Healthy Skepticism Library item: 2176

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

Coulthart R.
The doctors' gravy train
Channel 9 TV Australia 2001 Aug 5

Full text:

The old saying goes there’s no such thing as a free lunch … or should we say dinner? Oh, what the heck. Bring on the dancing girls! The host: Pfizer, one of the world’s biggest pharmaceutical companies. The guests: 270 Sydney doctors and many of their partners. The occasion: Well, it’s an ‘educational dinner meeting’ for doctors – all about arteriosclerosis – hardening of the blood vessels. Clearly this function was touting the benefits of regular exercise and moderate drinking. But a major reason why Pfizer’s laid on tonight’s entertainment is to encourage doctors to prescribe a drug for high blood pressure, ‘Accupril’. And here’s the rub … all this is costing $20,000 and we taxpayers are paying for most of it.

REPORTER: Almost every night of the week in the major cities and luxury resorts across Australia, Doctors are enjoying the hospitality of our major drug companies. Now let’s be clear, it’s perfectly legal what the drug companies are doing. The only issue is – is any of this lavish entertainment and often quite generous gifts influencing the decisions that doctors have to make about which drugs they prescribe. And the cynical amongst you might ask: why else would the drug companies be doing it? As you’ll see, taxpayers are footing the bulk of the bill for the aggressive drug marketing that’s caused a massive blow-out in the costs of the PBS: the Pharmaceutical Benefits Scheme, which subsidises the costs of drugs doctors prescribe.

REPORTER: So all these gifts, these inducements that are being offered to doctors at for example these lavish nights at hotels and ferries on the harbour, that money from the pharmaceutical companies is actually coming from you and me, the taxpayer?

DR KEN HARVEY, DRUG POLICY ANALYST: Yes. Yes. The PBS subsidises something like 90 percent of all the costs of drugs and that’s taxpayer’s money. Ultimately going back into profits, into marketing and into ads.

REPORTER: Internationally, the way the industry pushes drugs to doctors has become a huge concern.

LARRY SASICH, U.S. PUBLIC CITIZENS’ HEALTH RESEARCH GROUP: I don’t think we can trust the pharmaceutical industry any longer to provide objective information about the risks or the benefits of their drugs. They’re not in that business.

REPORTER: And yet the evidence is that that’s what the doctors are relying on?

SASICH: That’s correct.

REPORTER: Today a former drug company manager reveals to Sunday the sensitive information some drug companies secretly keep on the doctors they target.

DAVID BAZELEY, FORMER AVENTIS MANAGER: The word insidious comes to mind. You know they are keeping private notes on a secret database about, you know, an individual professional is, you know, a little bit, it’s a little bit beyond the pale.

REPORTER: He also details how millions of dollars of taxpayers’ money are being spent not just on entertaining doctors but also on extravagant overseas trips and lavish entertainment for drug company sales staff:

BAZELEY: And my first reaction was if they do this for an internal sale, you know, what are they going to do for the real people that are going to prescribe it.

REPORTER: The Government does fund independent information through organisations like the National Prescribing Service to encourage GPs to responsibly prescribe drugs – since 1998 the NPS received $6 million a year. But its efforts are dwarfed by the estimated $1 billion the pharmaceutical companies spent last year on marketing – mainly targeted at doctors.

DR HARVEY: I don’t think we can just blame the pharmaceutical industry for their promotion and their wining and their dining. Regrettably many of my colleagues have almost come to expect that they should have their snout in a trough at regular intervals and indeed I think they’ve forgotten they’ve turned into pigs.

REPORTER: The Government budgeted $3.8 billion to June 30 for the drugs it expected to subsidise under the PBS. But doctors’ prescriptions of just two drugs – the anti-smoking drug Zyban and anti-arthritis drug Celebrex – helped blow the budget out a staggering 21 percent to $4.25 billion. The Government admits the increase has a lot to do with the money Australia’s drug companies are spending to market their drugs. The APMA – Australia’s Pharmaceutical Manufacturers Association is unrepentant.

