As recently reported at Croakey, the Australian arm of the pharmaceutical company GlaxoSmithKline (GSK) is moving to be more transparent about how much it pays health care professionals.
Today it disclosed the aggregate amount of fees paid to Australian health care professionals and health-related organisations for all sponsorships, grants, speaking engagements and consulting services during 2010. It is the first pharmaceutical company in Australia to do so.
According to a company statement:
The total amount was $2,047,728 and covers all parts of the GSK business in Australia. This includes:
- $371,659 for grants to individual health care professionals in relation to attendance at domestic and international conferences and symposia
- $774,942 for consultancy fees in relation to speaker presentations, work on clinical development advisory boards and medical copy writing
- $901,126 in sponsorships, donations or grants to health related organisations (non-individual).
The company will post annual disclosures each February, and has said it will work towards disclosing on an individual and institutional basis. GSK has been disclosing individual payments to patient and community groups for the last three years.
Meanwhile, Dr Peter Mansfield, a GP in Adelaide who runs Healthy Skepticism, explains below why he has mixed feelings about the company’s announcement. Amongst other things, he calls for more research into the impact of open disclosure.
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Open disclosure is no silver bullet
Peter Mansfield writes:
I have mixed feelings about GlaxoSmithKline Australia’s announcement that it will declare the total of all its payments to health professionals, and that it will work towards declaration on an institutional and individual basis.
This is an important issue because conflicts of interest (COI) have been shown to distort research, clinical practice and policy.
On one hand, it’s my impression that GSK is showing leadership in being more ethical. Apart from moving towards openness about payments in Australia, GSK in the USA is reconsidering the sales bonuses for drug sales reps that currently are an important incentive for misleading persuasion.
Gaining more information about a problem is often a useful first step towards solving it. There is a strong case for rewarding small steps in the right direction, so the company deserves acknowledgement. It would be good to see them rewarded by the market, so that competition would spur other companies to catch up.
On the other hand, it will be really unfortunate if people develop the mistaken impression that open disclosure is a silver bullet that will solve the problems caused by COIs.
The problems arise because people who take money or gifts from companies have a conscious or unconscious obligation to reciprocate. They may reciprocate by helping the company or at least remaining silent or less critical than they otherwise would be about the failings of company or its products. Furthermore COIs are only one of many causes of bias which is the real problem.
The very little evidence that we’ve got about the impact of disclosure of COI is that it may not reduce bias and paradoxically may even increase it.
Thus greater transparency about the COIs of researchers and clinicians should not be confused with being a proven solution. It will be harmful if small steps like this announcement from GSK are seen as reducing the need for big picture reforms.
Rather than blaming the companies or blaming the doctors, we need to blame the system and change the system. What we need are system reforms so that researchers can have good careers without money from pharmaceutical companies. Two of the world’s leading economists have suggested that patent monopoly protection be abolished. Instead research and education etc could be funded by competitive grants that reward the best competitors for doing those things well. The NHMRC’s systems for giving competitive grants are far from perfect but they are far better than patent monopoly protection.
When people suggest to me that these reforms are unachievable, I point out that the political and economic issues are very similar to tariff reform. There was a time when tariff reform was considered unachievable like people in past regarded the fall of the Berlin Wall or the Feudal system or the Roman Empire.
If doctors and other health professionals believe that COIs are not problematic, I can only assume that this means they are not familiar with the evidence from psychological studies about the impact of having COIs. What our profession needs to do is to learn the evidence on this issue. Meanwhile if they really believe that COI’s don’t cause any problems then they can’t object to making them public.
If doctors and other health professionals understand that COIs can cause bias then I don’t understand how they can justify keeping COI’s secret.
The Australian Medical Association (AMA), medical boards, universities and professional groups need to do much more to ensure health professionals are better educated about the all the main causes of bias. Consumer groups also need to learn about these issues so they can make better informed decisions about whether to take industry money. They too should be able to get adequate funding from competitive grants.
Given how little research there has been into the impact of open disclosure of COIs, the moves by GSK deserve to be closely followed by the research community.
