Which doctors and other healthcare professionals are receiving payments from pharmaceutical companies? And how much are they getting?

To some extent, people in the US already have access to this information (as shown by the Dollars for Docs database compiled by ProPublica), and they will gain even greater access as a result of the Physician Payment Sunshine Act which requires drug, biologic, and medical device manufacturers in the US to report certain gifts and payments made to physicians from 2013.

But in Australia, our public institutions – including universities and research institutes – have shown little interest in promoting such open disclosure. Very few, if any, universities, hospitals or healthcare services make such information publicly available.

Interestingly, one major corporate player has just announced a challenge to the status quo. In a significant development, the Australian arm of the pharmaceutical company GlaxoSmithKline (GSK) will soon begin reporting the total value of its payments to Australian healthcare professionals via grants, consultancies, speaking fees etc.

And as the company’s general manager Deborah Waterhouse intimates in the article below (and has also confirmed in more detail in an interview with me), the eventual goal is to ensure public disclosure of who is being paid what.

As Waterhouse notes, community expectations around transparency and disclosure have changed. It seems that one company, at least, has gotten this message. Maybe it’s time for public institutions to do likewise.

Wouldn’t it be nice to know, for example, if the experts providing governments or other bodies with policy advice are also receiving payments from relevant companies? Or if their institutions are receiving such payments?

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GSK discloses payments to healthcare professionals

By Deborah Waterhouse, General Manager, GlaxoSmithKline Australia

There are many good things that come from commercial partnerships between pharmaceutical companies and healthcare professionals.

Some of these include research grants and sponsorships, the dissemination of best-practice treatment guidelines, improved education for company representatives and improved awareness of specific health conditions among consumers and other healthcare professionals.

All of these outcomes can be delivered without the company unduly influencing the prescribing behaviour and clinical decisions of healthcare professionals.

While people in the pharmaceutical industry accept all this as true, there is no escaping the fact that public scrutiny of the relationship between pharmaceutical companies and healthcare professionals has increased significantly in recent years. And that some skepticism exists around the nature of these relationships.

One way we have chosen to address this issue at GSK is to be increasingly transparent about the nature and detail of these relationships. We want to dispel the perception that they are about influence, advocacy and persuasion.

We have taken an important step in that direction today by announcing that we will shortly be disclosing the total aggregate amount of fees paid to Australian healthcare professionals for speaking and consulting services during 2010.

The final figure will include all grants, donations, consultancy fees and sponsorships made to healthcare professionals for research grants, advisory committee work and educational projects. Our intention is to update this figure regularly and to make it available via the GSK website.

We have written to many of the major players in the medical and pharmaceutical sector in Australia (eg, the AMA, the Pharmacy Guild, Pharmaceutical Society of Australia), to key political stakeholders (eg the Federal Health Minister) and to the healthcare professional groups with whom we have existing commercial relations to tell them of our plans and new policy.

Letters of Agreement or contracts with Australian healthcare professionals who do consulting, research or educational work for GSK will specify that the financial value of the arrangement will be added (anonymously) to the aggregate amount disclosed by GSK on a regular basis. Work will only proceed where the healthcare professional or professional group agrees to this condition.

This will help to dispel some of the misconceptions around these arrangements. Commentators, journalists and health policy analysts will still be free to form a view about these issues, but will be doing so (in relation to GSK projects) in an environment of improved transparency.

From a GSK perspective this development is consistent with our long term commitment to increase transparency around commercial relationships with healthcare professionals and other third parties.

We will be the first pharmaceutical company in Australia to disclose a total amount of payments made to healthcare professionals. This is consistent with a number of recent steps relating to greater transparency of our activities. These include our clinical trial register, our disclosure of commercial arrangements with patient groups, and our commitment to ensure timely publication of all clinical research results in the scientific literature.

We hope that other pharmaceutical companies will adopt this approach and we are engaging with our industry representative group, Medicines Australia, to support this disclosure.

GSK’s relationship with healthcare professionals is positive, interactive and educational in spirit. In almost all cases we have a shared interest in improving patient care and their input is often crucial in helping us develop better products and processes.

You may be thinking: Why not disclose arrangements on an individual basis so that each specific project is open to scrutiny?

Notwithstanding some important legal issues related to individual privacy and commercial-in-confidence information, we are certainly not ruling that out in the future.

But for now it is one step at a time.

We’ve written to our partners and stakeholders explaining our commitment to disclose an aggregate amount paid to healthcare professionals as sponsorships and consultancies. We will honour that commitment by disclosing the total amount in early June 2011.

We see this as a critical important step at the start of an era for pharmaceutical companies where transparency around healthcare professional relationships will need to change in order to match community expectations.

***

Update 1:

• Some reaction to the announcement (from Ray Moynihan and the AMA) in The Australian’s story.

Update 2:

• More reaction to the announcement was included in this piece I wrote for the Crikey bulletin today.

• And below is comment provided by Medicines Australia. It arrived too late for the Crikey story so is published here instead:

Deborah Monk, Senior Manager responsible for  the Medicines Australia Code of Conduct, said:

“There is certainly a global trend towards greater transparency and Medicines Australia supports that. As an industry we need to earn the trust of the public and that trust is built on transparency.

“In Australia the industry is moving inexorably towards greater transparency, and Medicines Australia continues to consult with the wider community to ensure industry conduct meets changing community expectation.

“There will be a comprehensive review of the Medicines Australia Code of Conduct this year, which will be informed by submissions from the healthcare sector, consumers, academia and the general public. I would encourage anyone with an interest in transparency or other Code of Conduct issues to contribute to that process.

“There is no doubt that what GSK is doing will inform the direction the wider industry takes in the future.”

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