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What will it take for doctors to reject pharma largesse?

When the NHMRC convened a workshop on conflicts of interest in Canberra recently, participants were told that Australia had been slower than some other countries to take steps to minimise the impact of such conflicts upon research and clinical practice.

In the piece below, Sydney dermatologist Dr Chris Commens argues that unless the medical profession smartens up its act, it may face the sort of legislative action that has already occurred overseas:

“Quite frankly I find it insulting to suggest I would be influenced by being given a pen or a mug.”

“So what if the drug rep brings pizzas for lunch for the staff!”

These are the sort of comments you often hear from doctors and others who are resistant to the evidence that pharmaceutical marketing can influence patient care.

While the level of debate swings around this trivialisation, the pharmaceutical companies are laughing their way to the bank. The average punter in the street hardly registers this sort of junketeering as a problem.

However, some medical practitioners who prescribe extremely expensive drugs are being given free travel, meals and accommodation to attend interstate drug familiarisation conferences.

After all, spending approximately $2000 over a weekend on a doctor is quickly returned with increased prescribing of  drugs costing tens of thousands per course.

The possibility of this sort of hospitality consciously or unconsciously swaying prescribing habits has credibility. Reciprocity (repaying a favour or hospitality) is a strong social, cultural and possibly biological response, particularly in highly socialised creatures like  doctors.

It’s something the drug companies use to the hilt – and something a lot of doctors deny to the hilt.

So how is this issue of drug company influence being addressed?

State Medical Boards have markedly differing emphasis with their Codes of Conduct. NSW directs doctors not to accept material gifts. “Material” is undefined. State Health departments have rules for employees but these are variably administered.

The variations in state codes has  recently seen the Australian Medical Council attempt a uniform Code of Ethics for doctors across Australia. The
first AMC draft addressed the issue of drug company sponsorship bluntly by prohibiting all gifts, inducements or hospitality.

A hullaballoo followed.

The subsequent draft is a more subdued document. Conflict of Interest is discussed and we are now advised to “not accept any inducement, gift or hospitality of more than trivial value that may affect, or be seen to affect the way you prescribe or treat”.

I predict little will change until it is put in law.

And this is precisely what is happening in a number of  USA States.

The legislators in Vermont have recognised that hospitality is a marketting tool that tends to encourage the use of expensive therapies over
evidence-based cheaper therapies. Importantly since 2002 they have required drug companies to publish on a public website the names of all individual recipients of all gifts and payments.

Overall , since instituting this publication of named recipients. they have documented decreased pharmaceutical spending on hospitality to doctors
although one individual doctor in 2008 racked up US$15000 in free meals.

As a result the Vermont legislators  will now PROHIBIT  most hospitality to doctors from July 1, 2009.

The AMC code of Conduct is a start but unless we doctors smarten up, the legislators will move.

CROAKEY comments: It’s worth checking out the Vermont link as it details some of the pharma payments to nurses and doctors (one psychiatrist received more than $US100,000).

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