ALAN EVANS, AUSTRALIAN PHARMACEUTICAL MANUFACTURERS ASSOCIATION: If someone thinks it is inappropriate, then they’ve got the ability to make a complaint to the APMA and it will be dealt with by the independent code of conduct committee.

REPORTER: But why would any doctor complain about this gravy train – this largesse from the drug companies. They’re on the receiving end.

EVANS: But it’s not a gravy train. They’re getting information about pharmaceutical products which will you know go to the aid of their patients. They’re better informed so they can be better prescribers for their patients.

REPORTER: Dr Deepak Malhotra is a GP in the Sydney CBD. But he has also worked as an executive with a major pharmaceutical company, so he knows how they operate.

DR DEEPAK MALHOTRA: I think it has got out of control because the number of functions that are held, the number of occasions where, under the guise of educational meetings, marketing exercise is being carried out. It is too much and a lot of doctors do accept it. And I think that they are being influenced very strongly by this particular marketing technique.

REPORTER: Earlier this year, Dr Malhotra decided to help Sunday show taxpayers just how their money is being spent by the subsidies given through the Pharmaceutical Benefits Scheme. He stopped throwing the invites in the bin and started keeping all the free offers he was getting from the industry.

DR MALHOTRA: I would get about two or three invitations a week. However in larger practices the invitations do keep coming in virtually at the rate of four or five a week and there are some colleagues of mine who virtually spend their entire week at functions like this.

REPORTER: Do you think a lot of your colleagues believe that this kind of marketing has no influence on their prescribing behaviour?

DR MALHOTRA: A lot of my colleagues think it does not have any influence however we again come back to the fact that they are spending so much money on it it must be having an effect, like if you take the maximum promoted drugs are the cholesterol lowering drugs and they are the ones which have got the highest amounts of prescription rate at the moment.

REPORTER: Dr Peter Mansfield is an Adelaide GP who also runs Healthy Skepticism. It’s an international non-profit health lobby group which aims to protect medical care from the bad effects of marketing. Dr Mansfield says that in a country like Australia where advertising of prescription drugs to consumers is not allowed, the industry’s marketing directly to GPs is dramatically influencing how doctors prescribe.

DR PETER MANSFIELD, HEALTHY SKEPTICISM: I think that it’s one of the most important sources of information for most GPs especially about new drugs. We know that doctors who rely more on information from pharmaceutical companies prescribe less appropriately.

REPORTER: And how do you know that?

DR MANSFIELD: There’s a number of studies done in the US, in Europe and also in Australia that have consistently found that doctors who are less sceptical about information from drug companies and who have contact with them more often prescribe less appropriately.

US DRUG COMMERCIAL: [“I asked my doctor about Lipitor. Have you?”]

REPORTER: In the US, industry spent over $20 billion promoting prescription drugs in 1999. Government education efforts internationally are being left behind, according to Steve Findlay from the Washington DC-based National Institute of Health Care Management.

STEVE FINDLAY, US NATIONAL INSTITUTE OF HEALTH CARE MANAGEMENT: We have an industry which has become perhaps really one of the best marketers of their product in the world. For example, hospital-based doctors love to get free meals. They don’t have time to eat so free meals has become a big thing. Trips … doctors love to go to nice resorts and locations and they bring along their family. Pharmaceutical companies have become extremely adept at booking great hotels all around the world and attracting physicians to those meetings.

REPORTER: Now what’s wrong with that?

FINDLAY: I think to a certain extent it can be educational. But I think that the concern over the last four or five years has become that these events, doctor education events and selling promotional events have become particularly intense.

DR MANSFIELD: The problem about medicine is that it’s a very difficult job. It’s very emotionally draining and we get very tired and then somebody really friendly comes along and wants to give us gifts and nurture us and understandably being human, we love it.

REPORTER: Here on Sydney Harbour Dr Malhotra joined over 200 other doctors for some nurturing as a guest of Pfizer. As with all these drug company-sponsored education nights, there was an informative speech on-board presented by a respected medical opinion leader. But the promotion here for Accupril, Pfizer’s drug for treating high blood pressure left our doctor in no doubt what the evening’s main purpose was.

