The links between doctors and the pharmaceutical industry are coming more and more under the spotlight. To be upfront, I have over the years been given various pens, coffee mugs, and have been to sponsored dinners. Over the past few years I have deliberately stopped going to these and have not regularly seen reps since 2005.

It always struck me that these promotions were advertising and that it was up to me to decide whether the claims were valid in much the same way, as I would assess claims made about products advertised on TV. The media has tended to focus on these gifts as the main game.

What has become clear is that pens, mugs and dinners are not the main game. The big issue is payments to doctors as consultants and speakers. Pfizer has reported that in the last half of 2009 it paid $US20 million to doctors and medical professionals for consulting and speaking. A further $US15.3 million was paid to academic medical centres and research groups for clinical trials. Other companies are also disclosing payments.

Some states in the USA now have laws covering gifts given to doctors from pharmaceutical companies. Various universities and medical schools have implemented disclosure policies. Harvard Partners Healthcare put a cap on how much doctors can be paid to sit on boards.

Institutions, which employ doctors, are able to put conditions on employment. Doctors in private practice are of course not bound by such conditions. Consequently there is a trend to get local doctors to give talks. The payments for this can be lucrative with reports of payments of tens of thousands of dollars.

None of this is “wrong” as such. Speakers are paid in all forms of industry. Companies are free to promote their wares and pay people to endorse them. Many sports people earn more from endorsements than they do from their chosen sport. So is it a surprise that some doctors can earn more from “endorsements” than their practice?

The short answer is no. However there is one key difference. When you see and add with a celebrity you know they have been paid to advertise the product. When doctors talk about drugs it is presented as clinical information. It is known that pharmaceutical companies seek out “opinion leaders” in medicine so that their names can be quoted to other doctors. “Specialists”, who, rightly or wrongly, are deemed to know more about particular areas of medicine, can influence primary care physicians.

I do not believe any doctor will say things at a talk, which they do not believe. The point is that they are selected because of their views. A doctor advocating lifestyle treatments rather than drugs probably will not be invited to speak. It is more about what is not said. A talk on diabetes sponsored by a drug company will of course focus on drug treatment rather than diet and exercise.

Bottom line is that millions of dollars would not be spent if there were not some return to the company. This matters because the costs of drugs are generally borne by governments and insurers rather than the individual. Hence unnecessary use costs everyone.

As the rope tightens around this method of promoting pharmaceuticals another subtler one is opening up. This is payment by pharmaceutical companies to patient support groups. In some instances pharmaceutical grants have been used to set up patient groups. Australian figures show several pharmaceutical companies donated over $1 million to assorted health groups including the Heart Foundation. The Australian Lung Foundation was set up by a grant from a company that makes a quit smoking drug. Guess who may have funded the establishment of Impotence Australia.

Once again none of this is “wrong” or illegal. However might your view of a news story quoting a health group be affected if you knew who had funded them? As with the doctors it is not about paying people to say things they do not agree with. It is about finding people who agree with you and then having them promote your line “independently”. Similar to celebrity endorsement, this is patient endorsement.

Many patient support groups have a “saintly” air about them and claim that they are all about advocating for the people who have a particular disease. Fair enough. It also means they can have an interest in “disease mongering” and encouraging people to see traits or minor symptoms as part of some disease or syndrome. This builds the number of people they “represent”.

This leads to the medicalizing of life. In turn there is increasingly a drug to treat this medicalized life. These drugs are sold for a profit by the same pharmaceutical industry, which supports these groups in spreading the word.

If we take three steps back, it may become apparent that there is something not quite right with this picture.