Healthy Skepticism International News
Gifts: a transcript of a television report
September 2000
This edition provides a transcript of a segment from the Australian current affairs television program “A Current Affairâ€. The program was broadcast on 13 September 2000.
The Appendix provides a summary of what has since happened to two members of the Pharmaceutical Benefits Advisory Committee (PBAC) who appeared on the program and to one of their supporters.
Introduction
This edition provides a transcript of a segment from the Australian current affairs television program “A Current Affair”. The program was broadcast on 13 September 2000. The people interviewed included, in order of appearance: Peter Mansfield (Director of MaLAM), Peter Davoren (President of the Doctors’ Reform Society), Martyn Goddard (Then Consumer Representative on the Pharmaceutical Benefits Advisory Committee (PBAC)), David Henry (Then Chair of the Economics Sub-Committee of the PBAC) and Keryn Phelps (President of the Australian Medical Association).
Since the program was screened David Henry has lost his position on the PBAC and Martyn Goddard has resigned in protest.
Further information about this was available at www-sph.health.latrobe.edu.au/PBAC but that website has been suppressed.
A summary of what has happened was published on the e-drug list on 25 July 2001 by David Henry and is copied in the Appendix below.
We believe this edition will be of interest to MaLAM subscribers outside of Australia because the problems with gifts and expediential growth in expenditure on drugs are similar in principal in all countries.
On a few occasions over the past 20 years MaLAM personnel have accepted the gift of funding for travel to meet pharmaceutical company staff. For example, in 1996 Joel Lexchin and I accepted funding from Sandoz (now Novartis) to travel to Basel to meet with senior staff of Sandoz and Ciba-Geigy including Dr Paul Vasella (then CEO of Sandoz and now CEO and Chair of Novartis) to discuss our concerns about the marketing of bromocriptine and related issues. It was not clear to me at the time, nor now, whether or not the travel to Basel was justified. At the time, we decided that the possible benefits of accepting the money might justify the risks because we could not afford to learn about the thinking inside two pharmaceutical companies any other way. In retrospect we did learn a lot but the trip cost a lot of time and did not lead directly to any improvements in marketing.
It has been suggested that one test for helping doctors to decide if accepting a gift from a drug company is ethical is: “How would you feel about your receipt of a gift being reported on current affairs television?” As you will read in the transcript, I have now had a personal experience of how it feels. My explanation about that trip to Basel was cut from the television interview. I understand and accept that one of the realities of television is that such explanations are likely to be cut. Knowing that, I answered the way I did because I feel it is better to be as honest as I can than to use silence to try to avoid the risk that some people will reach mistaken adverse conclusions about me. On one hand, having accepted travel funding makes it easier to be clear about not feeling “holier than thou” compared to those who accept research funding from drug companies. On the other hand, if people need “pure” leaders then I have lost the opportunity to provide that type of leadership.
Peter Mansfield
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Doctor’s Perks
Reporter: David Margan
Program: A Current Affair, TV Channel 9, Australia
Transmission date: 13 September 2000
Introduction by Mike Munro:
“Why we are all paying more than we should for prescription drugs? Every year Australian drug companies spend many millions of dollars lavishing gifts on doctors, overseas trips, luxury accommodation, nights on the town, the list just goes on and on. It’s a ploy designed to overcome a ban on advertising drugs to the public, so instead, the companies persuade doctors to prescribe them. The result though, is the prescription of expensive drugs when cheaper ones will do, and claims that the incentive system ultimately smacks of bribery.”
Peter Mansfield:
“There’s been problems with gifts since the Trojan Horse. But what I am concerned about is that the amount of money has got so large now, that it really is bringing discredit on the industry, on doctors and its just not good for patients.”
David Margan:
“Each year drug companies spend over $1 billion promoting their wares and buying the favours of the doctors who prescribe them.
Peter Daveron is President of the Doctors Reform Society.”
Peter Daveron:
“I have been offered a number of things, a number of invitations to dinners with some educational component. Hotel accommodation in Bethlehem, discounted tickets to movie world with my family, if I attended a short education meeting and a Casino evening in Cairns.”
