Gifts that keep on giving: pharma should disclose all links to doctors

If there are legitimate reasons for drug companies to gift doctors, then it should be disclosed. Steven Depolo/Flickr

How would you feel if your local GP or specialist was pocketing money from a drug company to promote its products? If your gut tells you that this falls squarely into the category of Very Bad Ideas then it turns out that you’re out of step with most Australians — or, you would be if you believe the PR efforts of drug companies.

A recent press release trumpeted “Majority support sponsorship between pharmaceutical companies and healthcare professionals if publicly declared.” It was issued by GlaxoSmithKline, which manufactures everything from Panadol to the asthma medication Ventolin to the antidepressant Aropax.

The surprising claim was based on a questionnaire completed by more than 1,000 Australians that asked how respondents felt about pharmaceutical companies paying fees to doctors – 90% viewed it in a negative light. But opposition melted away when people were given — in the words of the press release — “further information about the purpose of the funding”.

So what was this “further information”?

Here’s the text from the questionnaire: “The fees may be paid to help fund medical research, clinical education programs and provide payments for those that devote time to develop new medicines and advise how best to use them.”

Pharmaceutical companies helping to fund medical research programs was supported by 79% of respondents and 71% agreed with money being used to fund clinical education programs.

Now, on the face of it, it all sounds uncontroversial. After all, who could be opposed to research and education? But the devil, as they say, is in the detail. What, for instance, constitutes an education program?

To most people, that sounds like a pharmaceutical company paying a doctor to undertake further training in new treatments or procedures. The reality, however, is a little different.

In the world of the pharmaceutical industry, education can mean flying a medical “opinion leader” business class to a company-sponsored symposium held at an attractive overseas venue to “educate” GPs about the company’s drugs. The purpose of these educational sessions is, of course, to influence doctors to prescribe the company’s drugs over its competitors.

To be clear, it’s not being suggested that GlaxoSmithKline engages in such activities. But such practices are common within the pharmaceutical industry, and they are lucrative for the individual doctors involved.

Education at company-sponsored symposia can provide a cover for attempts to influence prescribing practices. ShuttrKing|KT/Flickr

An ABC Radio National’s Background Briefing program last year featured former pharmaceutical company representative Petra Helesic. She told of doctors — mainly specialists — being paid between A$750 to $,1500 to deliver a promotional presentation. The drug companies even dictated the topics and provided the PowerPoint slides to ensure the doctor stayed on message.

These “education” sessions weren’t always held in clinics, lecture halls or conference rooms. In some cases, they were held at Sydney’s top restaurants where the assembled doctors were plied with free food and wine.

In Australia at least, pharmaceutical companies aren’t obligated to report the amount spent on such activities. The federal government’s 2011 review of therapeutic goods regulations, which included promotional practices, found pharmaceutical companies can regulate themselves when it comes to paying money to doctors.

This view prevailed despite a range of criticisms of self regulation presented to the government. In his submission to the review of the therapeutic goods regulatory framework, Associate Professor Ken Harvey, senior lecturer in the school of public health at La Trobe University and an expert on health promotion, criticised self-regulation as “self-serving”. I also work for La Trobe University.

Dr Harvey noted that existing rules on public disclosure have gaps — targeting doctors, but not pharmacists, for example — and the penalties imposed are a fraction of their equivalent in the United States.

Drug companies in the United States have far stricter disclosure requirements than in Australia. Since 2010, US drug companies have been compelled to report payments and in-kind support they give to individual doctors over the cumulative amount of $100.

GlaxoSmithKline, to its credit, has led the way in reporting the overall amount it spends on health-care professional sponsorships. Since 2011, it has disclosed the total amount spent on sponsorship of health-care professionals.

But the company’s own research indicates that an overwhelming majority of Australians want the pharmaceuticals industry to take the next step and disclose their relationship with each and every sponsored doctor.

The same questionnaire that asked how people felt about pharmaceutical company payments to doctors found that 65% of respondents prefer drug companies to “disclose each and every individual sponsorship of specific doctors and specialists”.

Perhaps unsurprisingly, this finding didn’t make it into GlaxoSmithKline’s press release.

There may be legitimate reasons for drug companies to pay doctors. But if that’s the case, then it should all be above board. Patients should be able to find out who’s paying their GP or specialist — and possibly influencing their prescribing practices.

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