How would you feel if your local GP or specialist was pocketing money from a drug company to promote its products?
If your gut says tells you that this falls into the category of Very Bad Ideas then it turns out that you’re out of step with most Australians – at least 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’.
The press release was issued by GlaxoSmithKline, which manufactures everything from Panadol to the asthma medication Ventolin to the antidepressant Aropax.
This surprising claim was based on a questionnaire of over 1,000 Australians which asked how they felt about pharmaceutical companies paying fees to doctors. When asked, 90 per cent 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’.
But 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.
Seventy-nine per cent approved of pharmaceutical companies helping to fund medical research programs and 71 per cent agreed with money being used to fund clinical education programs.
On the face of it, that all sounds uncontroversial. After all, who could be opposed to research and education?
The devil though, as always, is in the details. For example, what exactly 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.
Reality, however, can be 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 a 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 pharmaceuticals industry. They are also lucrative for the individual doctor’s involved. As the ABC Radio National’s Background Briefing program reported in October last year, former pharmaceutical company representative Petra Helesic told of doctors – mainly specialists – being paid between $750 to $1,500 per presentation to deliver promotional presentations. 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 restaurant 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 most recent review of therapeutic goods regulations in 2011, which included promotional practices, concluded that pharmaceutical companies can regulate themselves when it comes to paying money to doctors.
This is despite a range of criticisms directed at self-regulation that have been presented to the Federal Government. In his submission to the Federal Government’s review of the therapeutic goods regulatory framework, for example, Dr 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’. (Full disclosure: I also work for La Trobe University.)
Dr Harvey noted that the existing rules on public disclosure have gaps – targeting doctors, but not pharmacists, for example – and the penalties imposed are a fraction of their equivalents in the United States.
Drug companies in the United States have far stricter disclosure requirements than in Australia. Since 2010, US drug companies are compelled to report payments and in-kind support they give to individual doctors over a cumulative amount of $100.
GlaxoSmithKline, to its credit, has led the way in reporting the overall amount it spends on healthcare professional sponsorships. Since 2011, it has disclosed the total amount spent on sponsorship of health care professionals.
However, GlaxoSmithKline’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 which asked how people felt about pharmaceutical company payments to doctors found that 65 per cent 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 be above board. Patients should be able to find out who’s paying their GP or specialist – and possibly influencing their prescribing practices.
Originally published on The Drum