The saying ‘no harm comes from shining light on workplace practices’ may leave some doctors uncomfortable.
With transparency comes accountability. At the recent Doctors Drum entitled “Transparency – Clear as Mud?” the Corruption and Crime Commissioner John McKechnie QC commented that he thought most doctors were not corrupt but failure to follow policies was the primary reason why serious misdemeanours went undetected.
As health spending has come under the spotlight so has the impact of fees on some consumers, from what seems like instances of ‘price gouging’ on privately-insured health consumers to shock ancillary costs. And, of course, reduced consumer access to primary care is touted as a consequence of health spending, for both public and private patients.
A raft of market forces influence behaviour. The recent SAT case involving the Lord Mayor Lisa Scaffidi has raised one serious question. What level of transparency should we expect from public officers?
A key test for identifying conflicts of interest is whether an impartial observer would reasonably question if the personal factors might inappropriately influence the way an individual carried out their work.
These conflicts of interest may be real, perceived, or potential and may be financial or non-financial. Doctors are no different to ‘public officers’ because they deal direct with the public.
As food for thought, we look more closely at one thing that may pose a conundrum for doctors: Pharma sponsorship.
MA’s reporting requirements
We know from experience, the knock-on effect of the PBS listing of a drug. Promotional money becomes available before that listing and during the life of the patent. For script-only items, doctors are heavily involved. Key opinion leaders (KOLs) are found to tell other doctors about the benefits of the drug. Doctors, who face a deluge of medical knowledge, are happy with the filtered information pharma companies offer. Some question this relationship, and wonder if it should be declared to the health consumer.
The ACCC has ordered Medicine Australia (MA) to stipulate to its 34 member companies the need to report whether “transfers of value” have occurred to health care professionals and member companies and MA are trumpeting the move that makes it sound like it was their idea.
All members are now required to report information relating to any declared-by-name health care professional (HCP) who receives payment.
These include:
- For speaking at an educational meeting or event.
- To attend an educational event in Australia or overseas– including airfares, accommodation or registration fees.
- All consultancy services related to educational meetings, preparation of promotional materials, assistance with training or any other advice to the company.
- Payments to HCPs as advisory board members including sitting fees, accommodation and airfares related to activities of the board.
- Payments to HCPs for market research.
Where payment is made at the request of a HCP to a third party, payments must still be disclosed for the individual healthcare professional, but the report will identify that third party.
Formulating the Transfer of Value into an easily digestible form is still not easy. MA has ignored the request of its own working party that transfers of value be readily searchable by practitioner across all member pharmaceutical companies. There is no filtering by state or postcode and research payments are not included.
With nine possible healthcare categories that pharma companies must declare, we found that medical practitioners took the lions share (the subject of this report) with a small smattering of nurses and pharmacists.
By comparison, it was noted that payments to NGOs such as Foundations, could be three times that made to doctors. This illness awareness creation has been criticised as a marketing strategy, and consumers have every right to ask doctors about their involvement and what might be the ‘expected return on investment’ by the pharma company?
As examples of the information that can be gleaned for the 2015-16 reporting period:
- One pharmaceutical company paid 218 WA doctors an average of $1,323.23 each in “air travel and accommodation” (total $260,675.64) for attendance at “educational meetings” within Australia. Included in this was $21,675 paid to 12 doctors (21 attendances) as “service and consultancy” fees for attending as Educational Meeting Speakers (with two receiving air travel and accommodation costs of just over $1000).
- Another pharma company paid seven doctors $6993 in registration fees and $49,987 in air travel and accommodation for overseas meetings.
- Overall, fees of $262,033.52 for “service and consultancy” were made to 257 doctors for company meetings in Australia, with $76,226.46 in air travel and accommodation.
- Overall, payments to attend overseas educational meetings amounted to $74,978 (airfares and accommodation) with $14,352 in registration fees paid.
- $119,352 + $675,421 were paid for 450 air travel and accommodation claims to attend company meetings in Australia.
- $52,198.18 went to employers or third parties for services or consultancy, while $73,010.24 went in airfares and accommodation and $9,289.85 in registration fees. Only 11 of 38 of these meetings were independent – involving 29 doctors.
- Have there been individual excesses? It is almost impossible to gauge from the figures provided without knowing what individuals did as part of their “consultancy” or whether they were flown business class, etc. Surprisingly few doctors had conference registrations paid amongst the 1,440 payments made over the 12-month period, but very few doctors appeared only once. A quick glance at the ‘frequent fliers’ revealed: Dr A received about $10,900 for 14 “service and consultancy” episodes from 3 different pharmaceutical companies; Dr C $12,800 for 3 “airfares and accommodation” from 1 company; Dr B received $23,800 for 3 episodes of “airfares and accommodation” and “service and consultancy” from 2 companies; Dr D received $45,000 for 20 episodes of “airfares and accommodation” and “service and consultancy” from 1 pharma company; and Dr I received $27,000 for 12 episodes involving payment of “conference fees” “airfares and accommodation” and “service and consultancy” by 4 different pharma companies.
Research funding is not covered. It should be.
We should question whether payments from some pharmaceutical companies to doctors and labelled for “research” purposes are just that. In any event, health consumers want to know if research findings are published, who financed that research; or if research findings are not published was the doctor involved receiving benefits from any pharmaceutical companies to conduct research.
In an epoll published in October 2012, we surveyed specialists, GPs and doctors-in-training in WA (n=250) around the issue of pharmaceutical sponsorship.
- Then, about 40% didn’t think declaring sponsorship of individual doctors wrongly damage their independence; 25% were neutral.
- 61% believed the public benefited from doctors’ ethical relationship with pharma companies. 28% were neutral
- 75% thought educational events sponsored by pharma were needed by the profession; 13% were neutral.
This echos a sentiment expressed at the last Doctors Drum meeting and sets down the challenge to colleges and representative groups to do drug education better.