Should Canadian doctors disclose how much Pharma pays them?
Canadian pharmaceutical professionals who work for Rx&D member organizations follow the Code of Ethical Practices, which, among other guidance, provides guidelines on when and how the organization can provide financial or other type of incentive to physicians. These guidelines help maintain trust in the pharmaceutial industry by consumers and all other healthcare stakeholders, and also provide some consistency in how healthcare professionals (HCP) are treated from one organization to the other.
But how would you feel if all financial and other types of gifts that you provide to physicians for their services were made public for the whole world to see? That’s exactly what will be happening in the U.S. in January 2012 (only 9 months away). This is a result of the “Sunshine Provisions” Act, which was passed in March 2010.
Paul Meade of Thought Leader Select (disclaimer: Thought Leader Select is my blog sponsor) has written an article questioning the benefits of the transparency that will be offered by the Sunshine Provisions Act: ” Transparency and the Sunshine Provision – Is This a Good or Bad Thing?
What do you think of this upcoming situation in the U.S.A. Would Canada be wise to copy this level of transparency? Leave a comment and be part of the discussion.
Paul Meade asks “So why are we so concerned with knowing what healthcare professionals get paid for advising healthcare manufacturers?” He goes on to answer his question “Maybe we just want to know that a medical expert is receiving fair compensation for his consultative services in a way that would not bias their judgment. But the transparency that is most important to me when receiving medical care from one of these experts is more about disclosure and conflict of interest, than it is about how much compensation that expert makes for advising manufacturers.” That may be a small part of the concern. The large part of the concern from a public health and societal good point of view is “what influence do these key opinion leaders have on the broader population of physicians and the provision of health care services?” This effect may be more profound on public health and on the payers.
Looking at this issue from a broader perspective can help one see why there is a perception that excessive payments from pharma to health professionals may not be a good thing. See the effect of actual cases at Emory and Harvard Universities. The final paragraph states “Disclosure serves a valuable purpose, especially for investigative reporters and attorneys. But the real problem of pharmaceutical industry gifts and payment to doctors is not secrecy, but influence. Doctors who take money or gifts from a pharmaceutical company are more likely to prescribe that company’s drugs, write favorable journal articles about the drugs, give lectures recommending the drugs and suggest adding the drugs to a hospital formulary. That influence does not disappear when the payments are disclosed. To fix that problem, the payments must be eliminated.”
- 6.1.3 Members must never provide a donation, directly or indirectly, in order to have access to a health care professional.
- 6.2 Access Fees: Under no circumstances shall a Member company pay a “clinic room rental fee”, “clean-up fee” or any other similar type “fee” that can reasonably be construed as a direct or indirect payment in order to gain access to a HCP.
- Advisory boards: 13.3 Remuneration must be in the form of an honorarium (fair and reasonable). Travel, accommodation and out-of-pocket expenses in providing the consulting service, where warranted, may be reimbursed.
- CHE: 4A.3.4 Member companies should not be involved in the development of, or payment for social functions conducted in conjunction with any CHE event.
- 4A.3.5 Grants and honoraria may be provided to health care professionals who speak at or moderate CHE programs. Such grants and/or honoraria do not apply to other health careprofessionals attending the program. Members may provide financial support for a maximum of ten (10) individuals to any one international CHE event. Notwithstanding the provisions in Section 7B.1.3. a member company may extend hospitality to all their duly sponsored health care professionals to international CHE event. For hospitality, please refer to sections 7B.1.4 and section 7B.1.5.
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24 responses to “Should Canadian doctors disclose how much Pharma pays them?”
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I think that, as often happens, the pendulum has swung to far in the US. The vast majority of Docs operate in a completely ethical manner, and provide the best treatment possible to their patients.
One unintended effect from this scrutiny is it’s effect on Market Research. Some companies are insisting that MR suppliers, such as Panoptika, not pay Doctors for their participation in Market Research. In all other debates regarding marketing practises, the Do Not Call Registry for example, the MR industry has been exempted as they are not “marketing” anything, simply seeking information and understanding.
Transparency is great, but don’t put the handcuffs on legitimate activities, like Market Research, which contribute to the development and safe, effective, use of important medicines. The focus on payments makes respondents gun-shy about participating.
Thanks for the market research perspective Steve. I didn’t realize that this was impacting market research here in Canada. I wonder if non-pharma people realize how much the industry bends back and forth to try to be as ethical as possible.
