Liberty Duke, of Clanton, is a lobbyist for Maryland-based MedImmune, which manufactures a drug called palivizumab (brand name Synagis). State Senator Gerald Dial (R-Lineville) introduced a bill in the 2013 legislative session that would boost use of Synagis in an effort to reduce the state's infant-mortality rate.
The proposed legislation, styled Senate Bill 3 (SB 3), is controversial because a number of medical professionals in the state have said it actually could harm infants. The Anniston Star added another layer of controversy when it reported in January that Dial had received a $500 donation from MedImmune in October 2010.
As for Liberty Duke, the Alabama Ethics Commission lists her as a registered lobbyist for MedImmune--and sources tell Legal Schnauzer that she has developed a close working relationship with Sen. Dial.
We reported in January that Duke and Rob Riley, a Homewood lawyer and son of former GOP Governor Bob Riley, had an extramarital affair that led to a number of personal and political complications. From our earlier report:
The reports about an extramarital affair, and the ugly repercussions from it, raise new questions about the ethics of a political family that has claimed to be opposed to abortion rights, gambling, and other cultural issues on moral grounds.
It also raises new questions about a political son who is seen as a possible future governor, even though he already has a checkered ethical past. Rob Riley's slippery grasp on matters of right and wrong dates at least to 1996. That's when he engaged in campaign-finance irregularities, on his father's behalf, and eventually received a $10,000 fine from the Federal Elections Commission.
The latest revelations could prove to be far more damaging than the FEC case to any future political hopes Rob Riley might have. In a pair of telephone interviews with Legal Schnauzer, Riley admitted knowing Liberty Duke, but denied having an affair with her. During our conversations, Riley angrily hung up on me three times.
Liberty Duke did not respond to a voice message, seeking comment.
We will be disclosing details about the Rob Riley/Liberty Duke relationship in a series of upcoming posts.
According to records from the Alabama Secretary of State’s office, MedImmune donated $500 to Dial in October 2010. Dial has received several contributions from the pharmaceutical industry over the years, including $1,000 from the Alabama Pharmacy Association in 2011 and $500 from Takeda Pharmaceutical last year.
Dial said he did not remember receiving any money from MedImmune but that the bill is targeted at the use of Synagis.
“I’ve been in this way too long so I don’t let money impact me . . . this is just something I feel passionately about,” Dial said of his efforts to help premature infants.
Synagis is used to treat respiratory synctytial virus (RSV), a common lung ailment among infants. The drug is designed to reduce severe lung infections in high-risk babies.
Dial's bill would require the Alabama Medicaid Agency to ensure medications given to premature infants are dosed according to Food and Drug Administration (FDA) guidelines, which recommend doses higher than those Medicaid currently uses. But some physicians say that approach would do more harm than good. From The Anniston Star:
Grant Allen, president of the Alabama Chapter of the American Academy of Pediatrics, said . . . that his organization opposed the FDA guidelines requirement in Dial’s bill. Allen wrote that the Alabama Medicaid Agency currently follows guidelines for use of the drug in infants listed in the AAP Redbook, which has more up-to-date medical recommendations than the FDA. The AAP Redbook is produced by the American Academy of Pediatrics.
“The guidelines … more than adequately protect the population with RSV while balancing the high cost of expanded use of this drug to the state Medicaid program,” Allen wrote. “These guidelines are based on the recommendations of dozens of our country’s top pediatric infectious disease experts who have carefully deliberated on how best to use it.”
Huntsville pediatrician Pippa Abston says SB 3 is a rehash of an almost identical bill that died in the 2012 legislature. She wrote a blog post called "Stop the Forced Drugging of Babies: Say No to SB 3." Abston calls Dial's handiwork a "drug company bill" and says, in fact, it has become known in Montgomery as "the MedImmune bill." From the Abston blog post:
If used according to the FDA guidelines applied to ALL infants born at less than 37 weeks gestation, this bill would have cost our state about $9 million extra a year with no clear additional benefit. The FDA specifies it is to be used for prevention in high risk groups of pediatric patients (but gives no age limit or definition of high risk), for the duration of RSV season, usually 5 months in the Northern hemisphere. Pediatricians and insurers, including Alabama Medicaid, use published research and guidelines to decide when to prescribe palivizumab and the number of doses to give for each group (5 for some, 3 for others), and [the bill] would have prevented us from practicing according to good evidence.
Here is what the bill really says, in effect: “Medicaid must ensure that palivizumab is given to babies who shouldn’t get it at all, according to the best research, and that babies who should only get 3 doses are given 5 instead.” Intentionally giving unneeded medication or more doses than are needed to babies is at best fraud and at worst malpractice.
Is SB 3 really about reducing infant mortality in Alabama? Or is it designed to help Liberty Duke, Gerald Dial, and their allies cash in?
Infant mortality in Alabama is certainly a travesty. Death rates of over 20 per 1,000 births in some counties put us in third world country territory. But these sad numbers have nothing to do with palivizumab, which has never been proven to decrease the death rate anyway. The deaths are primarily related to prematurity and lack of prenatal care. Universal insurance, expansion of our rural labor and delivery capacity, and rural prenatal clinics in the state are critically needed. Diverting millions of dollars and legislative effort on the wrong solution will not help matters.