Healthy Skepticism Library item: 5810

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

Fyfe M, Nader C, Baker R.
The true cost of a free lunch : Should we be worried about drug company funding of GPs' education?
The Age (Melbourne) 2006 Aug 9

Full text:

The true cost of a free lunch
Author: Melissa Fyfe, Carol Nader and Richard Baker
Date: 09/08/2006
Publication: The Age, Page: 15

Should we be worried about drug company funding of GPs’ education? By
Melissa Fyfe, Carol Nader and Richard Baker.

NOT long after Nancy Atkin arrived at the Northern Division of General
Practice, she came to a conclusion about drug companies. Getting money
out of them to run GP education events was dead easy.

She would ring and ask for $2000. No problem, came the answer. “There’s
a lot of money floating around,” says Atkin, who organises education for
500 GPs in Melbourne’s northern suburbs.

Compared with her previous job working for community groups, it seemed
drug company sponsorship money came in endless buckets – up to a point.

Pharmaceutical companies, she says, are happy to underwrite education
sessions on heart disease, diabetes, mental health and asthma – all
big-market ailments. Talks on refugee health or exercise, however, are
not so popular.

Atkin, famous for plundering Preston’s Lebanese bakeries to feed her
doctors during dinner sessions, puts on about 65 events each year and
about three-quarters rely on drug company money.

An Age survey has found that, like Atkin’s group, almost all Victoria’s
30 divisions of general practice – regional support groups for doctors –
need drug companies to fund their educational program, which doctors
attend to maintain their registration. The pharmaceutical industry has
always chipped in for GP education, but as government funds fail to keep
up with inflation, divisions are actively chasing industry money to
cover food, venue hire and speaker fees.

As the practice has grown, divisions have become wary that this could be
a “back door” way to influence the 200 million prescriptions doctors
scribble each year – entrenching expensive brand medication and
inflating the taxpayers’ drugs bill.

In response, some divisions now have rules to quarantine the influence
of drug company marketing while doctors catch up on the latest news in
medicine.

The Age survey found:

Drug companies pay $500 to sponsor events with fewer than 20 GPs, $750
for up to 30 GPs and as much as $2000 if the evening is held in a
restaurant – all of which, in the end, is tacked on to drug prices.

Some divisions, especially those in regional areas, where it is hard to
get speakers, allow drug companies to choose the topic and speaker,
which is against the Royal Australasian College of General Practitioners
guidelines.

Some divisions have asked drug companies to pay for their annual general
meetings, which is a grey area under the pharmaceutical industry’s code
of practice.

As many division sessions are in the evening, drug companies pay for the
food (which is more modest these days).

“Pharmaceutical companies do sponsor some … education activities and
we have very strong policies around how this is undertaken,” says Dr
Dale Ford, medical director of the Otway division. “There’s no doubt
that without pharmaceutical sponsorship, the number of educational
activities would be reduced.”

GPs must earn 130 “continuing professional development” points over
three years to maintain their vocational registration, which allows them
to bulk bill Medicare at higher rates. They can earn points by attending
conferences, division sessions, reading medical journals or attending
drug companies’ education dinners, which must be accredited by the
college of GPs and are not allowed to advertise a particular drug.

Doctors who choose this last option for their education are known as the
“knife and fork brigade”, but drug companies see them all the time. The
real value for the companies is getting access to the GPs that may shun
their events and salespeople. These GPs are often found at division-run
events because most doctors see them as a source of independent
information and better-quality education. Sponsoring a division session
gives companies a chance to meet these GPs and set up a product stall,
often with samples and showbags.

It is difficult to know how much money drug companies spend on GP
education, as the industry body Medicines Australia could not provide
The Age with figures. An annual Flinders University survey of
Australia’s 119 divisions puts pharmaceutical contributions at $1.8
million in 2003-04. But often drug companies will pay a venue directly,
so the money need not pass through the divisions’ books.

Drug company funding of GP education goes from the grassroots division
level right to the top. This October the college, the peak professional
body for GPs, will hold its annual scientific meeting in sunny Brisbane.
Queensland holds a large number of scientific meetings of doctors, and
this one is like any other – almost every part of it is up for sale.

