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Healthy Skepticism Library item: 16476

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

Moynihan R
Financial ties that threaten health
The Sydney Morning Herald 2009 Sep 10
http://www.smh.com.au/opinion/contributors/financial-ties-that-threaten-health-20090909-fhl1.html


Full text:

This week we learnt that manufacturers of surgical implants and devices have been secretly wooing Australian doctors with lucrative consultancies, trips away and tickets to the World Cup. Last week we heard that the planet’s biggest drug company, Pfizer, had been systematically paying kickbacks to doctors in the US to promote blockbuster drugs, plying them with free massages, golf trips and a host of other juicy inducements.

These scandals are not just about the salacious details of doctors’ lives. Influence from hidden financial ties is a threat to public health. Evidence shows that such ties can distort the way that practitioners treat us.

New technologies can save lives and reduce suffering, but they can also cause harm and waste millions of dollars. Each year hundreds of Australians are seriously injured by implants and devices. Yet some surgeons are apparently being paid up to $3000 a day by companies keen to expand sales of their devices, presumably without the knowledge of patients. When was the last time a specialist disclosed a conflict of interest to you?

Pfizer, among other things, paid doctors to promote an anti-arthritis drug for conditions for which approval was explicitly withheld, in part because of serious safety concerns. Pfizer faces a criminal fine of more than $US1 billion, the biggest in US history, on top of more than $US1 billion in civil penalties.

Repeated scandals in the United States and an aggressive congressional committee provoked the drafting of the Sunshine Act, which would force drug and device makers to disclose every payment they made to doctors on a database. You could check how often your doctor was being taken to “educational” lunches by a drug company before accepting your doctor’s prescription for that company’s drug.

The reform will bring a refreshing breeze of transparency to the corridors of medical power, and its simplicity may well appeal to policy makers here. In the latest Medical Journal of Australia, the editor, Martin Van Der Weyden, describes our approach to disclosure as “hopelessly fragmented”. He calls for comprehensive disclosure, backed by a national organisation with clout.

Yesterday the parliamentary secretary for health, Mark Butler, said providing inducements to prescribe is “simply unacceptable” and authorities would meet industry players in the hope of strengthening codes of conduct.

But observers of doctor-drug company relationships, like Peter Mansfield from Healthy Skepticism (formerly the Medical Lobby for Appropriate Marketing), argue that self-regulation is a failure. “Industry won’t stop marketing strategies that work,” he says, adding that a Sunshine Act would be a step in the right direction.

The policy director at Choice, Gordon Renouf, says consumers want a regime to remove conflicts of interest and promote transparency. Self-regulation has not done that, in his opinion. The executive director of the Consumers Health Forum, Carol Bennett, wants an overhaul, not tinkering.

In recent weeks there have been attacks on the exorbitant incomes of some specialists, and the Health Minister has pointed out that many doctors prescribe expensive drugs and devices when less expensive ones may be as good, or better. Doctors have complained that clinical decisions are for them to make, not governments. But those complaints would have more credibility if there were fewer doctors on the payroll as “key opinion leaders”, attending sponsored seminars at swish hotels that are marketed as “education”.

The entanglement between industry and the medical profession has grown out of control, and calls for greater separation now come from the highest levels of the medical establishment.

A recent report from the Institute of Medicine, part of the US National Academies of Science, argues that collaborations between doctors and industry can benefit society. But critically, it found financial entanglements “present the risk of undue influence” on doctors’ judgments, and may jeopardise scientific integrity, patient care and public trust.

The report recommends new disclosure laws like the Sunshine Act and much greater independence between doctors and industry, a call echoed by task forces and reports everywhere. Last year a report by the Josiah Macy Foundation urged a comprehensive ban on drug and device makers funding doctors’ education.

Disentangling hidden financial ties is harder than forcing their disclosure. While some doctors seek more independence, many will fight to keep the wining and dining for as long as they can.

We know doctors attend about 30,000 “educational” events funded by drug companies in Australia every year, many at extremely lavish restaurants. What we don’t know are the names of those who attend. If we get mandatory disclosure, we soon will.

 

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You are going to have many difficulties. The smokers will not like your message. The tobacco interests will be vigorously opposed. The media and the government will be loath to support these findings. But you have one factor in your favour. What you have going for you is that you are right.
- Evarts Graham
See:
When truth is unwelcome: the first reports on smoking and lung cancer.