REPORTER: What was the impression that you got from speaking to other doctors at tonight’s function? What are they saying to you about?

DR MALHOTRA: Some of them said they were there because it’s a great function. It was very well done. We had semi-naked girls over there trying to push the sale of a particular drug.

REPORTER: And did any of the doctors say it would influence their prescribing habits?

DR MALHOTRA: Yes I did speak to some of them and they said that, yes, after listening to tonight’s talk, because the speaker was an excellent speaker and has got great reputation. So they did say, yes, it would influence their prescribing habits.

REPORTER: Well isn’t this a perfectly reasonable hypertensive drug though?

DR MALHOTRA: It is a reasonable hypertensive, anti-hypertensive drug however whether I would prescribe this one or another one would depend on what the background of the patient is because there are so many other factors involved in prescribing a drug.

REPORTER: The Australian Pharmaceutical Manufacturers Association’s code of conduct says that:

READ CODE OF CONDUCT: “Entertainment or other hospitality offered to healthcare professionals should be appropriate, secondary to the educational content and in proportion to the occasion…”. “Inappropriate financial or material benefits, including inappropriate hospitality, should not be offered to healthcare professionals to influence them in their prescribing or dispensing of pharmaceutical products.”

REPORTER: This evening cost Pfizer $20,000, including dancing girls. It may be OK with the industry’s code of conduct but would taxpayers think it was alright if they knew they were paying for the bulk of such largesse?

EVANS: The vast percentage of the costs of pharmaceutical products is in the research and development.

REPORTER: Are you saying that the taxpayers aren’t paying for the extravagant entertainment of doctors?

EVANS: Taxpayers are paying for the pharmaceutical products they receive which make them healthier. That’s what they’re paying for.

REPORTER: But they’re also paying for those free dinners, those free lunches, the car washes, the ferry rides, the bottles of wine … we’re paying for it aren’t we?

EVANS: And in every other product you buy you’re probably doing the same thing.

REPORTER: So why should taxpayers be paying for this when they’re subsidising the drug industry to the extent that they are?

EVANS: No they’re not subsidising the industry, they’re subsidising themselves.

REPORTER: Under the Pharmaceutical Benefits Scheme, taxpayers subsidise as much as $26 for every script a doctor writes for Accupril. Pfizer will recoup its $20,000 from taxpayers very quickly if evenings like this persuade doctors to write more scripts for its drug.

DR MALHOTRA: At $25 a script and certain subsidy from the Federal Government the cost would be realised with a thousand prescriptions.

REPORTER: Pfizer declined SUNDAY an interview. It told us in a written statement that it rejects any suggestion the evening was inappropriate promotion. It also told us it rejects the suggestion that taxpayers are subsidising the cost of drugs marketing through the PBS – claiming the prices it gets for its drugs from the Government are totally unrelated to company expenditure.

Sydney’s luxurious ANA Hotel – another educational dinner.

VIDEO CLIP: [“Well, if I learned how to cope with stress better, maybe I’d be okay.”]

This time: a workshop on generalised anxiety disorder, funded by Wyeth Pharmaceuticals. Over roast lamb, fine wine and silver service, a dozen or so doctors, including our Dr Malhotra, discussed the merits of treating fictional case histories with antidepressants, including anxious Rick.

VIDEO CLIP: [“Well, I’ve been really stressed at work, and I wondered if I should take some vitamins or something.”]

REPORTER: But as with all such nights, whatever it says about informing doctors, a major reason for Wyeth’s funding the evening is to encourage doctors to prescribe more of its antidepressant drug, called Efexor-XR.

DR MALHOTRA: A lot of emphasis was given to the fact that we should step into antidepressants much earlier than what is needed. I would like to try some other therapy techniques in relation to depression. There are metabolic tests to be done, have to know if the patient is a diabetic, thyroid deficient or some other problems which may be causing this thing. So you really have to investigate the patient further.

REPORTER: The drug pushed here, Efexor-XR, is an antidepressant called an SSRI. It costs more than older antidepressants but like many of the newer drugs it is not necessarily better despite the glossy marketing. Larry Sasich heads research at the Public Citizens’ Health Research Group in Washington DC.

