Aussie doctors and Big Pharma - a case of give and take

The biggest investigation into gifts to Australian medical specialists has found they actively ask for gifts from companies worth between $50 and $100,000.

The requests extend to money for nurses' salaries, donations to their departments, computers, microwaves, journals, textbooks, CDs — even funds for a Christmas party.

In Australia, the University of NSW study asked 823 specialists nationwide what companies gave them and what they asked for. It found that almost all the specialists were offered food and gifts for their office and one in two received personal gifts — including harbour cruises and tickets to the opera — as well as money for conference travel. Fifteen per cent asked drug companies for gifts, money and travel.

"Doctors are sometimes seen as the innocent victims and the villains in the piece are the pharmaceutical industry," the lead author, associate professor of ethics and law in medicine Paul McNeill, told The Age. "In reality it is a two-way relationship."

The survey, published online in the Internal Medicine Journal today, follows recent comments from Australian Competition and Consumer Commission head Graeme Samuel that "these grubby issues" acted "as an unpleasant stain on the professionalism and good name of Australia's medical practitioners".

The study found six specialists asked for money for the salaries of nurses, one being $80,000, while another asked for a $60,000 donation to their department "in return for time seeing (drug company) reps".

Each year, drug companies spend millions trying to persuade specialists to prescribe their pills. The stakes are high because a recommendation from a specialist can add an expensive drug to a hospital pharmacy list and make the drug company handsome profits. Doctors are supposed to prescribe the best, most cost-effective medicines.

The study found that personal gifts offered to doctors were valued up to $40,000 and included wine, flowers, a "spa" dinner, harbour cruises and tickets to events such as the opera. Tickets to non-educational events are banned under the ethical code of Medicines Australia, the pharmaceutical industry's leading organisation.

Professor McNeill told The Age these types of gifts, although much less common than free travel and food, could be an indication of something more widespread. Of the one in two specialists offered travel to conferences, two-thirds accepted and most attended the meetings as audience members, not speakers. The authors — who included ethics and medical professors from the University of Sydney and the University of Newcastle — recommended in their report the end of direct payments from drug companies for travel. Industry funds for travel should be distributed through an independent group, the report said.

The Royal Australasian College of Physicians recently updated its voluntary guidelines, suggesting that doctors "carefully consider" travel offers to attend conferences. But Professor McNeill said this was not strong enough. "There shouldn't be any equivocation … It is not appropriate," he said.

The study, conducted in 2002, found that doctors involved in research for industry, who are engaged as consultants or who sit on drug company advisory boards, are more likely to be offered gifts, invitations and items of higher value. They were also more likely to accept the offers and ask for things from drug companies. A Medicines Australia spokesman said the study was done before a 2003 improvement to its code. He would not comment on the recommendation to scrap direct drug company payments for travel to conferences.

The study recommended that the Medicines Australia code of conduct be upgraded so that it is consistent with the American industry code, under which direct payments for travel are discouraged.

The Australian industry code also lags behind its British counterpart, which has completely ruled out business class travel for doctors.

"It is worth noting," said Professor McNeill, "that doctors are rather keen on that perk (of travel). One of the things that physicians really enjoy about their job, is that they get to travel business class overseas every year. But for people on the street, travel is a major perk, it is not a small thing at all." Professor McNeill said doctors are uneasy with the situation and were wanting to discuss the issue.

The Age