Healthy Skepticism Library item: 5633

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Publication type: news

Moynihan R.
The sugar-coated pill : Three nights of lavish dining paid for by Roche drug company compromises doctors
The Australian Newspaper 2006 Jul 25
http://www.theaustralian.news.com.au/story/0,20867,19898069-23289,00.html

Full text:

The sugar-coated pill
Three nights of lavish dining paid for by Roche drug company compromises doctors, writes Ray Moynihan
July 25, 2006
IT was a glamorous Saturday night out in Sydney. The restaurant, the food, the wine and the calibre of guests were all first-class. The exclusive Guillaume at Bennelong restaurant sits atop the stairs at the Sydney Opera House, commanding one of the best views in the nation.

The restaurant’s enticing degustation menu includes multiple courses, each served with a glass of one of the world’s best wines, creating an unforgettable dining experience.

Among the 278 diners were some of the nation’s top cancer specialists from our leading public hospitals. Some had brought partners, some were alone. All were there as guests of Swiss drug giant Roche Pharmaceuticals. At a cost of more than $65,000, Roche had booked out the restaurant and thrown a $200-a-head feast for the doctors.

“The gluttony of the whole thing was mind-blowing,” says Karen McLeod, the former partner of one attending doctor.

The Australian Medical Association, the nation’s peak doctors’ group, takes a different view. AMA national president Mukesh Haikerwal strongly defends the $200-a-head dinner at the Opera House. “It’s understandable why it’s done there, rather than doctors slumming it somewhere in a budget chain motel,” he says.

Pharmaceuticals is a global $500 billion-a-year industry. Drug companies’ burgeoning sales and healthy profits are fed by sophisticated marketing strategies. At the centre of this marketing is the company’s relationship with the doctor who prescribes their products.

In Australia, global drug companies collectively spend more than $1 million a day on promotion, including lavish dinners such as the one at the Sydney Opera House, which took place last July.

“These events are ethically problematic,” says University of Sydney ethicist Ian Kerridge. “Firstly because of the possibility of influencing prescribing, and secondly, the cost of these events ultimately contributes to the costs of drugs, which is borne by the patient directly or indirectly through government health budgets.”

Critics such as Peter Mansfield, from the drug marketing watchdog group Healthy Skepticism, are concerned about $200-a-head dinners because of the strong scientific evidence that shows drug company promotion, including wining and dining, can be bad for patients’ health. Evidence to support this view can be found on the Healthy Skepticism website (www.healthy

skepticism.org), among other places.

Reviews of all relevant studies about the giving of gifts show that doctors who accept them on average end up being more favourable to the sponsor’s drug and more likely to prescribe it.

A summary of 29 individual studies conducted at McGill University in Canada in 2000 and published in the respected Journal of the American Medical Association investigated how gifts, free meals, travel subsidies and sponsored education affected doctors’ attitudes and practices.

The findings are predictable. Dealings with industry tend to lead doctors to prescribe more favourably. Doctors who regularly meet drug company sales representatives tend to lobby their hospitals to make that company’s drug the preferred one in the hospital pharmacy.

Marketing makes doctors more likely to prescribe the drugs being promoted. It causes doctors to become biased, often in subtle ways, towards the latest, newest, most expensive drugs, at the expense of other less costly and perhaps more effective remedies. Rather than being objective and dispassionate in decisions about which drug to prescribe, the doctors’ deliberations can sometimes be clouded by food, flattery and friendship. And sprinkled through these dinners are the beautiful, and often young, company sales representatives, there to make sure doctors have a good time.

At an individual level, inappropriate prescriptions can lead to patients being exposed to unnecessary drugs and the side-effects that go with them. For the public health system, it can waste millions of precious health dollars. Anti-depressants, hormone replacement therapies and the new anti-arthritis drugs are three examples where costly, powerful and potentially deadly drugs have been aggressively promoted and widely over-used. Sometimes a new drug is the perfect option; sometimes it is dangerous and wasteful.

Medicines Australia, the drug industry’s representative, has a code of conduct stating that drug company-funded hospitality must be “simple and modest” and be able to “successfully withstand public and professional scrutiny”.

Last week Mansfield made a formal complaint to Medicines Australia. “I don’t think these meals would stand public scrutiny,” he says. Mansfield believes the industry as a whole may be at fault, not just Roche, as no drug company appears to have a limit on what it spends on doctors.

MA confirmed yesterday a complaint had been received and will be adjudicated by an independent committee. Asked the $65,000 question about whether Roche’s $200-a-head dinner could be seen as modest, an MA spokesman would not comment, saying it was a matter for an independent committee. He did say, however, “the code is taken very seriously” and it “allows for sanctions up to $200,000”.

Roche is officially arguing that the $200-a-head dinner was simple and modest. In a statement, the company explains the meals were provided as part of a scientific meeting that the company sponsored and organised, and that “it seems reasonable to us that a dinner of this type was on offer at the end of such an educational day”.

McLeod, one of the partners present at the Opera House, says the dinner was far from reasonable. She says she was shocked that leading public hospital blood and cancer specialists were attending and, after separating from the doctor she was with, decided to reveal the details of three nights of indulgence she was part of, all funded by Roche almost a year ago.

The night following the Opera House dinner, a smaller, more select group of specialists was taken to the harbourside restaurant the Boathouse, where Roche spent more than $2000. Along with the snapper pie, the doctors tucked into four bottles of Kooyong Pinot Noir and five bottles of Domaine Day Viognier.

The medical meeting held over that weekend was called HOTT – Hematology Oncology Targeted Therapies – treatments for blood disorders and cancer. Roche had flown in doctors from around the country, put them up at Sydney’s top hotels and wined and dined them. Roche has quite an interest in blood disorders and cancer. Its top-selling drug in the world is MabThera, a cancer treatment for non-Hodgkins lymphoma, which costs almost $10,000 a treatment. According to Kerridge, a hematologist and ethicist based at Sydney’s Westmead hospital, the wining and dining of cancer doctors remains commonplace.

The Australian Consumers’ Association echoes Kerridge’s concerns. “Doctors should not be accepting drug company dinners when they are making important decisions costing a lot of money,” says ACA health policy officer Viola Korczak, who argues the industry’s code is ineffective.

Yet the AMA’s Haikerwal maintains that drug companies funding restaurant meals for doctors is acceptable and that they are there to “oil the wheels”. He argues that company-sponsored events give doctors an opportunity “to critically question the companies’ products” and that “no patient harm comes from this process”. He says he regularly accepts drug company-sponsored hospitality.

Haikerwal’s views contradict evidence published in medical journals that drug company largesse distorts doctors’ practice and the scientific records, because so many trials are now company-funded.

The third night of Roche hospitality took place in a private function room at Aria, another exclusive restaurant with views of Sydney Harbour. On this occasion 13 bottles of wine were consumed. The cost of this meal was a cool $4184 for fewer than 20 people.

Ray Moynihan is the co-author of Selling Sickness: How drug companies are turning us all into patients, Allen and Unwin, Sydney, 2005.