Healthy Skepticism Library item: 5788

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Publication type: news

Harvey K.
Drug companies' free lunches have expensive side-effects
New Matilda 2006 Aug 4
http://cpd.org.au/2006/08/drug-companies-free-lunches-have-expensive-side-effects/

Full text:

Drug companies’ free lunches have expensive side-effects

http://www.newmatilda.com.au/policytoolkit/policydetail.asp?PolicyID=462

By: Ken Harvey
4 August 2006

Last week, the Australian Competition and Consumer Commission (ACCC)
re-authorised the Medicines Australia Code of Conduct [1], but with one
important condition. The industry association now has to monitor and
publish six-monthly reports of all drug company-sponsored meetings
provided for healthcare professionals, including their cost. ACCC
Chairman Mr. Graeme Samuel said “the condition will raise the level of
transparency about functions sponsored by pharmaceutical companies”. [2]

Imposition of this condition has caused dismay and anger among
pharmaceutical companies who fear it could lead to a media feeding
frenzy each time the report is published. They are also concerned about
the cost of compliance.

Roche Pharmaceuticals was recently in the news for providing cancer
specialists with a $200-a-head meal at the Opera House Bennelong
restaurant. Roche argued that this dinner was simple, modest and
appropriate given that it followed an education conference the company
had organised and sponsored. [3]

AMA President, Dr Mukesh Haikewal said drug company dinners “oiled the
wheels” of medical education and that $200-a-head meals were
appropriate, rather than doctors “slumming somewhere in a budget chain
motel”. [4] He argued that company-sponsored events gave doctors an
opportunity “to critically question the companies’ products” and that
“no patient harm comes from this process”. He called the condition
imposed by the ACCC “unreasonable” and said it would discourage company
support for medical education.

Dr Haikewal’s views are clearly honestly held; they are also widespread
among the medical profession. However, a large amount of research
contradicts the view that no patient harm comes from such interactions
between the medical profession and the pharmaceutical industry. Research
shows that industry-doctor interaction correlates with doctors’
preferences for new products that hold no demonstrated advantage over
existing ones, decreased prescribing of more cost-effective generic
drugs and a rise in both and irrational and incautious prescribing. [5]

A theme issue of the British Medical Journal that explored this
interaction had a cover depicting pigs and reptiles. The editor noted
that this isn’t a Manichean battle between good and evil but the
entwinement of individuals from different backgrounds and value sets who
get to know, and often to like, each other and therefore want, as humans
do, to reciprocate friendships and favours. “Food, flattery, and
friendship are all powerful tools of persuasion” wrote Ray Moynihan in
his two part article on such entanglements. [6] Which is why one web
site set up to make the medical profession think more seriously about
such matters is called “No Free Lunch”. [7] Another is called “Healthy
Skepticism”. [8]

In Australia, under the umbrella of our Quality Use of Medicines Policy,
a number of organizations provide unbiased, independent sources of
information about medicinal drugs. The National Prescribing Service
(NPS) conducts ongoing education and other activities. [9] They
encourage GPs to use resources such as the Australian Medicines Handbook
(an excellent source of drug information) [10] and Therapeutic
Guidelines (information on cost-effective drugs of choice for common
conditions) [11]. NPS educational events are well attended by GPs and
have received excellent evaluation reports despite “slumming it in
motels” and expending no more than $40 per head on room and equipment
hire, a two course dinner, a glass of wine or juice and coffee or tea.

In short, the “condition” added by the ACCC to the re-authorisation of
the Medicines Australia Code of Conduct is welcome. It should restrain
some of the more flagrant abuses of hospitality that are often not
reported because those who benefit have no desire to complain. However,
the “condition” does nothing to address the many other concerns about
the Medicines Australia Code that were made to the ACCC in public
submissions. [12]

For example, concern was expressed about the recent infiltration of
pharmaceutical promotion onto GP’s prescribing software because these
advertisements can be viewed by patients despite legislative prohibition
on advertising to consumers. [13] The ACCC agreed that (despite minor
modifications to the Code) “there may still be screens that patients are
likely to view during a consultation, regardless of whether they are
designed to be viewed. As such, it is not clear that the sections as
currently drafted will ensure full compliance”. [14]

Of even greater concern is the fact that many pharmaceutical companies
repeatedly breach the Code, probably because the fines imposed are
minuscule in comparison with the money gained from promotional excess
(and Code breaches). The ACCC was “concerned that the Code and Appeals
Committees do not appear to impose heavy sanctions in any
circumstances”. It considered that this raises some doubt about the
effectiveness of the Code. The ACCC was also concerned that “Code Annual
Reports indicated that some companies were regularly breaching the Code
and that the penalties imposed by the Code Committee do not appear to
reflect this”.

The ACCC noted that, “when considering an application for authorisation,
the ACCC is required under the Trade Practices Act to assess what the
likely benefits and detriments of the arrangements before it. If it is
not satisfied that the arrangements are likely to result in a net public
benefit, it may impose conditions. However, its role is not designing a
better code, nor considering whether other regulatory arrangements may
be more or less appropriate.” Finally, the ACCC considered that the
appropriateness of self-regulation of the pharmaceutical industry “is a
matter for government policy and well beyond the scope of Code
authorisation”. [14]

In the light of these comments by the ACCC the Australian Consumers’
Association (ACA) sent a letter to the Minister for Health, Tony Abbott
MP, arguing that the focus of regulating the promotion of pharmaceutical
products should shift from self-regulation to more direct regulation, as
has occurred in a range of other sectors of the economy. The ACA
believed this should be achieved through legislation enforced by the
appropriate regulator such as the Therapeutic Goods Administration.
Failing this preferred option, there should be a requirement that
industry develop an effective Code of Conduct that met defined policy
objectives established by legislation. [15] In response, the Minister
noted that the government had confidence in the existing approach.
That’s not surprising when the headquarters of many large pharmaceutical
companies happen to be located in North Ryde, in the Prime Minister’s
electorate of Bennelong.

References

1. http://www.medicinesaustralia.com.au/pages/page5.asp

2. http://www.accc.gov.au/content/index.phtml/itemId/755224/fromItemId/142

3. http://www.theaustralian.news.com.au/story/0,20867,19898069-23289,00.html

4. http://www.theaustralian.news.com.au/story/0,20867,19914938-23289,00.html

5. http://www.drugpromo.info/read-reviews.asp?id=4

6. http://bmj.bmjjournals.com/content/vol326/issue7400/cover.shtml

7. http://nofreelunch.org/

8. http://www.healthyskepticism.org/

9. http://www.nps.org.au/

10. http://www.amh.net.au/

11. http://www.tg.com.au/

12.
http://www.accc.gov.au/content/index.phtml/itemId/744908/fromItemId/278039

13. http://www.mja.com.au/public/issues/183_02_180705/ruf10450_fm.html

14.
http://www.accc.gov.au/content/index.phtml/itemId/744908/fromItemId/278039/display/acccDecision

15. http://www.choice.com.au/files/f123970.pdf

About the author

Dr. Ken Harvey was a member of the group of experts that formulated the
World Health Organization’s, “Ethical criteria for medicinal drug
promotion” and was also an inaugural member of the PHARM committee which
devised Australia’s Quality Use of Medicine Policy.

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