Clearly, a fire has been lit on this topic. With regard to Market Research, we have to classify this into two categories: 1) where the sponsor of the research is disclosed, and 2) where the sponsor is not disclosed. In the United States, if Market Research is conducted in a blinded fashion, there is no disclosure of honorarium on the part of the sponsor. So it is only Market Research where the sponsor is unblinded and the honorarium is paid to a physician that it must be disclosed. Perhaps we will see more “blinded” research in the future. Will the Sunshine Provision have an impact on Market Research, and will this effect flow north of the border? Only time will tell how much of an impact it will have, but I suspect it will not have a large overall effect. Will it impact the types of studies conducted by Market Research companies? Yes, most definitely. Studies that are deemed informational will continued since they serve to advance medical knowledge. Studies that are deemed somewhat promotional in nature that really seek to influence a participant will likely diminish over time. The goal of transparency is to force the moral imperative. Conflicting studies fail to answer the question of whether greater transparency does indeed result in more ethical behavior.
One of the reasons that physicians demand remuneration for services rendered has to do with what I call the “Managed Care Effect.” Over the past few decades the total compensation for practicing physicians has eroded steadily due to forced discounted fees by managed care organizations in the United States. Remember simple economics: the only way to maintain profitability when prices erode is to increase volume. So as fees for services continue to be cut, physicians are forced to increase volume (see more patients). So when someone comes along and asks for their consulting time, be it a Market Research study or an Advisory Board meeting, the doctor sees it as an opportunity to supplement income, without having to see more patients. I see no problem with this.
The real question at stake is whether or not a physician’s objectivity is being compromised. Someone mentioned in the comments that when a physician receives a gift or fee from a pharmaceutical company it has an influence on their behavior. Sure, but does it make them compromise their ethical standards because you fed them a sandwich at lunch? Everyone is influenced in some way or another every day, but does that mean we compromise our beliefs and morals. For some of us, sure, but for many, I seriously doubt it. Do you really think a physician would prescribe a medication to a patient knowing full well that it was ineffective because of a meal provided by a drug company representative. If that was the case, the job of a drug representative would be very easy! If I saved your life by pulling you out of your vehicle in an accident would you likely feel indebted to me? Would you feel the same way towards me if I bought you a sandwich at lunch one day? There are degrees of influence that events have over people. Sometimes we are all to quick to condemn a physician’s objectivity in conducting their medical practice because of a token gesture or gift bestowed upon them. Sure, when it becomes excessive we would all likely agree. So if we understand and agree about the polarity of influence and ethics at both extreme ends, we end up debating the middle ground, known as the dreaded “gray zone.” I believe it is this “gray zone” that will get sorted out with measures like the Sunshine Act.
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Thanks Paul, for the thoughtful feedback, the U.S. perspectiving, and for writing the article that initiated this discussion in the first place. It is fascinating to see Canadian pharma folks’ different opinion on the matter.
IMHO, it is absolutely essential that Canadian doctors and researchers disclose how much Pharma pays them and any other gifts, trips, conferences they are provided with. We know from reports in the United States that many millions of dollars are involved every year. To avoid any appearance of ethical conflict and maintain a high degree of confidence and trust in our medical profession full disclosure is essential. Like Ceasar’s wife they must not only be pure, they must be seen to be pure.
If there is no conflict of interest, I don’t see what the problem is in full disclosure. However, I am concerned with the comment that Pharma contributions to research might dry up if they had to make full disclosure. Really?
On the question of whether Canadian doctors should disclose how much Pharma pays them, I say, “why not!”. Transparency helps all stakeholders to form their own opinions about the credibility of the work product. Many, many years ago when I first started out in PR it was easy to engage a physician in an awareness campaign. They viewed it as an opportunity to help educate and inform and no funds were exchanged. Of course even back then physicians were compensated for their involvement in advisory boards and research. For years now, the participation of doctors in all manner of activity comes with a price tag. I support disclosure, but question what would happen if all payments were eliminated. I suspect, the collective “we” in pharma would be without an important contributor. Are we really saying that the doctor’s are being bought?
My general belief is that by disclosing the docs’ payments, one is not suggesting that doctors are being bought, but rather that it helps public perception of how physicians work with the pharma industry. I think in Canada, organizations that are Rx&D members are probably paying acceptable fees for the docs’ services, so they probably have nothing to be ashamed of, nor the doctors who are receiving the honoraria. But the public may not be aware of this, so if they saw the data, it might reassure them. But luckily we don’t have as much trust issues as in the U.S., so it might not be necessary at all.
I would be curious to know what others think. Should disclosure take place in Canada, or not?
My only comment (and a question): are you disclosing your salary? The work they do or advices they provide are not a public service. When we are consulting, we are not divulging how much we are paid. Their counsel is useful for many reasons; how best to leverage data and communicate to their peers, what next unanswered scientific challenge should be prioritize in clinical trials, etc. Grand public (and even our community) tend to generalize that physicians are in it for the $, but we need to keep in mind that most of them are not, and are really concerned by making their patients feel better.
