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Drug Money
<p>The Kansas City Star/MCT via Getty Images</p>

The Kansas City Star/MCT via Getty Images

Doctors’ Secret Wining and Dining Continues

Australian plans to shine sunlight on hidden pharma freebies are moving at glacial speed.

Australians are uneasy about drug companies giving secret gifts to health professionals — and for good reason. It’s not because we, the public, are envious of the free meals and fine dining at fancy restaurants, but because there’s evidence pharmaceutical marketing can distort doctors’ decision making, and drive prescription of the latest and most expensive pills, even when older cheaper medications — or no drug at all — may be the healthier options.

A survey last year found that more than 70 per cent of us worry that drug-company payments may influence our doctors’ advice, and 50 per cent consider these payments a form of bribery.  The survey was funded by drug giant GlaxoSmithKline (GSK) — a company now pushing for a new regime of transparency in Australia with comprehensive disclosure.  Like other big-pharma companies GSK is desperately trying to regain public trust globally, having last year pleaded guilty to criminal offences in the United States, and paid a US$3 billion dollar settlement, the biggest health-care fraud settlement in US history.

At the heart of many recent court cases involving big pharma, is misleading marketing — the exaggeration of a drug’s benefits and playing down of its harms. And at the heart of those marketing strategies is peddling influence with prescribing doctors. While the public has become increasingly well-informed and alarmed about that marketing, the names of the doctors who accept the payments and the wining and dining have remained secret — until now.

Believe or not, the new Sunshine Act in the United States is forcing every drug company to publicly disclose every single payment made to every single doctor — all the trips and dinners and hotel rooms and generous speaking fees that routinely flow to physicians must now be disclosed. In the not-too-distant future US law will require that all this information – including names and dollar amounts — be made available on a searchable website. Some companies are already disclosing,  and US media organisations, led by non-profit ProPublica,  have started analysing the data and making it readily accessible to the public.

Australia’s self-regulatory system means the drug industry is largely responsible for policing its own marketing, so instead of a new law, we have an industry-backed Transparency Working Group. In coming days, this group will release a draft report specifying which kinds of payments to doctors should be disclosed, and which should be excluded.

Public response to that report will determine whether the disinfectant of sunlight will ever shine on all of the doctor-drug company entanglements in Australia — and by which date the information will have to be revealed. The current draft contains loopholes that could keep much marketing activity secret — and under its proposed timelines, no names would be included until 2016 at the earliest.

One of the big controversies will be the dollar threshold at which disclosure kicks in. The US Sunshine Act requires companies to record and disclose all payments once the cumulative value (of gifts and/or fees) reaches $100 in any year. The current industry-sponsored Australian plan would see any payment or benefit worth less than $25 escape disclosure completely — no matter how many times such small payments occur.

According to the chair of the Transparency Working Group, Dr Dominic Barnes, general manager of Shire Pharmaceuticals, this would mean many ‘low value’ but ‘high volume’ interactions — in which sales reps provide your GP with warm muffins, for example — would not be publicly disclosed.

Dr Justin Coleman — the college of GP’s rep on the Working Group — worries the $25 threshold and other aspects of the plan may keep secret a large proportion of important contact between doctors and industry, including some of the wining and dining, and he wants to see public debate about “what could be a large loophole” in the plan.

Ironically, only a few short years ago Australia was at the forefront of transparency reforms. In 2007 the government’s watchdog, the Australian Competition and Consumer Commission (ACCC), forced the industry to reveal details of all 30,000 “educational events” for which it provided hospitality every year — including the names of restaurants patronised, and the aggregate amounts spent on each occasion.  Such data has formed the basis of The Global Mail’s current Drug Money series, and revealed ugly examples of promotion disguised as education — such as the million-dollar bash in which hundreds of doctors were flown to the Gold Coast to help launch an anti-depressant.

The ACCC first raised the issue of naming individual doctors back in 2009, and late last year the ACCC released a strongly worded report with the clear expectation it wanted the drug industry to deliver “greater disclosure around sponsorship and fees paid to individual doctors” – with public reporting required by 2015.  Whether the draft plan to be released next week by the industry’s Transparency Working Group lives up to that expectation is uncertain. No major political party has taken much interest in the issue, and a Greens bill demanding more transparency, and bans on certain promotion, is unlikely to succeed- a senate review of that bill is due for release soon.

Alison Marcus, a consumer representative on the working group, believes there’s a strong public responsibility to understand more about how much companies spend wining and dining doctors, because taxpayers ultimately pay for it through the Pharmaceutical Benefits Scheme. Concerned about loopholes in the current plan, she’s still optimistic that the push for full transparency is unstoppable. “If someone tries to close this window of reform,” she says, “they’ll be closing it on their own fingers.”

Ray Moynihan is a Senior Research Fellow at Bond University and has published four books on the business of medicine. He’s currently co-organising a scientific conference called Preventing Overdiagnosis, which will take place in the US in September.

8 comments on this story
by Terry Wall

Nothing less than complete transparency will suffice, because now enough people are aware of the long term high value influence that pharmaceutical companies have had over our health advisers.