Peter Mansfield:
“Oh I have been offered a trip to Switzerland.”
Interviewer:
“Did you take it?”
Peter Mansfield:
“I did.”
David Margan:
“Even the opponents of the drug companies’ marketing strategies succumb to them. Peter Mansfield runs a lobby group pushing for the appropriate marketing of pharmaceuticals.”
Peter Mansfield:
“What it is doing is encouraging doctors to prescribe more expensive drugs when cheaper drugs will do. What I am concerned about, is that it’s driving costs so high that we are going to loose the Pharmaceutical Benefits Scheme.”
David Margan:
“The latest figures show that the cost of our Pharmaceutical Benefits Scheme (that provides subsidized medicine to all Australians) is increasing by almost 15% per annum. As the cost of prescription drugs steadily rise.”
People in the street being interviewed:
“Well they are pretty high, yeah!”
“Obviously it’s too high, with a family like this it costs us a fortune!”
“In general terms I think that drug companies have a fair sort of control over the pricing, as is the fuel companies, very similar, almost cartels aren’t they?”
“Everything goes up I suppose!”
“I don’t know how anyone on Social Security can survive!”
“It’s control of the sick, isn’t it?”
Martin Godard:
“There is going to be a crunch point at some point. I don’t know what we are going to do about it. Know body knows what we are going to do about it.”
David Margan:
“The pharmaceutical industry claims it’s $1 Billion is spend is mainly on educating doctors about their products, but Martin Godard, who is a Health Policy Consultant and a consumer representative on the Pharmaceutical Benefits Scheme advisory committee, doubts that.”
Martin Godard:
“It goes beyond that. Of course it has an effect on price, of course it has an effect on the way they prescribe, otherwise they wouldn’t do it.”
Peter Daveron:
“When the drug company organises their own educational activity, they are not going to get speakers who are going to give a view of things which are not a commercial good for the drug company.”
David Margan:
“Why these educational seminars and conferences are often held in exotic locations or even in theme parks in any ones guess. Perhaps a free ride on the Cork-Screw is a study aid. Certainly AMA President Dr Keryn Phelps would deny such perks are a bribe.”
Dr Keryn Phelps:
“Doctors will quite often combine a holiday with an educational conference. But that’s not to diminish the educational value of that conference.”
David Henry:
“It’s simply not true!”
David Margan:
“According to medical specialist Professor David Henry the medical profession in increasingly fall under the spell of the drug companies.”
David Henry:
“The industry is spending a huge amount of money, it is giving gifts, it’s paying for airline tickets, it’s hosting meetings, it is not doing this out of the goodness of their collective hearts. They are doing it because it influences doctors prescribing behaviour to prescribe more of their drugs so that they can make more profit, it’s quite simple.”
Peter Daveron:
“There is no doubt that it is recognized that doctors exposed to drug company promotional activities do change their prescribing habits.”
David Margan:
“So, you get the drug of the company who paid for dinner.”
David Henry:
“Now that may not be the best drug for that patient, it may not be the most effective drug for the patient, it may not be the drug with the least adverse effects.”
David Margan:
“Despite a recent inquiry recommending that the ban on drug companies advertising their wares to the public be maintained they have managed to bend the rules and do it anyway.”
On the screen: “Consumer awareness” funded by Pfizer and Pharmacia who sell Celebrex (celecoxib)
“If Arthritis is stopping you from doing the things you enjoy”
“Ask your doctor about the new arthritis treatments….…1800 678 988 Arthritis Foundation of Australia.”
David Margan:
“These ads commissioned by the Arthritis Foundation were paid for by two drug companies marketing the very lasted in anti- inflammatory: Celebrex, but what the ad doesn’t tell you, is that Celebrex had more reported adverse effects than any drug in the history of the Therapeutic Good Administration, and there are some who doubt that doctors are telling you about this either.”
Keryn Phelps:
“They will make a judgement that is based on the best interests of the patient not the best interest of the pharmaceutical company.”
David Margan:
“With an increasing number of our medical and research specialists on the payrolls of drug companies, as speakers or advisors, what of the professions independence?”