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Thanks Marie-Karina. Agree 100%
If your car mechanic sold you a new transmission and failed to disclose to you that he has taken honoraria from his parts manufacturer, you would quite rightly question the mechanic’s motivation — and demand to know whether he has put your needs over those of his financial patron. Do you honestly think the physician/marketer relationship is any different? (Hint: It isn’t.)
I believe the question was about disclosing the price of gifts as well as salary. I agree with Carol and Nat – why not. Why should anyone be uncomfortable sharing this information if they know they are doing fair and legitimate work. The physicians I work with [and I am sure the situation is the same for most] put considerable time in during program development and consulting – this is time taken away from their regular practice and patients. They deserve to be compensated for their time.
Regarding gifts – the docs I work with have a policy against receiving anything. I’m not sure if a meal counts as a gift. I am curious about what others have to say on that front.
How can we make disclosure/transparency work to improve public confidence in productive Physician/Industry cooperative educational/clinical projects:
1. It is clear that the public remembers vividly the few misdemeanors reported describing unethical behavior by industry and/or physicians – not the vast majority of productive partnerships which have resulted in saving or improving countless lives – it will remain very difficult to eliminate the fraudulent 3%!
2. It is absolutely necessary to preserve the physician/industry relationship to guarantee future medical therapy innovation, proven so effective over the last century
3. We, the people, will not accomplish this unless we have the courage to reveal the process, what it costs and who gains financially – there is no choice, if we agree that we must earn public support.
Transparency and educating the public on the benefits of the process is the answer!
I couldn’t agree more with my friend and colleague Mike. Helen, of course an expensive meal with a wine accompaniment counts as a gift. Come on, now…
@Mitchell: Why be so defensive. I agree with Mike that the past still impacts the “atmosphere” in which activities with physicians are conducted, but as Helen put it, faculty I work with put a lot of their time into advancing education, or recommending new paths for research, etc. They deserve to be compensated for this. Not talking fancy wines here (which would never fly with compliance offices these days), I am talking getting a reasonable consultant fee for their work and insights. I have worked in this industry long enough to know that most experts work with ALL pharma, as they should; and if they only work with one, they have no credibility with their peers, therefore no influence.
This can be a very long discussion…
Mitch – I think you know I didn’t mean an expensive dinner with wine. That I think everyone is clear about and if we read the spirit of the code – we know that is a no-no. Often I need to meet up with the docs to go over materials for approval. Sandwich and pop kind of thing. Like I said – my docs do not accept anything for the reasons of influence alone so I was curious how the group classified things and how they expect the docs to log them. Discussion purposes only.
It’s true that I’m being intentionally provocative here, but only because the PAAB Commissioner personally promised me five bucks for every person I managed to irritate. Helen, you would brighten any doctor meeting, with or without sandwiches and pop. M-K, I don’t question your good intentions, although I think you mean `obstreperous’ when you say ‘defensive.’ If so, I`m guilty as charged. This could indeed be a long discussion, but it`s an important subject, and one that might be regarded as the current Achilles` Heel of pharma marketing.
Hey Mitch, what happens if I up that to $10 bucks? I am fascinated by the lifespan of this discussion and that this is could be the Achilles Heel of pharma marketing. Have I underestimated the issue? Frankly, we will always look critically at the interaction between pharma and physicians, not to mention the public and we come by this honestly. Hopefully bad behaviour on both sides has made us skeptical enought and encouraged our vigilence. It’s not just the meals and wine or honoraria for valuable consulting and insights. It is hard to dissociate this from the sullied reputation and perception of individual doctors and the industry overall, amplified by headlines like physicians accepting cash for faster service or pharma companies not disclosing unfavorable research results. There are a lot of things to be worried about in pharma marketing and one, if not the first, should be justifiably improving the public’s perception and confidence with health care professionals and industry.
Wow – I underestimated how passionate Canadian pharma stakeholders would be about this topic. Glad to see the heated debate and both sides being so well represented.
I also didn’t realize that Mitch would be profiting so much from this discussion …. LOL
Many thanks!
Thankyou Mitchell Shannon and Mike Farley.
I sense some naivety with some of the posters.
Disclosure by doctors is not just about “receiving gifts.”
It goes much further than not thinking doctors “need to disclose their salary.”
Doctors ARE being bought by pharmeceutical companies to blatantly lie to the general public. I’ll show you 2 examples of two doctors that lied to the general public. The first two with sleeping pills, one is well respected highly reknowned sleep study US Dr. Michael Thorpy and one prominent on the TV network Canadian Dr. Art Hister.
