It's only fair to share…


There is a human tendency to focus on small rather than big issues. This is for a number of reasons. Firstly life is made up of small things and we can all relate to everyday tribulations better than big picture issues. Also we feel more that small things can be controlled whereas big ones cannot.

When it comes to “cleaning up” the relationship between doctors and the pharmaceutical industry there has also been a tendency to focus on the small things. It is easy to criticize pens bearing logos or post it notes. These literally cost cents but are highly visible.
Meals for doctors (usually GPs) attending postgraduate events, which by the way are compulsory under assorted government regulations, are also a soft target. In Australia, The USA and soon Europe there needs to be declarations by companies on how much money they spend on hospitality.

Having been to various dinners in years past I can say the food is generally fine but not extraordinary. The cost per head for dinner will obviously vary. As do sponsored lunches where the cost is around $10 per head.

Again it is easy to target the free meal.

These things miss the main game completely!

There are two major areas of pharmaceutical industry funding which gets next to no attention for two reasons. The first is that it is better hidden and the second is it is harder to understand than a pen or a meal.

The first bid spend is on speakers. Whenever doctors attend an educational event there is a speaker who is generally a professor or specialist. Speakers cost money. For the first time Australian figures have been released. These show payments of $600,000 to 376 doctors for “honoraria” work in the first three months of 2013. This is for speaking and advisory work. The latter includes sitting on committees and other panels.

The highest figure was $2700 per neurologist to attend a meeting in Melbourne. When one looks at the relative spends, the amount spent on  “honoraria” is generally five to ten time that spent on food!

In the USA the website Propublica has been running a long-term investigation into payments to doctors by industry. Its latest revelation is that the top twenty prescribers of a drug for high blood pressure were paid between $1250 and $87,000 in speaking fees by the drugs manufacturer.

The biggest issue remains the conflicts of interest between doctors (generally specialists and academics) who provide education to other doctors without declaring their interest. And who sit on advisory panels, in hospitals or for government also without declaring interest.

In fact declaring an interest is not actually the answer. In sport you cannot play for a team and umpire the game at the same time. It does not work. Being a paid advisor to a company should preclude you from advising others on the merits of the products made by those who pay you. Or if you do recommend them then it can only be done as a representative of the company. Hence the information provided is not seen as “independent”.

When decisions were made about the swine flu vaccination some 64% of doctors on advisory panels had financial ties to vaccine makers. They are not independent. I do not doubt they genuinely believe their recommendations but in turn that is usually why the companies pick them. There is no need to convince someone who shares your view of the world!

There is nothing wrong with doctors working for industry and getting paid to do so. There is something very wrong with lack of transparency and doing two roles, which are not compatible with each other. Much has been written about how industry uses “key opinion leaders’. This sways guidelines, government policies and even sways courts. When some      seven in ten adults in the USA take at least one prescription drug this matters.

In turn doctors who want to run an independent line are under significant pressure to toe the “party line’. The same party line is in many instances being corrupted and not independent.

So forget pens and meals. The main game is advisory roles. That is where the money is. Rule number one is to follow the money.