Healthy Skepticism Library item: 17365

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Rout M
Doctors' danger swallowing drug companies' line
The Australian 2010 Mar 6
http://www.theaustralian.com.au/news/health-science/doctors-danger-swallowing-drug-companies-line/story-e6frg8y6-1225837527835

Full text:

IT was an expensive cocktail party. One pharmaceutical company hosted 45 respiratory specialists for drinks at an hour-long reception on Queensland’s Gold Coast. This company paid more than $36,000 to fly them in for the party, billed as an educational event because it included an international expert speaker. The company just happened to have a drug that it wanted those specialists to prescribe.

This was one of 14,649 “educational events” put on by drug companies in Australia in six months at a cost of a $31 million. According to researchers from the University of Newcastle, this works out to an average of 600 events a week and about $1000 a year spent on each Australian doctor. It may seem a big investment, but the companies get access to doctors, the key to more than $10 billion annual sales to patients. In exchange, doctors learn about new treatments and get points towards professional development requirements.

Big Pharma has been under the spotlight for what it does to sell its products but the doors were blown open on their activities when Graeme Peterson sued US drug giant Merck in the Federal Court of Australia, with hearings last year. He claimed Merck’s arthritis drug Vioxx caused his heart attack and the US company and its Australian subsidiary knew of the safety risks but played them down to general practitioners. Merck’s internal marketing documents and sales staff training manuals were tendered by the plaintiff as evidence of the lengths to which the company went in convincing doctors to prescribe Vioxx.

This included allegations that Merck created a hit list of 12 doctors critical of the drug who needed to be “neutralised”; came up with “cunning plans” to promote the drug to doctors at educational events; and even faked a medical journal promoting its product.

Yesterday in Melbourne Federal Court judge Christopher Jessup found Vioxx did double the risk of a heart attack and did contribute to the one Peterson had in December 2003. He concluded Merck’s Australian subsidiary, Merck Sharp and Dohme, breached the Trade Practices Act because Vioxx was “not reasonably fit” to be on the market.

Jessup also found the company’s sales representatives ought to have better warned prescribing doctors about the safety risks of the drug but he ruled this would not have contributed to Peterson’s heart attack.

He dismissed other claims that Merck had turned a blind eye to its own research that raised safety concerns about Vioxx, that the company should have known about the drug’s cardiovascular risks and that its lack of action over this constituted negligence.

Irrespective of the outcome of this case, the allegations presented during the trial highlight the interwoven relationships between pharmaceutical companies and the medical profession.

“If their primary obligation is to their shareholders to turn a profit, they may carry out altruistic and scientifically laudable acts but we know what their true motivation is,” says Jon Jureidini, head of psychological medicine at the Women’s and Children’s Hospital in Adelaide. Jureidini, former chairman of medical consumer watchdog group Healthy Scepticism, says what worries him is that drug companies invest money and time into grooming doctors to become what they call “key opinion leaders” in a medical field by advancing their career.

This means the company can later call on the doctors as expert speakers at their educational events and to join drug research trials. They are likely to influence other doctors’ prescribing habits.

He says this often starts early in a doctor’s career when they receive a cold call from a company asking if they want to be the chief researcher on product trials. Next they are asked to present their findings at an overseas conference, and the relationship builds from there.

Recent research led by the University of Newcastle also raises concerns about the transparency of the relationships between drug companies and doctors, especially in relation to educational events.

The study found educational event details provided by drug companies to the regulatory body, Medicines Australia, for July 2007 to December that year revealed a high level of contact between drug makers and medical professionals, including trainee doctors.

“The available information suggests companies exert influence over the educational context of events in most cases, and doctors in training are often present at these functions,” the study says. “There is substantial evidence that attendance at company-sponsored events modifies prescribing practices.”

The researchers, led by Jane Robertson, also conclude that while lavish gifts given by drug companies were a thing of the past, it is likely that more modest, sponsored educational events are becoming “increasingly important and influential”.

But others in the medical profession believe there is nothing untoward in the relationship between doctors and pharmaceutical companies and there is enough regulation to keep everyone in check.

Henry Krum, director of Monash University’s Centre of Cardiovascular Research and Education in Therapeutics, says doctors are smart enough to see through any marketing ploys.

Krum was on Merck Australia’s arthritis advisory board and gave talks on cardiovascular safety and prescribing Vioxx. He says he was never affected by the relationship he had with the pharmaceutical manufacturer.

Medicines Australia chief executive Brendan Shaw also disagrees with any suggestions that there are problems with the way the industry converses with doctors, especially at any educational events the companies run. He says as part of the industry’s code of conduct companies have to ensure they are providing information at the seminars that are “balanced, accurate and correct”. Breaches of the code attract fines of up to $300,000.

“I think the educational events that the companies organise have an important role,” Shaw says. “And doctors value that the companies take that role seriously and in a responsible way.”