Healthy Skepticism Library item: 5862

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Publication type: news

Woodruff T.
A question of funding and control
The Age (Melbourne) 2006 Aug 11
http://www.theage.com.au/news/opinion/a-question-of-funding-and-control/2006/08/10/1154803025186.html

Full text:

A question of funding and control

http://www.theage.com.au/news/opinion/a-question-of-funding-and-control/2006/08/10/1154803025186.html?page=fullpage#contentSwap1

Tim Woodruff
August 11, 2006

WE HAVE seen sufficient evidence in The Age this week that many within
and outside the medical profession are concerned about the effects on
our patients of the marketing efforts of the pharmaceutical industry. From the industry’s influence on the direction and publication of
research, through its support for patient lobby groups and its indirect
advertising in the infotainment media, to its influence on opinion
leaders and ultimately on the prescribing patterns of doctors at the
coalface, this is an issue well recognised by professional colleges and
sadly rejected by the largest medical political lobby, the Australian
Medical Association.

Having documented the problems, we have heard little about what might be
done. There is no easy solution. There is an almost total reliance on
self-regulation, and the evidence suggests that this has failed dismally
to minimise the negative influence of the pharmaceutical industry.

Self-regulation can be improved. The industry writes its own code of
conduct and effectively administers it itself. The Australian
Competition and Consumer Commission must authorise the code but has
admitted it is not its role to improve the code itself. The ACCC’s
recommendation that the industry publish on its website details of
financial dealings is designed to improve this self-regulation through
shaming both doctors and the industry. It could be useful but is simply
tinkering at the edges.

The professional colleges have their own guidelines for members, and the
most recent set released by the Royal Australasian College of Physicians
goes a long way to addressing the problem. Most members of the college
will not have read it, and many would not adhere to its constraints if
they did read it. The professional colleges have no power to compel any
adherence to such guidelines. Despite their limitations, guidelines are
worthwhile for education.

For every small success against any particular marketing strategy,
however, any good industry will find an alternative. Over the past
decade there has been a huge growth in funding for patient support
groups and in pseudo-advertising on infotainment shows.

To seriously address the total problem, two broad areas need to be
considered. These are funding and regulation. The industry is powerful,
first because of the limited regulation of the conduct of the industry
and of doctors, and second because there is a huge funding gap in
medical education, research, and patient support. The industry fills the
gap. Medical conferences, seminars, and training courses would be
decimated without industry funding. At many such events funding from
industry is pooled and the agenda of the meeting is determined
independent of industry. The industry is then given the marketing
opportunities around such meetings. At many such events, however, the
industry has a much bigger input, setting the agenda and providing the
speakers. In the research field, 80 per cent of drug trials would cease
without industry funding. Many patient support groups would struggle to
stay afloat without industry funding.

An alternative method of funding must be found. First, more government
money needs to be spent. Second, the money the industry provides needs
to be pooled and distributed independent of the industry. This requires
regulation; governments must take the lead.

In education, this already occurs to a small extent through the National
Prescriber Service and through various more targeted support for
education. But the total Government budget for this is less than $30
million a year. The industry spends $1 billion a year. In research, the
issue is even more difficult to address because much of the
industry-funded research is itself international. Australian researchers
would be delighted, however, if there was funding available in Australia
for clinical research. Research whose agenda is controlled directly by
the researchers rather than by industry-paid experts from overseas would
be far more appealing to most researchers. Such funding must either come
from government or be distributed by independent agencies, whatever its
source.

Advertising through infotainment can be controlled by a code of conduct
regulated by government. Patient support group funding also requires
regulation to ensure that there is a separation between the company and
the activities of the particular group. If that happens, funding will
decrease. Government should consider appropriate funding support.

The Federal Government is to be commended for its increasing but still
small contribution to the education of doctors. Such funding must be
increased. It reflects a recognition that there is a need for education,
independent of the pharmaceutical industry. But it addresses only one
part of a multifaceted problem that requires national leadership. This
can only come from Government.

The pharmaceutical industry is an essential part of our health system.
It must be profitable. At the same time it must be controlled to prevent
its perfectly understandable profit-driven practices from having
negative effects on our patients and on the costs of our health care
system. These negative effects are mediated through doctors and
patients. We need help. Self-regulation is not enough. The Federal
Government must acknowledge the problem and work with the industry,
professional bodies and patient groups to address the issue. It must
regulate and it must invest taxes that will result in better health for
our patients and ultimately a cheaper, healthier health system.

Dr Tim Woodruff is president of the Doctors Reform Society.