This week Radio National’s Background Briefing looks at how pharmaceutical companies market their products to doctors.
The program is presented by Ray Moynihan, an award-winning journalist, columnist at the British Medical Journal and conjoint lecturer at the University of Newcastle.
You’ve written and researched extensively about the business of medicine – what is it that attracts you to this area?
It’s a good story. I’m essentially a journalist and the corruption within the medical world is an incredible story to follow and investigate.
The extent of the financial entanglement between doctors and drug companies seems to know no bounds and I think it’s vitally important that there’s more scrutiny of these relationships.
The reason people are interested in doctor-drug company relations is not because of the desire to expose doctors wining and dining habits, the reason to expose this is because it distorts prescribing patterns and it means doctors are more likely to prescribe the latest and most expensive medicines. Sometimes a good thing but other times, wasteful and dangerous.
The example we use in the program is the antidepressant Cymbalta. Here’s a drug that is getting the thumbs down from a number of independent educational groups but is being ferociously promoted by drug company reps who stand to get a sizeable bonus if they can get a certain number of patients taking this drug.
And it’s being promoted by specialists, who are being paid generous fees secretly to present company slides about it at “educational events” to their peers.
This is an extremely unhealthy aspect of the Australian health-care system, and I think one of the most frightening aspects of what Petra Helesic [a former drug company insider] says is how she became aware in recent years of how aggressively anti-psychotic drugs were being marketed for depression.
That, in itself, is worthy of a great deal of public scrutiny.
What can be done to ensure the independence of the medical profession?
There are many ways in which doctors, professional groups, universities, hospitals and other players in the health-care system can roll back their interaction with some of the unhealthy marketing practices.
A classic example comes from Christchurch, New Zealand, where many doctors have stopped seeing pharmaceutical company sales representatives and have replaced that kind of interaction with independent education.
In the same town, the college of general practitioners has stopped taking drug company sponsorship for their annual conference.
This is one of many examples around the world where there are small-scale attempts to engender a more independent relationship between health professionals and the pharmaceutical industry.
One of the simple things that every single university could do tomorrow is to mandate all of their staff to declare their financial relationships with drug and device makers and make that available on a publicly-searchable website.
That’s the sort of thing University of Sydney’s Professor Martin Tattersall and others have been suggesting. It’s going to become standard practice around the world and I would love to hear an argument about why it’s not possible for Australian universities to do that.
There’s also a great opportunity here for the tertiary education sector to offer genuinely independent education to our health professionals.
The industry appears to fund the lion’s share of ongoing professional education either directly at these dinners or indirectly through their sponsorship of conferences, seminars and meetings.
But there’s an abundant amount of evidence that industry-funded approaches are not in the best interest of patients or the public.
There’s a real, genuine, timely opportunity for the tertiary education sector to play a bigger role in this kind of education.
The AMA strongly opposes having a public register that names doctors who receive benefits or attend events sponsored by pharmaceutical companies, instead favouring disclosure of the cost of meals and names of restaurants.
AMA president Steve Hambleton says, “bringing it down to an individual level is going too far”. Why do you think the AMA is resisting transparency?
One of the things that Steve Hambleton says very clearly in the program is that one of his concerns is that being on a public register could besmirch a doctor’s reputation.
But if there’s something wrong with being associated with these marketing events, then why are doctors going to them?
If doctors believe that attending drug company lunches and dinners or accepting those generous speaking fees ($750 to $1500) are in the interests of their patients and in the public interest, then they should have no problem at all with that information being transparent and publicly available.
But there’s huge resistance from the AMA in Australia and its very much behind thinking around the world on this.
In fact, one of the senior executives of one of the companies in Australia has already publicly flagged the potential desirability of much greater transparency, in terms of disclosing the names of doctors who attend dinners and the amount of money that drug companies pay to individual specialists.
And Medicines Australia, the industry body for pharmaceutical companies, has said greater transparency is one of the things they will be looking at in their review of their voluntary code.
But more importantly, the United States has a law called the Sunshine Act, which is sitting there as a policy option for the Australian government.
It would be great to hear the argument for why such transparency isn’t appropriate in Australia but is in the United States.
What ways could doctors be learning about medicines that are independent or not emanating from drug companies?
There are three that were mentioned in the program – the National Prescribing Service, which is Australian; the Drugs and Therapeutic Bulletin out of the United Kingdom and; Prescrire which is a very reputable French journal.
There are many other sources, such as the Cochrane Collaboration, and there are many ways in which doctors can educate themselves.
But the truth is that going along to a dinner in a fancy restaurant in your local area is easy, and it’s fun. And you’re treated like a bit of a VIP.
A small but growing number of other doctors are absolutely horrified by the fact that their colleagues are still going in their thousands to these promotional events – which are described as “educational” in an extremely disingenuous way.