LARRY SASICH: Both our national institutes of health and other independent researchers have done summary studies and these studies really can’t find a therapeutic advantage in terms of being a better drug to treat depression. One has no apparent advantage in studies over another.

REPORTER: That’s certainly not what you’d find from the way drug companies market these products.

SASICH: Sure and I think at least in this country that there is the mistaken notion that because a drug is new or in a newer class of drug that means it’s safer and more effective. There is no requirement in our drug law that a new drug be safer and more effective than drugs that are already on the market.

REPORTER: In a statement to SUNDAY, Wyeth agreed that the efficacy of SSRI drugs might be similar to the older tricyclics. Wyeth cited Australian expert guidelines warning of side effects and the risk of overdose with the older drugs. Every doctor who attended the Wyeth dinner at the ANA walked out with a swag of gifts and information

REPORTER: How many of these could you get a week?

DR MALHOTRA: If I really went to all the meetings I would collect, apart from what is given to me here, what is sent in the mail, probably about five at least a week.

REPORTER: This must be about $20 worth of gear at least.

DR MALHOTRA: Yeah I could get gifts up to $50, $60, $100 and over the year maybe worth eight, nine, $10,000.

REPORTER: The medical opinion leaders chosen by the drug companies to speak at these education nights also do well. The psychiatrist who hosted this evening’s event got an overseas trip from Wyeth.

DR MALHOTRA: Well I had a chat with one of the reps and asked her very frankly about the fact that the lecturer who was on tonight was he given a recent trip to Hong Kong.

REPORTER: And what did she say?

DR MALHOTRA: And the answer was yes. Because he does a lot of lectures for them.

REPORTER: Wyeth said it paid $385 to the psychiatrist who spoke at the ANA dinner. It also agreed it funded his trip to a Hong Kong conference but said this was not intended as compensation for running the workshop.

REPORTER: Dr Ken Harvey is a director of Therapeutic Guidelines, an independent non-profit company producing best practice treatment guidelines for doctors including non-drug alternatives. The whole emphasis is to stop over-prescribing of expensive and often inappropriate drugs. Despite the aggressive drug company spending on marketing, there’s only been very limited Government support for Therapeutic Guidelines’ efforts. Dr Harvey believes so long as drug companies remain the chief source of educational information for doctors, the blow-out in our PBS is only going to get worse.

DR HARVEY: The cost of a pharmaceutical scheme is going up exponentially. It took something like 40 years to get to $1 billion but in the last 10 years it’s now reached $4.25 billion so the cost of drugs is going up exponentially in this country and there’s excellent evidence that a high proportion of that cost is unnecessary, inappropriate and irrational and driven by the marketing activities of the pharmaceutical industry.

REPORTER: In Part Two, you’ll see just how far the drug reps are encouraged to go by the Pharmaceutical giants to target doctors who’ll prescribe their drugs.

BAZELEY: The doctors are getting their – you know – all their special little trinkets and whatever, but at the same time data is being collected on them which I don’t think they really realise exists and which I think they would resent existing.

TRANSCRIPT – PART TWO

REPORTER: It’s GPCE time – The General Practitioner Conference and Exhibition – the biggest annual event for doctors in the Southern Hemisphere. This year staged at Sydney’s Homebush Bay Olympic site. For our medical insider, it’s a long weekend orgy of gifts and pharmaceutical industry promotion.

DR MALHOTRA: Gifts galore. I mean I’ve already had three bags full and I couldn’t carry any more. And I intend going back again to get some more

REPORTER: The hand-outs started even before Dr Malhotra arrived. Medical product manufacturer Smith & Nephew got free passes as part of its sponsorship. It shouted him and 99 other doctors the conference attendance fee.

DR MALHOTRA: I haven’t been given such an exorbitant prize before, this is the first time, the only time. Before that the only thing I got that was worthwhile was a camera from one of the companies which had a photography contest.

