Ray Moynihan: Disclosing all

A GOVERNMENT agency has told the pharmaceutical industry to start publicly disclosing the benefits given to individual doctors, and it wants those doctors publicly named — not to shame them, but to make important information available to their patients and the public.

In a historic announcement last month the Australian Competition and Consumer Commission (ACCC) proposed that “all relevant transfers of value” from drug companies to doctors should be made public, including fees for speaking events, consultancies, advisory services and sponsorship to attend conferences and meetings. The arguments for and against comprehensive disclosure are laid out in detail by the ACCC.

Such disclosure will easily meet Australia’s privacy laws provided doctors have agreed to such disclosure before they receive the benefits.

One of the pharmaceutical industry’s key arguments to the ACCC against the move is that if doctors are asked to agree to these payments being made public, many of them will shy away from being speakers and consultants. As a result, industry-sponsored educational events will lose their presenters, and the public health will be damaged.

The industry, through its lobby group Medicines Australia, supports a new transparency regime — with the key caveat that doctors are able to opt out. Unsurprisingly, the argument has been rejected by the ACCC, which describes the industry “opt-out” proposal as having “serious flaws” which “fundamentally undermines the transparency objectives of the regime”.

The arguments relate to what will become the latest version of the Medicines Australia code of conduct, which covers the relationship between the pharmaceutical industry and doctors. The system currently is largely self-regulated, as the code is administered by Medicines Australia, but it’s also grounded in regulation through its endorsement by the ACCC, which attempts to make sure the code keeps up with community expectations around transparency.

Many doctors who’ve become accustomed to working with industry will understandably be affronted by the idea they have to declare these links to the world on a searchable website. They may feel the need for disclosure implies they’ve been doing something shady, and may fear it will unfairly impugn their good reputations. These fears are understandable, but they are unsustainable in the current international climate of transparency.

In the US, the bipartisan health care Open Payments scheme is now operating under the Sunshine Act, and at the click of a mouse you can find out which companies doctors receive money from, how much they receive and for what purpose.

Arguments in favour of transparency in Australia are, in fact, very neatly laid out in a document from the Transparency Working Group — convened by Medicines Australia after pressure from the ACCC for more transparency — which included representatives from all major stakeholders including doctors, consumer groups and specialist colleges.

It states that “transparency of payments and other transfers of value … will assist to reduce the likelihood of undermining the independence of healthcare professionals”. It concludes with a list of aims, arguing that transparency measures shall report “all” payments and benefits “in a form that is readily accessible and meaningful to the public”. For reasons not entirely clear, that Transparency Working Group was abandoned by industry before it made any formal findings.

It is understandable that a patient might want to know whether a doctor prescribing them a powerful and potentially dangerous drug has received any benefits from that drug’s manufacturer. Similarly, given how influential specialist prescribing decisions are, many GPs are keen to know which companies are paying their specialist colleagues, and how much.

In the latest version of Medicines Australia’s Code of Conduct, as well as the “opt out” clause for direct payments, meals costing less than $120 would also be exempt from public scrutiny. This would effectively mean most of the wining and dining that currently takes place would remain hidden from public view, unlike the US where all benefits are disclosed.

The ACCC is considering a requirement to include hospitality as a “transfer of value” (and subject to disclosure), cognisant of the need to help foster a transparency regime that is genuinely transparent. Submissions on its latest proposals close soon.

While it is possible that Medicines Australia may try to back out of seeking ACCC endorsement for the code of conduct, senior voices within industry and the health professions will be pointing out both the inevitability and desirability of bringing Australia into the sunshine of full disclosure.

If a doctor is confident about the reasons for accepting benefits from a drug company, surely they have the courage to justify that to the people on the receiving end of the prescriptions.
 

Ray Moynihan is a senior research fellow at Bond University and an author who has published extensively on conflicts of interest and made submissions to the ACCC on the desirability of disclosure.