For $12,000, a drug company can get its name on the name tags and
conference passes. For $1000 less, a drug’s name can adorn the satchels
GPs will carry around during the conference. Or for $7000 beach towels
become an advertising space, even though such non-medical gifts fall
outside the ethical guidelines set by Medicines Australia. There’s room
also to brand the umbrellas, sunglasses, sunscreen, beach balls, morning
tea, afternoon tea or internet cafe.

So why are drug companies spending a chunk of their GP marketing budget – estimated at $21,000 a year for each Australian doctor – on education?
Perhaps it sends a more palatable message than the endless supply of
brand-name knick-knacks, fresh orange juice, doughnuts, espresso just
the way the doctor ordered, and sushi lunches.

“They want to be seen as good corporate citizens,” says Kate Carnell,
chief executive of the Australian Divisions of General Practice, who has
no problem with drug companies funding education events. She admits that
federal funding for divisions, $302 million over four years, has not
kept up with inflation, but says it is not the Commonwealth’s role to
pay for doctors’ dinners.

THE federal Department of Health and Ageing says funding will return to
match inflation by next June. A spokeswoman says that although drug
companies provided some support for GP education, they are “by no means
the sole providers”. Strict criteria set by the college ensured
appropriate content, she says.

For Australian Medical Association president Mukesh Haikerwal, the
question of GP education goes to the heart of “the GP business model”.
GPs, like other professionals, could pay for their own education if they
had to work less and were paid more. He says that often a division
education night is financed by several companies and “the promiscuity of
that shields you from the allegation of being biased to one company or
another”.

Medicines Australia says every company wants to be a good corporate
citizen, and supporting GP education is one way of doing that. “The
pharmaceutical companies know the products better than anyone else and
on that basis it is logical they would play a significant part in
educating doctors,” a spokesman says.

But pharmaceutical companies are not charities. If their contributions
do not sell products, why waste the money, asks Peter Mansfield, South
Australian GP and director of Healthy Skepticism, a drug marketing
watchdog group.

“I think it is a huge problem,” he says. “The drug company won’t provide
the money unless they are able to predict a competitive return on their
investment. Having funded it, people then feel a reciprocal obligation
towards the company, so the reps get a fair hearing.”

For those keeping an eye on the big bottom line – how much money
taxpayers spend on subsidising drugs, running at $6 billion a year – any
extra interaction between a drug company representative and a doctor is
bad news, whether it is in the guise of education or not. Studies have
shown time and again that doctors increase their prescribing of a
company’s drug following contact with that company. This means the best,
most cost-effective drugs are not always prescribed.

“We’ve been doing the figures and we think we could be saving $170
million on the Pharmaceutical Benefits Scheme across Australia,” says
Steve Sant, who has just left his post as chief executive officer of the
Central Bayside Division of General Practice Association – which covers
300 Melbourne GPs in almost 80 practices. Doctors could also save money
by reducing doses and using non-drug solutions such as diet management
and exercise, a message that gets lost in the paraphernalia about the
latest blockbuster drug.

“We have one person who works three days a week providing drug
education, but the drug companies have three times that,” says Sant, who
now heads the Rural Doctors Association of Australia.

It has now become clear to the Federal Government that gaps are emerging
in what should be prescribed and what actually is. For example, new
drugs for high blood pressure are overprescribed compared with less
expensive and often just as effective older pills. Part of the concern
about drug company interaction with doctors is that the information
provided is often of poor quality.

Each year, the Medicines Australia code of conduct committee
consistently fines the big players for presenting false claims to
doctors. Last year, for example, the world’s biggest pharmaceutical
company, Pfizer, was again found in breach of the code for telling
doctors that “a large body of evidence” showed that its arthritis drug
Celebrex had “no significant increase in cardiovascular risk”, which is
not true.

Dr Lynn Weekes, the chief executive of the National Prescribing Service,
an independent, government-funded body, says drug companies “weren’t
necessarily providing objective information” to GPs.