REPORTER: GP Dr Colin Owen sits on the conference’s organising committee. Yet he admitted he didn’t know some doctors were getting their conference fees paid for them.

DR COLIN OWEN, GPCE ORGANISING COMMITTEE: I’m not aware of that. I’ve never heard of that. In fact I’ve been on the advisory committee for five years and I’m not aware that there are registrants here whose registrations are paid for by drug companies. I’m not aware of that.

REPORTER: If that was happening would that be of concern to you?

DR OWEN: Yes it would actually. I’m not aware of that. I don’t like the principle of that. I think if a GPs coming here they should be paying their way because they’re going to get something out of it.

REPORTER: There’s no doubting that there is a lot of useful information and training classes here for an inquiring doctor. So much so, it’s endorsed by the Royal College of GPs to earn doctors who attend a swag of points towards their required continuing medical education.

SALES REPRESENTATIVE: Two or three patients, and we’ll send you out a box of a hundred.

REPORTER: But there’s also no doubting the reason industry is backing this conference is because it’s a great opportunity to get up close and personal with the doctors who prescribe their drugs and order their products. And doctors have the incentive of possibly winning $22,000 in prizes to if they visit every stand and get their conference passport stamped. Where of course along the way they are hit with the product spiel.

SALES REP: There’s a few competitions, one of them is actually just to update them about all the different products, give them a summary of them to see if they know the products. And obviously representatives are here to help them out and once they’ve completed the questions they get a prize which is actually a big Toblerone chocolate … they don’t know that.

REPORTER: Pavlovian dog therapy?

SALES REP: Yes. But they don’t know they’re actually winning a prize so it’s a way of basically giving them an incentive, a quiet incentive.

REPORTER: To know about your products?

SALES REP: Sorry … yes, that’s right. Yes!

DR OWENS: I don’t think the sorts of things that are here, the freebies if you like which are basically pins and bottles of wine and so forth. I don’t think they’re going to make any difference to people’s prescribing habits at all.

DR HARVEY: They’re deluding themselves Ross.

REPORTER: Why do you say that?

DR HARVEY: Firstly big business would not spend that amount of money if they didn’t have good evidence that it actually influenced prescribing behaviour and secondly, in our own small way here at Therapeutic Guidelines we’ve shown that a good dose of counter marketing, counter-advertising, academic detailing can change habits for the better.

REPORTER: Some of the lengths drug reps go to win the ear of a doctor are inventive…Glaxo Smith Kline offered these Sydney doctors a chance to get their cars hand-washed and waxed. While they waited they sat through a free lunch and a workshop touting the merits of the pharmaceutical company’s products. But not all of these events are mainly a marketing exercise. Here at the Stamford Hotel in Sydney’s Double Bay Dr Malhotra attended a talk on renal medicine sponsored by Essex Pharmaceuticals.

DR MALHOTRA: I think it was a very educational evening. They put their entire resources into making all the GPs that are present there wiser to a lot of things that we didn’t know about and a lot of things that we would love to know about.

REPORTER: How many occasions like this are educationally beneficial events?

DR MALHOTRA: Drug companies would put shows like this, it would probably be about one in ten to fifteen where you would get this. Otherwise it is straight through marketing.

JON MARSHALL, HEALTH COMMUNICATION NETWORK: The advantages of the electronic prescribing are that the doctor can very quickly look through all the brands available.

REPORTER: One area where marketing is now most furious is in the battle for doctor’s hearts and minds through their computers. Most Australian doctors have taken advantage of a generous $10,000 Federal Government subsidy to adopt computers.

JON MARSHALL: One of the again significant advantages of clinical computing is that a doctor can legibly produce a script.

REPORTER: This software called Medical Director is marketed by Health Communication Network. It’s now installed on well over 85 per cent of those computers. Every time a doctor writes a script on Medical Director he or she is randomly bombarded with drug ads.

DR HARVEY: What the Government did not do was impose any standards on that particular prescribing software. It did not say anything about whether there should be advertisements on essentially an electronic script-pad and it did not say anything about what standards should apply to the databases or whether there should be best practice information, for example our Therapeutic Guidelines information, in that software.