David Henry:
“It’s an insidious influence, whereby the industry is everywhere in many doctors lives now, its on their desk, its at home, its in the journals, it’s at the meetings that they go to, it’s ever present and the profession has to learn to distance its self from the industry.”
David Margan:
“Well what do the pharmaceutical manufacturers have to say about all this? Well not much, we approached 15 of the major manufacturers and they all declined to comment, referring us instead to their industry association, who also declined to be interviewed.”
On the screen: “Consumer awareness” advertisement funded by Roche who sell Xenical (orlistat)
“Sometimes, diet and exercise just aren’t enough.”
“Your GP can make a difference!”
David Margan:
“The industry claims it’s promotional activities with the medical fraternity are governed by a code of conduct. But it’s a code with few teeth.”
Peter Daveron:
“Any breach of conduct which is reported to them is investigated by them.”
Peter Mansfield:
“There will be small sanctions, maybe a few thousand dollars, on a practice that has earned a drug company many millions of dollars.”
David Henry:
“The integrity of the profession is threatened by this.”
Peter Daveron:
“I think that none of us are above being seduced by sophisticated advertising and marketing and that is what the drug companies are doing.”
Martin Godard:
“It is a real straight jacket of information, and the level of accountability to the tax payer out there who is paying for all this and the help for consumers, who’s lives and health depend on it, is almost zero and I think it stinks.”
David Henry:
“What you shouldn’t have is one particular product promoted to you by the doctor because a free sample has been left on that doctors desk, or because that doctors has just had a free weekend in the Blue Mountains, courtesy of the manufacturer.”
END
Appendix
E-drug: Further dirty tricks in Australia
————————————————————————————————————-
Recent events have moved me to put on record some of the further
experiences of former members of the Australian Pharmaceutical
Benefits Advisory Committee and their supporters. As some readers
of this site will be aware, most PBAC members (10/12) were
sacked or resigned in December 2000 after a serious disagreement
with the Australian government, which viewed the committee as
having an unduly adversarial relationship with the pharmaceutical
industry. An investigative television program (ABC Four Corners)
established that the industry had lobbied to have particular
members removed from the committee and to place an industry
representative on the committee.
Most of us who were involved thought that the dissolution of the
committee would be the end of the matter and we could get on
with our lives. Not so…
Three people have been targeted for special continued attention - 2
former members Martyn Goddard and myself, and a supporter, Dr
Ken Harvey from La Trobe University (Melbourne).
Ken Harvey was unexpectedly accused by his institution of serious
misconduct for posting on a university Web site news articles and
published cartoons relating to the PBAC debacle. The material, an
extremely useful summary of the history and background to the
events, had links to published material that featured alleged
relations between the federal health minister and the pharmaceutical
industry. The material had been available for some time and the
timing of the University’s attack on Dr Harvey was a surprise to all.
As you know, the latest news is that the university has not
proceeded with official action and has settled its differences with
Dr Harvey (who appears unable to comment) - I feel sure that the
many international expressions of support must have helped.
Martyn Goddard is a very effective consumer advocate, and was a
consumer representative on the PBAC; he is well known in Australia
as a journalist and AIDS activist. He tried harder than anyone to
hold together the remnants of the old committee, but after an
industry representative was placed on the PBAC he resigned and
became an outspoken critic of the present government and the
industry. He has been dropped from all his committee advisory and
consulting roles - with no warning or justification.
In my case, federal health department officials were ordered to
retrieve any documents relating to me. Subsequently, confidential
documents were released to a PR company and then to news
outlets with an accompanying written commentary that accused me
of taking money from a pharmaceutical company and biasing PBAC
decisions in favour of that company’s products (and against
another’s). Fortunately, some very good journalists chased down
the truth (the story was a complete fabrication and was easily
disproved).
There has been a systematic campaign in Australia to discredit
former members of the Australian PBAC and their supporters.
It seems that anyone who makes a stand on issues of equity and
fair prices for pharmaceutical products should expect to encounter
such tactics.
David Henry
Professor of Clinical Pharmacology,
Head of School of Population Health Sciences,
Faculty of Medicine and Health Sciences,
The University of Newcastle, NSW
Phone + 61 249 211856
Fax +61 249 602088
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