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Healthy Skepticism Library item: 20460

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

Blumer C, Seccombe M
Who’s Your Doctor Dining With? (And Why You Should Care)
The Global Mail 2013 Feb 28

Full text:

Suppose someone bought you a round-trip, business class flight to Paris or New York, put you up in first class accommodation, wined and dined you at top class restaurants, and maybe slipped you a bit of money to say a few words as well. Would you feel that you owed them?

Well, pharmaceutical companies do this kind of stuff for doctors all the time. But the companies and doctors insist it’s not about obligation, but education.

And so it is. It’s all about educating those doctors about what they should prescribe for their patients.

There’s big money involved here. According to Medicines Australia, the self-regulatory body which provides the very limited available data, in just six months, from the start of April to the end of September last year, big pharma spent $35 million duchessing doctors.

We should add that this figure does not include the companies that make generic drugs; nor does it include some other pharmaceutical companies which have not signed on to MA.

Let’s give you one example of the sort of thing that goes on. Last July Eli Lily Australia flew three doctors described on their disclosure form as “cardiac interventionists” to Paris, at a cost of $27,730, and provided them with food and “alcoholic/non-alcoholic beverages” at a further cost of $500.

The three doctors listened to various speakers for a total of nine and a half hours.

We do not mean to suggest Eli Lily is particularly egregious in its conduct. This is pretty standard practice. There are other companies that do not even report details on travel costs.

There are numerous other ways by which drug makers provide benefits to doctors. They employ them as speakers. They pay them to sit on advisory panels and to perform other consultancies.

These companies have not been obliged to report on these activities at all, although under changes to the voluntary code of conduct, signed off in December last year, the companies now will have to make public these other payments to doctors. But only in aggregate terms.

Nothing in the voluntary code of conduct specifies exactly who got what. There is no way a patient can find out if his or her doctor is on the payroll of one drug company or another, unless they ask them outright.

This is just the way the doctor’s union likes it. The Australian Medical Association is resolutely opposed to anything that might interrupt, or even chart, the flow of tens of millions of dollars a year into members’ pockets.

Interestingly, some of the drug companies — we stress only a few of them — are well out ahead of the doctors on the subject of disclosure and curtailment of the largesse. In part this is due to their recognition that they have a big reputation problem.

In part, too, it’s because the multinationals already have got used to doing it elsewhere, notably in the United States, under the provisions of the Sunshine Act. They know there is significant international momentum towards greater disclosure and reform.

Apart from allowing patients to make better informed choices of doctors, there are other very good reasons for both reporting and limiting the freebies given by big pharma to doctors.

As Greens Senator Richard Di Natale noted in Parliament on Thursday, numerous studies into the effects of pharmaceutical promotional activity “on the quality, quantity, and cost of physicians’ prescribing found unambiguously that promotion was associated with more prescriptions, higher costs, and lower prescribing quality”.

Richard Di Natale
In other words, it pushes up health care costs — and potentially results in patients being prescribed drugs inappropriately.

Di Natale, himself a doctor, was introducing a bill which would cut out a lot of this stuff.

Di Natale noted that in a couple of ways, Australians are well protected when it comes to the medicines they take. The Therapeutic Goods Administration had a great reputation in regulating the safety of medicines. The Pharmaceutical Benefits Advisory Committee also sets a world-standard in the evaluation of treatments for public funding, keeping costs down.

The major problem in the system related to the third component of it, he said, “which begins when a physician writes a prescription and concludes when the script is filled and paid for — usually by the Commonwealth — at a community pharmacy.

“It is thus in the interactions between industry and doctors that the potential exists for the integrity of the medicines system to be undermined, and is the reason for this bill,” he said.

His Therapeutic Goods Amendment (Pharmaceutical Transparency) Bill would replace the voluntary code with one based in legislation, and its provisions would ban companies from paying for doctors’ travel and accommodation costs, unless they they were actual company representatives, or the payments were reported.

It would also limit entertainment to $100 per attendee and prohibit companies from staging “educational” events outside Australia if the majority of those attending were Australian.

Perhaps more importantly, drug companies would have to report annually all “payments made to doctors, including fees, gifts, honoraria, services such as travel and accommodation, donations or research grants.

“These reports will name, as individuals, medical practitioners (who are not full-time employees of the company) who receive this largesse.”

That low rumbling sound you can hear is the stirring of the army of lobbyists that some big pharma companies and the medical profession now will deploy in an attempt to have the major parties nip this fine idea in the bud.

For it is as yet a bud. The bill’s been introduced, and Di Natale has spoken to it, but the debate has been adjourned to a date to be determined.

It will be interesting to see whether the Labor Government has the courage to line up with the “extreme” Greens (and the presumably equally extreme legislators of the United States), with patients and with fiscal good sense. Or whether they stand with big pharma and the doctors’ union.

For the current situation regarding pharmaceutical company payments to doctors is untenable.

And one last footnote: Di Natale had a big day Thursday. He and his party have long sought to make an issue of the fact that the government’s Future Fund had large holdings in tobacco company shares. They argued this was inconsistent with the government’s opposition to smoking.

Just after he introduced his bill, the Future Fund rang his office to say it had divested $222 million of shares in 14 tobacco companies.


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