Put an end to these cosy relationships
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HOW would you feel if your doctor prescribed a drug from a pharmaceutical firm that sponsored his trip to attend international health conferences each year, or paid him to speak at an event sponsored by the firm?
Whether the gesture is above board or not, there would, undoubtedly, be a sense of discomfort knowing that a drug is being prescribed by a doctor or specialist who receives some form of incentive or sponsorship from his supplier.
It also plants a seed of doubt on the veracity of medical ethics in the prescription of drugs, where there is potential for a conflict of interest.
In any other sector, this would constitute a conflict of interest. Imagine a hospital chief executive being paid by a supplier to attend a workshop – and later insisting only medication from that supplier be used in the hospital.
This would undeniably be considered a conflict of interest and calls for an investigation would follow. Yet there is silence around this practice when it involves private health professionals and their, somewhat cosy, relationship with the pharmaceutical giants which monopolise our markets.
While new South African policies have substantially closed the loophole used to justify perverse incentives, that were often paid to doctors in the form of cash payments, from pharmaceutical firms based on sales volumes of their drugs, there are concerns that new incentives masked in the form of sponsorships to conferences have replaced past, and now illegal, cash benefits. In essence, it seems, one perverse incentive has been traded for another.
To their credit, it would be unfair to call all sponsorships perverse. Many are legitimate, ethical and above board, but the concern lies in the non-disclosure of such relationships. Pharmaceutical firms are reported to spend millions sponsoring health professionals each year and there is no legal obligation on them to disclose such payments.
It doesn’t help that even when asked to do so, most pharmaceutical firms refuse to disclose these payments, arguing they are not obliged to do so – leaving the public wondering what they had to hide.
Of the three major pharmaceutical firms approached to disclose how much they pay healthcare professionals for public speaking engagements, Aspen was the only one who agreed to disclose such details, saying it paid R833000 in the last financial year.
Adcock Ingram and Eli-lilly declined to offer any information on their payments, saying there was no legal requirement for them to do so.
The debate brings to mind the controversy over prescription drugs to treat ADHD, with South Africa reportedly having among the world’s highest rates.
Alarmingly, South Africa reports more use of Ritalin, the drug of choice to treat ADHD than the US.
There’s ongoing concern that there is an over-prescription of Ritalin and diagnosis of ADHD, but little or no investigation has ever been done on this, and so any unethical correlation, if it exists, between sponsorship and prescription, was never explored.
While South Africa has not yet flagged this pharma-doctor relationship, international trends move towards tighter control and more transparency.
Patients’ rights groups in the UK are now calling for a change in policies, to force doctors to reveal any potential conflict of interests.
This, amid recent findings by the Association of British Pharmaceutical Industry that cash and hospitality incentives to doctors from pharmaceutical firms increased to more than £116million (over R2billion) last year despite calls for more stringent disclosure.
It also found that at least one in three clinicians was taking money or treats from drug companies – and refused to publicly disclose their earnings.
In the US, policies have clamped down on the debate with legislation compelling doctors to disclose conflicts of interest.
It’s a debate we are yet to have in South Africa. The time is now, particularly as the Competition Commission is investigating the role of pharmaceutical firms in the pricing of cancer drugs.
It’s a call also being made by the South African Medical Association, which says that while legislation has reduced financial incentives, there continues to be concern over sponsored trips and payments for speaking at conferences.
The association has called for pharmaceutical firms to disclose their sponsorships, or other payments to health professionals, and goes further to call for new legislation enforcing such disclosure, and for doctors to publicly state any potential conflicts of interest.
It’s in the interest of all South Africans to be informed about such disclosures. It would be beneficial if the Competition Commission expanded its enquiry into cancer drug prices to include an investigation into payments from drug firms to health professionals.
Full disclosure, open transparency and the public’s right to know will put to bed any doubt over potential areas of conflict of interest.