EVANS: That advertisement on that software is accurate and balanced and secondly it appears randomly so if you went in to seek treatment of a particular disease you couldn’t guarantee that you’re going to get Company X’s product being advertised. It’s random.

REPORTER: It’s still a product. It’s still marketing of a product.

EVANS: Of course, yeah. But it’s providing information. I mean what are you suggesting that we don’t provide information to medical practitioners

REPORTER: Are you saying that it’s not about encouraging a doctor to prescribe
More of a particular drug.

EVANS: It’s about encouraging that doctor to prescribe a particular product but we’re not about encouraging…

REPORTER: So it’s all about marketing?

EVANS: Of course it’s about marketing I mean

REPORTER:Thank you.

EVANS: You’re not going to spend money to you know have no marketing in a sense you don’t inform anybody about anything.

REPORTER: Well it’s poppycock isn’t it then to go around asserting then as you have been that it’s just about providing doctors with information.

EVANS: It is about providing information about particular prescription products. I mean a pharmaceutical company spends millions in research, spends hundreds of millions to get the product to market, goes through all the testing and the trialing and thenhas got to recoup that investment.

DR HARVEY: Pharmaceutical advertisements provide biased information. They, by and large, only promote the latest and the most expensive products because that’s where the market share is to be made. They rarely promote generic products and they never promote non-drug solutions.

REPORTER: Until August last year David Bazeley managed Customer Service for Aventis Pharma. Who better to ask about the effects of drug company marketing.

REPORTER: What do you say to the GPs who say that kind of marketing doesn’t influence their prescribing behaviour?

BAZELEY: They’re wrong, because it does. That’s why drug companies do it.

REPORTER: Bazeley says some doctors have become so used to the drug company largesse that surgeries would call Aventis asking for a free lunch.

BAZELEY: I think it’s quite standard at the moment, particularly in these larger practices. The rep is required to bring a certain cuisine, like a Thai or an Indian or whatever and also an appropriate wine to go with it. And they not only sort of feed the doctors but the receptionists and basically anybody that’s there.

REPORTER: And the drug company’s quite happy to play along with this?

BAZELEY: I don’t know about happy but they do it.

REPORTER: Why do they do it. What’s the advantage?

BAZELEY: It’s probably, well, I think it’s getting in the door. Getting in the door is one of the major problems for medical reps.

REPORTER: Aventis spends big dollars not only on entertaining doctors but also on morale boosting holidays for its sales and marketing staff. Last year the entire Aventis team was flown to Kota Kinabalu here in Malaysia for what Bazeley cheerfully admits was a fantastic holiday partly at the taxpayer’s expense. One night at the hotel bar alone cost thousands of dollars.

BAZELEY: They just kept on bringing out drink after drink after drink, almost like a United Nations of alcohol because there were drinks of every colour there. And people just drank until they could drink no more.

REPORTER: Another year, two to three hundred staff were flown to Thailand and lavishly entertained at this luxury Bangkok hotel for a week of fun.

REPORTER: The obvious question is: who’s paying for all this?

BAZELEY: Well that’s exactly what I asked. I thought this is very special stuff and it suddenly dawned on me who’s paying for it. And that’s when I started to look at the activities and say well who is you know where is this money coming from. You know like who’s paying for it. And you know, the big question is … you and I are.

REPORTER: Why are we paying for it?

BAZELEY: Well it all comes out of pharmaceutical benefits.

REPORTER: Aventis declined to answer our questions about the cost of overseas trips for its sales staff. In this statement it said:

READ FROM AVENTIS LETTER: “The notion that taxpayers are funding drug company expenses is naive in the extreme. There’s no basis for assuming that because the Government subsidises a product that the company is therefore using taxpayer money to run its business.”

REPORTER: For years there’s been rumours about the personal information drug companies keep on doctors to improve their marketing.

DR PETER MANSFIELD: Every doctor has a profile and I’ve seen profiles for doctors where they are classified as to whether they are high prescribers. I’ve even seen a list where a group of doctors were put in order with the highest prescriber at the top down to the lowest prescriber at the bottom.

