Healthy Skepticism Library item: 5860

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Publication type: news

Doctors, drugs and money, and the perception of trust
The Age (Melbourne) 2006 Aug 11
http://www.theage.com.au/news/editorial/doctors-drugs-and-money-and-the-perception-of-trust/2006/08/10/1154803026437.html?page=fullpage#contentSwap1

Full text:

Doctors, drugs and money, and the perception of trust

August 11, 2006

LAST Monday The Age asked, “Who paid when a doctor accepted a free
lunch?” The question was posed at the start of a major, week-long series
this newspaper initiated into the relationship between the medical
profession and pharmaceutical companies. Now, as the series concludes,
we can say that it seems there is no such thing as a free lunch.

Various organisations, such as the doctors and the drug companies, may
say that the health of the patient is their only aim. But, as this
series has shown, the tentacles of the industry are so intimately
linked, and hidden, that any party professing independence is likely to
be looked upon with some doubt.

The pharmaceutical industry is big business in Australia. There is a lot
at stake. The top 10 drugs have sales of about $1.5 billion annually,
and the cost each year to the Government through the Pharmaceutical
Benefits Scheme is about $1.8 billion. The competition between the
international drug companies for a slice of the market is intense, which
is where the issue of ethics enters the equation. A drug unknown is a
drug without worth; so the makers become marketers and ply their trade
with relentless vigour. At the frontline of this assault are the doctors.

Bribe would be too coarse a word to describe this flow of inducements,
and the Australian Medical Association would rightly say that the first
and only imperative of its members was the health of the patient. But in
the eyes of the layperson, the situation may be seen differently.
Doctors’ surgeries are littered with the gifts of drug companies; they
are only little things – a pen here, a calendar there. However, from
little things, big things grow, and in this case it is perception, and
perception matters. The patient must be able to have full and complete
trust that what is being prescribed is in his or her best, and only,
interest.

The AMA defends its members from accusations of being manipulated.
Today, on the Opinion page, the AMA’s president, Mukesh Haikerwal, sets
out the problem. Pharmaceutical companies provide the money for the
doctors’ education of their products, but at what point does education
become influence? As Dr Haikerwal writes, the association’s policies
“have a simple but strong message – the patient must always come first”.

Tim Woodruff, of the Doctors Reform Society, writes that although the
problem is well recognised, finding the solution is not so easy. Codes
of conduct and guidelines are based on self-regulation, which is fine in
concept. But what use is a code if it is not driven by an independent
arbitrator? Victoria has come some way along this path. In 2002, the
Bracks Government introduced laws by which companies could be fined for
pressuring doctors to act unprofessionally.

The crux of the problem, however, was highlighted by Martin Tattersall,
the chairman of the Australian Drug Evaluation Committee. Professor
Tattersall said that finding experts to sit on his committee who did not
have links to drug companies was extremely difficult. There were “huge
conflicts of interests”. The companies had targeted “key opinion
leaders”. Professor Tattersall labelled this as “buying” opinion
leaders. Buying by any other name is bribery.

The chief executive of VicHealth, Rob Moodie, has also called for
caution in dealing with drug companies. “We just have to make better
judgements about how we spend the health dollar and be more resistant to
the lobbying of drug companies,” he said. The Age also reported on drug
companies funding

education sessions for GPs, which was seen as an alternative way to
influence doctors and the prescriptions they write. More than 200
million prescriptions are written in this country each year.

It hardly needs to be said that drugs have been of immeasurable benefit
in treating the sick. Our quality of life is better, a battery of
ailments alleviated. The flip side to this is that drug companies are
not altruists. They need

to turn a profit to exist. On the other hand, doctors at core are
altruists. There needs to be a meeting ground between the two, where
patients can trust they are being best served.