Wednesday, April 27, 2011

House Votes to Repeal "Physician’s Oyster and Wine Takeaway" (POWT)

Hungry Massachusetts doctors seeking a return of free fine dining were salivating yesterday after the House voted to repeal the 2008 Physician’s Oyster and Wine Takeaway (POWT) Act, otherwise known as the Massachusetts Gift Ban. The fate of this mean and stingy bill now rests with the State Senate, which blocked a similar repeal effort last year.

The despicable POWT Act has forced Massachusetts physicians to pay for their own dinners at restaurants such as Davio’s, where an average entrée is 30 to 40 bucks, a chunk of change that our doctors simply cannot afford. Davio’s owner Steve DeFillipo has been on the forefront of anti-POWT lobbying efforts. In fact, he appeared on the Emily Rooney Show last year to debate the repeal effort with a local psychiatrist/blogger (see that blogger's coverage here).

Simply put, physicians need this food subsidy, because in Massachusetts, the median physician income is a paltry $216,700, according to the Massachusetts Medical Society. This is only 7 times the median Massachusetts income of  $30,751. Those who say that doctors are “10 times richer” than other people are engaging in ridiculous hyperbole.

The fact is, your doctor is hungry and shouldn’t have to pay for his own meal after having gone through medical school and residency. You try getting paged at 3 AM and to put an NG tube through someone’s nostrils. These are punishing experiences and doctors deserve special compensation.

Furthermore, as the Massachusetts Restaurant Association has pointed out so eloquently,

 "Restaurants provide much-needed seclusion from the everyday demands and distractions of the workplace. Medical practitioners and physicians are particularly taxed by time constraints and conflicting responsibilities."

Yes, commoners escape workplace demands by going home at 5 or by taking a stroll through a park during lunch. But doctors need raw oysters and wine after a hard day of work—plenty of it, free, and with fawning pharmaceutical reps complimenting them on their knowledge of vintages.

Hopefully the State Senate will realize that Massachusetts doctors have stronger ethical compasses than Massachusetts politicians, who since 2009 have been barred from receiving anything of value from lobbyists. Lawmakers are, indeed, vulnerable to inappropriate influence from meals and other gifts. But physicians would never prescribe more Abilify after enjoying a steak dinner funded by Bristol-Myers Squibb. After all, they’re doctors!

More coverage:

-CommonHealth Blog (WBUR)
-Boston Globe
-Health Care For All


David Behar, M.D., E.J.D. said...

This law was part of insurance company witch hunt. Insurance company intimidation is against the use of brand medication in dark skinned people on Medicaid. They want these folks on cheap gneerics they would not alloin heirso they may pocket the difference in cost.

There is no quid pro quo. The law violates the Freedom of Assembly Clause, the Free Speech Clause (to hear speech), as well as the Commerce Clause, both dormant and awake.

It is a little bit intrusive of the government to dictate with whom one may have dinner.

Mark McConnell, MD said...

It certainly seems reasonable for people to have freedom to assemble (over oysters or not). But if one of the people in the assembly is profiting by influencing another in the assembly to prescribe a drug paid for by the public, then is there not a public right to govern that assembly?

David Behar, M.D., E.J.D. said...

Dr. M: I am trying to sell my home for $500,000. Next door, an untreated paranoid schizophrenic is loudly arguing with the voices in his head. What is the real world value of my house? Isn't actually a negative value? I would have to pay someone to take it off my hands.

As a taxpayer, I have paid for the treatment and am getting a 10,000% return on investment. I want the doctor to treat the patient the best way possible, and to apply clinical judgment.

The idea that a dinner can trump patient outcome in prescribing practices is just not realistic. As a taxpayer, I am willing to pay more if it will work, to quiet my neighbor, at least until my house is sold.

David Behar, M.D., E.J.D. said...

Mark: Nice issue spotting. The Supreme Court has given commercial speech less protection than political speech. It applies the criteria of the Central Hudson Test.

"Regulations affecting commercial speech do not violate the First Amendment if:
1. The regulated speech concerns an illegal activity,
2. The speech is misleading, or
3. The government's interest in restricting the speech is substantial, the regulation in question directly advances the government's interest, and
4. The regulation is narrowly tailored to serve the government's interest."

I attended such programs and heard docs bash the product mercilessly. They were useful when I picked up tips to incorporate in my repertoire. Misleading such an audience would be suicidal for a company. I know of no evidence of harm to patients.