REPORTER: And these are lists prepared by pharmaceutical companies?

DR MANSFIELD: By their staff as part of their planning. So particularly high prescribers will be targeted to become opinion leaders. They will become the speakers at meetings to influence others.

REPORTER: Aventis Pharma spent one million dollars in one year according to David Bazeley on new lap tops and a computer software system called EDISON for its sales staff. He revealed to Sunday just how sales reps categorise doctors on EDISON’s database. This information allows the company to target doctors perceived as ‘conservative’ or ‘innovators’; ‘followers’ or ‘thought leaders’

BAZELEY: How would you feel as a 55-year-old doctor you know with a neophyte to the company – say 25-years-old – carting around a database where you are on there as a follower.

FINDLAY: That’s incredibly valuable information to them. Very incredibly. They can target their promotional activities and the conversations they have through detailing, through representatives going to the actual doctor. They can target their message. They can go into that physician’s office and basically try to switch that doctor to another drug.

REPORTER: Aventis told Sunday its sales reps do keep records on doctors. It claimed that the doctors provided this information ‘quite voluntarily’. Aventis declined to answer the specific questions we asked about exactly what information it keeps on doctors. But it told SUNDAY:

READ FROM AVENTIS LETTER: “Particular information, of a professional, not private, nature is essential to ensure their next visit is appropriate and relevant to the doctor’s interests.”

REPORTER: Every year the Aventis sales rep who makes the most sales of each drug gets a trip to an international conference of their choice.

BAZELEY: So really what the taxpayer is doing is subsidising to a large extent a very very nice holiday in somewhere like Europe. And it’s just the taxpayer seems to be being slugged not only for the opulence – of the activities of the drug company – but some of the personal perks of the people working for the company.

REPORTER: The issue is that the drug industry knows that the bulk of the costs of marketing these drugs is being borne by taxpayers.

EVANS: Well I’m not sure that what you’re trying to arrive at by suggesting that’s the case. I mean what happens as a taxpayer, one way or the other, you meet the cost of the pharmaceutical product.

REPORTER: The setting: One of Sydney’s most exclusive restaurants, Level 41. The host, again: Wyeth Pharmaceuticals. The occasion: Well, over some of the country’s best food and wine our invited doctors are tonight discussing … gastroenterology. On their way out, we decided it was time to ask the obvious question:

REPORTER: Do you think a drug company should be bringing you here?

FEMALE DOCTOR: Yes, yes, we had such a good time.

REPORTER: But really they’re just trying to sell you drugs aren’t they?

FEMALE DOCTOR: They’re not. It’s for education. Now don’t get it wrong. It’s purely for education. Do you hear the word Zoton the whole night.

REPORTER: So they weren’t pushing the drug.

FEMALE DOCTOR: No, it was not mentioned at all.

REPORTER: You think it makes no difference that they bring you to the most expensive restaurant in town.

FEMALE DOCTOR: It’s … ah … how can I put it. They’re marketing a drug and it’s just a means of getting together and sharing experiences. We talk about medicine. We have a good time. But Zoton, that product, is insignificant in these evenings.

REPORTER: Even though it’s at this restaurant.

FEMALE DOCTOR: Ummmmmm. There’s a lot of restaurants. Buon Ricordo. And ah Tetsuya. We go to some lovely places.

REPORTER: You go to them all?

FEMALE DOCTOR: mmmm, when I am invited.

REPORTER: Alan what doctor’s going to complain if he’s in receipt of such largesse?

EVANS: It doesn’t have to be a doctor …. you could complain

REPORTER: Yeah but I don’t know about it.

EVANS: Well you’re just telling me you do.

REPORTER: The only reason we did was because a doctor who was invited told us – now that’s the point isn’t it.

EVANS: You could complain. I invite you to complain. I invite you to complain.

REPORTER: So next time any member of the public sees one of these doctors functions going on in some posh hotel or some extravagant tourist resort somewhere they should walk up and demand to know who’s paying.

EVANS: Yes. And if they feel it’s inappropriate.