First, here is a Dr. Heather Ashton and what she says about sleeping pills. She is not paid by the pharmeceutical company. Sleeping pills which are z-drugs, change the brain and go to the same place as benzodiazipines to do that. Benzos are Klonopin, ativan, etc. Ambien, Lunesta go to the same place in the brain and need to be tapered for physiological reasons as the brain becomes dependent. If the sleeping pill is stopped quickly for many, they get strong side effects/withdrawal. Which can be physically painful and emotionally hard oh the person as it affects the mind. Not tapering for psychological reasons but physical. Here is the link. She is quick to say, doctors are addicting patients as the doses they prescribe are what is addicting patients. It’s not the dose amount that changes the brain but the consistency of even the smallest amount. It changes as little as 7 days. Go way down to z-drugs.
http://www.psychmedaware.org/HistoryBenzodiazepines.html
Dr. Michael Thorpy blantantly lied to the NY Times article “Are Sleeping pills Addictive?” He is on the payroll of 6 pharmeceutical companies. Here is his article.
http://consults.blogs.nytimes.com/2010/07/16/are-sleeping-pills-addictive/
He quotes sleeping pills are tapered for psychological reasons, omitting they change the brain and depending on the genetics of the person taking them the brain can change in as little as 7 days which means the patient is unwittingly dependent/addicted to a pill they have to taper off. He lies and says people are tapering for psychological reasons, but physical. He goes on to say to take as prescribed. As the MD above says, taking as prescribed is what is getting patients into trouble.
Here are the six pharmeceutical companies that pay him. 3 of which make the sleeping pills he is “selling as safe” to the general public.
Cephalon
Sepracor Inc.—————-makers of Lunesta
Takeda Pharaceuticals North America—————-makers of Rozerem
Jazz Pharmaceuticals
Sanofi-aventis————–makers of Ambien
He is also on an advisory board for GlaxoSmithKline
You can now verify this and you will find it on the websites of these drug companies, but they have not yet listed it on the pro publica website. Real easy to see his name on the private company websites though.
Now, Dr. Art Hister writes an article and lays “false claim” on the author saying essentionally, sleeping pills are benign. Conveniently putting the article in “the patient has underlying issues” if they still can’t sleep after the drug. Many can’t as rebound insomnia is a side effect. And so is anxiety, and many do not have chronic insomnia, and have never had anxiety, or burning skin and the 50 – 100 side effects one can get coming off the sleeping pill depending on genetics.
Now, I can’t check to see who is paying Dr. Art Hister, as he is Canadian. And you might bet because of dishonest “fluffy” sleeping pill article he wrote which followed suit with dishonest Dr. Michael Thorpy, there is a good chance he is being paid by a pharmeceutical company. Just like Thorpy. But he doesn’t have to disclose it.
The second example I’ll use is Dr. David Capuzzi who new the drug Avandia was killing people but was one of the three FDA approved doctors on the panel that voted to keep the drug after the facts of it killing people. The FDA missed this. That and the fact that Dr. Capuzzi was paid by the makers of the drug, Glaxo Smith and Kline.
How about the psychiatrist who was paid 500k by the pharmeceutical company to falsifly clinical trials with the dangerous drug seroquel, which gives diabetes and there are lawsuits right now getting paid out.
http://www.infiniteunknown.net/2009/12/18/astrazeneca-paid-500000-to-psychiatrist-for-testing-seroquel-on-patients/
This is all called conflict of interest. As said above, this is way more than inconveniencing a doctor to show his annual salary. Some of our doctors are GETTING PAID TO LIE. This is called “being bought.”
I for one, feel it is my right to pick a doctor that works for me. Not a doctor that works for a pharmeceutical company. There are good ones out there, but the only way I can do it in this day and age with so much corruption and conflict of interest with many doctors and the pharmeceutical companies, is by full disclosure by medical doctors.
My life is not going to be traded on the New York Stock Exchange.
Where is the FDA in this? Well, as said above, they missed Dr. David Capuzzi being paid by GSK and appointed him to the panel. It looks like they may have some problems of their own with conflict of interest.
The Health Industry is not just about Health Care. Lot’s of big business and padded salary’s for medical doctors that are not for educating the general public.
Wake up Canada. We need transparency just like the US.
