A US doctor has warned that patients will lose trust in healthcare professionals if they do not disclose the extent of their relationships with drug companies.
Writing on bmj.com, emergency doctor Leana Wen, from George Washington University, argues that more needs to be done and insists that “establishing trust is a critical part of care” and “at the core of what it means to be a doctor”.
She believes it should be mandatory for doctors to tell patients how personal incentives could affect treatment but says that her campaigning on the issue has made her an ‘object of hatred’.
In August an academic study found that doctors in the US who receive free meals or money from pharma companies are more than twice as likely to prescribe their drugs compared to those who receive no extra funding.
This year the Physician Payments Sunshine Act takes effect in the US, with drug and medical device manufacturers required to publicly report payments to doctors and teaching hospitals.
Wen argues that recent research showed “94% of American doctors have some relationship with a drug or medical device company” with other studies showing that this can “skew research findings and doctors’ prescribing practices”.
Part of the problem, she says, is that doctors’ salaries can depend on the number of tests they order and procedures they perform: the Institute of Medicine suggests that 30% of all tests and treatments done are unnecessary, “to the tune of $750 billion every year”.
Wen poses the question of whether tests are being prescribed because it is in patients’ best interest “or because they benefit the doctor?”
It is an issue which feeds into a more general debate about transparency for pharma. From 2016 European rules will require companies to make available on their website the names of healthcare professionals and associations receiving payments.
In the UK, pharma trade association the ABPI started a voluntary scheme last year with its members releasing aggregate payments to doctors, which totalled£40 million.
Bribery is an issue that remains in the spotlight for pharma: in China Novartis, Sanofi and GlaxoSmithKline are all currently being investigated for allegedly bribing doctors in order for them to prescribe their medicines.
In a separate development, a poll on www.bmj.com poll asks this week whether journals should stop publishing research funded by the drug industry - a live issue since the BMJ itself no longer publishes research funded by tobacco companies.
Richard Smith, chair of Patients Know Best, and Peter Gøtzsche, director of the Nordic Cochrane Centre, says drug company research is flawed and published to encourage sales - but Trish Groves, head of research at the BMJ, says the industries are fundamentally different and that “moves are afoot to increase integrity”.
Adam Hill
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