Doctors’ Secret Wining and Dining Continues
By Ray MoynihanJune 7, 2013
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.