Miss Lee McCabe
I’d left out the link where Canadian network television MD Dr. Art Hister wrote the article that says sleepijng pills are basically benign. He made a few “jokes” about how safe they are in his article. And puts down, a doctor that deemed them usafe. And his untruths also goe against everything the UK doctor Heather Ashton learned as she is one of the only doctors who studied the patients who take sleeping pills which are z-drugs. As well as anxiolytics. Again, I gave her link above and they have bad physcial side effects for many depending on genetics, toxicity, and when coupled with the fact she explains are prescribed passed the FDA guideline of 2-4 weeks by most doctors. She tells the truth in how they are not safe. She’s not paid by a pharmeceutical company. I’ll bet he is. Here is the link where the Canadian media mainstream doctor Art Hister, jokes about how safe they are. I’d love to see which company pays him.
http://drart.ca/tvweek_articles/p74HealthTodayNov20.pdf
Thanks Miss Lee. For sure, there are bad apples in all groups, but is it fair or even reasonable to paint the entire group with the same brush? For example, are all priests child molestors? I’m willing to bet that most of them are not. Are all doctors acting in the most professional ways? No, there are some bad apples here too. Most physicians care about their reputation, and they act accordingly. Those are boring cases, so you won’t read any real exciting news about them (like we don’t read any exciting news about the non-molesting priests – just too normal and boring for the media). So is it possible that some are poorly influenced? For sure, but they won’t be perceived as an authoratative figure by their peers for very long. In fact, when pharma companies sponsor education sessions with physicians. the physician usually gives as much attention to non-therapeutic and even competitive products as he/she does the company that sponsored him. Most of the time, if it was not announced who was the sponsor, the audience probably would not be able to guess. But the general public does not see this, so I understand that they are not aware. Maybe we should start writing more case studies about the physicians who act appropriately so that more people be aware that the majority of the doctors are doing the best they can with their patients in mind.
NBourre
These drugs and the doctors I’ve listed that get paid by the drug companies AND use vehicles like the New York Times and Medical Journals to publish FALSE INFORMATION which reaches MILLIONS and MILLIONS of people.
That’s the big picture, that’s the truth.
EG:The end result from Micheal Thorpy laying false claim “sleeping pills aren’t physically addictive” thus saying saying the brain will not change on the drug, and then this blatant lie goes in an article published by the New York Times equals millions of regular people becoming physiially dependent on the sleeping pills.
Why? Because millions read the New York Times. Because a well respected medical doctor getting paid by the company that makes the drugs lied in the article and said it wouldn’t happen. That’s HUGE. Huge.
You said in response to my post above: “For sure, there are bad apples in all groups, but is it fair or even reasonable to paint the entire group with the same brush?”
So look at how many millions of people Dr. Michael Thorpy has affected with his “brush, by LYING to one of the most read papers in the US. It affects the masses. With the right genetics these sleeping pill change the brain in such a way to make one unwittingly physically dependent and the person then incurrs further damage to the central nervous system and functional brain injury unless they taper off properly and even then it can be an extremely PHYSICALLY painful process.
He’s got a pretty big brush and he got paid to lie.
This type of “unique design” affect millions. This type of “conflict of interest” affects more world wide as these are big money hitting drugs all over the world.
You can’t downplay that with any type of semantics.
People have a right to know what their doctors are getting paid today. Good doctors are getting a bad name but unless they speak out for people against their peers like this Dr. Micheal Thorpy to protect us, we don’t have a choice and deserve the right to “access” the information to research everything. This is the only way to keep our families and loved one safe from this type of big business with serious repercussion that ruin lives.
Canadian DESERVE to see the conflict of interest a doctor has with a drug company. In today’s day and age, it’s the only way for us to distinguish between what’s real and what’s business.
And puts down, a doctor that deemed them usafe. Everyone is influenced in some way or another every day, but does that mean we compromise our beliefs and morals. Frankly, we will always look critically at the interaction between pharma and physicians, not to mention the public and we come by this honestly. I wonder if non-pharma people realize how much the industry bends back and forth to try to be as ethical as possible.
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I agree there should be transparency, I am very angry at my Dad’s Dr. right now. My Dad discovered recently that he had underlying Diabetes that he wasn’t aware of. He decided to go the natural way, eating the right foods, checking his blood regularily and taking Chromium to help balance his blood sugar. His Dr. prescribed a Diabetics drug anyway which has many many side effects. My Dad decided not to take the drug, but when his Dr. found out, he bullied my Dad into taking the drug again. We live in a small town and all the better Doctors are not taking new patients. My DAd has no choice here as he has to be checked regulariily for a iron blood disorder and is recovering from a heart attack over a year ago. This particular Dr. takes a LOT of trips, claiming they are medical in nature. He also has both my parents on sleeping pills, claiming they are harmless (which they are NOT). It seems to me that the Drs. that prescribe and push the most in drugs are also the ones who take the most trips. Coincidence? I doubt it.