Even with complete transparency, it will take years before people making a living from disease will ever gain their customers trust

June 8, 2013 @ 8:22am
by Terry Wall

By the way: Well done Ray, keep up the good work!!

June 8, 2013 @ 8:22am
by Desmond Kennard

Apart from all-expenses paid trips to conferences, there are the free samples of drugs distributed free to doctors as part of the marketing programme. I have nothing against these free samples, other than a clear need for disclosure.
While ball-point pens are freely distributed with the pharmaceutical manufacturer's name clearly marked, it is the more expensive products supplied to the surgery that should worry us.
In effect, as Ray Moynihan states, it is the taxpayer who pays. The question that should be asked: What really are the health benefit of these activities?

June 8, 2013 @ 11:48am
by steven

Where is the transparency?Articles like this one by Moynihan are biased and uninformed.What this does is establish for him a position that is just based on opinion.It is naive to believe a muffin will influence a doctors prescribing or the provision of a pen or a dinner or a meeting for that matter.Doctors work long hours and have limited opportunity to meet with peers and in situations where they can discuss topics.Doctors are taught to evaluate and make judgements based on information.A dinner meeting allows for peer interaction and critical appraisal of information.However, let us suppose that the humble muffin will corrupt the doctor and jeopardise appropriate patient care - then let us have a level playing field.Do not allow the politicians to hold fund raising dinners,do not allow the ALP to receive funds from the unions,do not allow sports administrators to be feted at the Olympics or the football or the cricket..Do these people, especially politicians , not have influence that is more far reaching than a doctor ? Perhaps not If you believe such trivial things impair the judgement of the medical profession rendering them unable to think and make unbiased decisions then you too are as naive and baised as Moynihan.What I say is that if you cannot trust your own medical practitioner to have the intelligence to make an informed decision; as opposed to a decision based on the latest provider of a muffin or a meal or a meeting then you are underestimating the dedication they all have to the provision of sound and educated and informed management -when you present to them with your problems.Open your eyes, think for yourselves and hide from the bias of the prejudiced .

June 8, 2013 @ 9:17pm
by Henry

A supplier of implants, LMT, is this very weekend hosting surgeons at a heavily subsidised conference in Fiji. Makes the Gold Coast seem kind of tame... Suggest you also look at companies that choose not to adhere to any of the self-regulatory codes.

June 9, 2013 @ 12:08am
Show previous 5 comments
by Brigid O'Carroll Walsh

This is not my only worry - but it is part of the scenario. I have adverse reactions to pharmaceuticals. One is to Macrodantin (an antibiotic) and the other is Lipitor (a statin). My experience, at both GP and Specialist level, is that the medical profession don't want to know about this. There is no central database in Australia for reporting adverse reactions to pharmaceuticals. One GP said to me that this because they know what the reactions are. I said that this may be the case but they have no idea whether the number of adverse reactions is up or down; the distribution - location, gender, age etc. I have come to the conclusion that while medicine is regarded as a science most medical practitioners haven't a clue about the social sciences and statistically based evidence. I would commend to people Norman Swan's 2006 interview on the ABC's Health Report with the climatologist Professor Stephen Schneider. And if GlaxoSmithKline are really interested in doing something useful they might fund - and then give over to independent management based on compulsory reporting - the database/statistical collection on adverse reactions to pharmaceuticals that is sorely needed in Austrlia.

June 9, 2013 @ 7:39am
by Dean

Brigid, I am sorry to hear that you have suffered adverse reactions to Macrodantin and Lipitor. Unfortunately, all medicines can cause adverse reactions and some people are more prone to them than others due to age, size, gender, pre-existing conditions, impaired kidney or liver function, or reasons as yet unknown.

The TGA is the body that you, or your doctor or pharmacist, can report these to. You can report online by going to The (de-identified) data from these reports is made available to researchers and the companies but you may need to make a few calls to find the information you were seeking regarding breakdown of rates.

Some health professionals can seem a bit uncaring when it comes to adverse drug reactions. They do occur, and we have good data on the general population and certain at risk groups, but they do tend to spike whenever there is publicity surrounding them which fuels cynicism. A common joke about statins, the class of drugs that Lipitor is in, is that they can cause painful muscle aches in some patients which are highly contagious, mainly spread by social contact, over the phone, online, or through the television, but can be readily relieved through the use of any herbal or vitamin product. Unfortunately, this makes determining true adverse reactions incredibly difficult, leading to cynicism or even disbelief of patients.

I wish you the best of health and hope you can find a suitable substitute for reducing your cardiovascular risk.

June 12, 2013 @ 4:04pm
by Barbie

I'm a doctor's wife and I've never known him to be wined and dined by pharmaceutical companies. He used to bring home pens with drug company logos but changed government regulations now mean even that is no longer allowed. Apparently doctors are not clever enough to know when a company is trying to push its product, and a free pen could tip them towards prescribing a product that could compromise patient safety.

June 29, 2013 @ 8:41am
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