuesday, would strictly limit gifts and other benefits that pharmaceutical companies can confer on medical professionals.

We think the intent of the bill is a good one – to help eliminate potential undue influence from drugmakers on prescribing patterns. However, we are concerned that an unintended consequence will be to limit critical educational opportunities and the exchange of important research about new medications or treatments.

Often, medical professionals attend educational events that also sometimes happen to be sponsored by pharmaceutical companies. Ethical interactions between the industry and health care providers should be encouraged to advance patient care.

Regulations that clearly guide these interactions and punish the isolated bad actors will help maintain public trust in medical professionals. Fortunately, such regulations already exist in both federal and state laws. The Physician Payments Sunshine Act requires pharmaceutical, medical device, biological and medical supply manufacturers to report payments or other benefits to some medical professionals. In addition, California already requires every pharmaceutical company to adopt a compliance program that includes limits on gifts and incentives to health professionals.

Even the appearance of a conflict of interest can be harmful to the health care system and the faith that patients have in their medical professionals. SB 790 can be improved by ensuring that educational programs sponsored by pharmaceutical companies will be free of conflict by requiring that they are not branded and cover a topic without bias toward one product or company. A substantial portion of talks are already given in this format.

However, it is also vital that SB 790 is changed to ensure health providers will not lose educational opportunities they have relied on for many years. The proposed $250 annual limit on all meals and other refreshments at these events will lead to professionals either not attending or only attending one or two a year.

We respectfully urge members of the Legislature to amend SB 790 and make it a positive step in assuring proper education of health care professionals in California.

Gary Feldman, a Los Angeles rheumatologist, is past president of the California Rheumatology Alliance and can be contacted at Eric Glassman, an Irvine physician’s assistant, is past president of the California Academy of PAs and can be contacted at