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Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.
Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.
We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.
Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.
What we did and what we found
Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.
We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.
We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).
The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.
This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.
A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.
Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.
Why does all this matter?
Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.
A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.
Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.
Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.
Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:
Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.
We know about payments to US doctors
The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.
Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.
Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.
US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.
In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.
So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.
A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.
Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.
Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.
Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Barbara Mintzes is a Professor at the School of Pharmacy and Charles Perkins Centre, University of Sydney
Malcolm Forbes is a Consultant psychiatrist and PhD candidate at Deakin University
The authors fall into the trap of confusing correlation with causation. An oncologist specialising in myeloma may go to lunch to hear about new formulations of thalidomide, an obstetrician would not. Funnily enough, the oncologist would be the higher prescriber of thalidomide. Another oncologist with a different subspecialty interest, who never prescribed thalidomide, would not attend.
A pain clinic doctor would be more likely to attend a lunch and seminar about the latest opioid, than a fertility doctor; or than a pain clinic doctor who had a specific aversion to opioid prescribing. Same for two GPs, one with an elderly patient group with chronic pain, versus one with a principally paediatric patient group.
A rheumatologist whose patients were not responding to current treatment may go to a dinner lecture about the latest monoclonals, Janus Kinase inhibitors etc, then prescribe them. I went to such a lecture at my local district medical association, and didn’t prescribe anything. Despite enjoying the free feed and convivial company of colleagues. It was of no influence on me that the drug company doctor was spruiking the recent PBS listing of its products, but that sort of information cannot be gleaned from the international rheumatology literature.
One paper the authors cited referred to prescribing “a branded drug in settings where a generic or biosimilar version was available” as evidence of baleful influence. However, neurologists and psychiatrists often claim the ‘similar’ generics are not as good for brittle epilepsy/psychosis, as the legally permissible dose difference between brands may be clinically significant.
On the plus side, the manufacturer of my favourite distal radius fracture fixation plate took me to lunch to ask about what modifications would be beneficial. Over a nice steak I explained that the screw inventory was complex, particularly for weekend emergency nursing staff who had never seen the set before. The different drill and screw sizes for the proximal and distal screws were frequently confusing, and awkward if alternating between proximal and distal, requiring multiple changes of drill, guide, screwdriver etc. Presumably I wasn’t the only surgeon in the world to give them this feedback, as the plate was the number one seller in America; but the second generation came with one diameter of screw, simplifying inventory and saving operative time, while reducing risks of inadvertent use of the incorrect drill. I advocate that plate to my colleagues (despite having received nothing more than one free lunch) because I have found it to be the most versatile. I have not been fed by companies whose plates I shun.
In terms of product ‘advertisement’ there is the traditional journal publication: didactic, minimal questioning possible, international journals have no regard for local TGA/PBS listing, and almost never mention costs. There is a presentation at a scientific meeting, some more interaction possible (ironically, often over a [possibly sponsored] meal), local scientific bodies may discuss availability of product locally, but the meeting may be closed (e.g. the Australian Hand Surgery Society does not permit non-members to attend) or so esoteric that only particular sub-specialists attend. Or there may be a paid consultancy, where the company pays for the doctor’s time and expertise. Many such consultancies are covered in the authors’ categories where a doctor is the lead author in a trial which confirms a benefit of drug X, and the company sends the doctor to the international conference to present the legitimate scientific research. (A sad corollary is if drug X is shown to be inferior, probably no funding to announce that.)
A sponsored meal is time-efficient (even doctors have to eat) and allows open interaction. Even better, ideas can be contested as the doctor can attend multiple statin-seller dinners and compare the assorted products.
Medical schools have for several decades selected students for critical thinking skills, and allegedly further imbued their trainees with such skills. It would be interesting to know if those medical schools banning students’ “attending industry-sponsored events during their clinical training” have a lower rate of graduates who subsequently conduct industry-sponsored RCTs. Or if there are “restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching” it would be impossible for a professor to participate in a trial of a new drug, even one they had developed themselves, unless all funding came from a non-industry funder like NHMRC. The academic researching a novel RSV vaccine would not be able to teach students about the flu vaccine made by the same company. The university would be staffed by out of date drones.
If the authors’ assumption of causation (rather than my assumption of mere correlation) is correct, the deans of all medical schools should be sacked forthwith. I will continue to rely on my personal adage: if you buy me dinner, you don’t get to sleep with me.
That “US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed” did not prove that these increased prescribing are inappropriate or detrimental to patient or health system.
For all we know, the increased contact with doctors by supplying meals gained more awareness of the product and the disease, but this should not always viewed negatively.
Unless they proved those meals result in inappropriate prescribing (by indications), prescribing a more expensive product when a cheaper alternative is available, or prescribing an inferior product, then we can get worried.
I am more worried by the idea some of us think our mind can be bought with a $20 (or even $100) meal. If someone want to be corrupted (hypothetically) I thought will be several ten of millions in exchange for losing their career and reputation!
@Linda Mann
As food and drinks are excluded in the reporting then it is no surprise that GPs are not flagged in the featured study.
Potentially you can have 10 big pharma company reps supplying “lunch time” updates and meetup with accompanying refreshments once a week and not attract the reporting to this study but hey, that assumes that you even got time to sit down for lunch to listen to them (being polite) or a large enough tea room for the huddle.
There should be no influence by the vested interests of pharmaceutical companies on doctors, who should get their information through independent sources that have no conflicts of interests.
of course hospitality will make doctors more favourably inclined to prescribe but the alternative to leave it all to the government such as NICE in UK means there is a bias against prescribing except the most cost effective- ie cheapest or no treatment at all. Allowing some pharma sponsorship creates a healthy tension between the rationing which the government and health economists want and innovation and better treatments which patients want.
AS AN OBSTETRICIAN I AM FEELING NEGLECTED!
GP is not in the list, IS this because we are not worth influencing, or are more moral?
we should ban all medical and pharmacy students and junior pharmists (as they also are prescribing now) from getting influenced by any gifts or payments as the training should begin earlier on in their careers to recognise this influence by big pharma .Unfortunately the recently graduated sometimes feel lost in how to manage things and depend on pharma output of new changes in medications etc . Guidelines are important to produce and follow in hospital management and out of hospital which gives these juniors more balanced outlook The dangers of new drugs introduction is always there .My policy is to wait for new drugs to get more data post marketing and get more affordable before i prescribe except in exceptational circumstances where there is no other equally good option