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The Australian Prescriber are reporting: Relationships between health professionals and industry: maintaining a delicate balance
The power and influence of the pharmaceutical industry has raised concerns among health professionals and the wider community and led to calls for increased regulation. Overwhelming evidence that advertising, contact with company representatives, gift giving, sponsorship of meetings and other forms of promotion influence prescribing behaviour, has drawn particular attention to drug promotion. In answer to these concerns a range of responses has developed, including rules set by government, processes for the review and management of research, industry codes of conduct, community responses, and guidelines generated by practitioner associations. The various forms of regulation taken together strike a delicate balance that aims to protect the interests of the community and individual patients, foster research and the development of new products, maintain public confidence in pharmaceuticals and medicine, and facilitate ethical decision making among the various participants. Although guidelines for health professionals provide some advice, they cannot cover all situations where conflicts and dualities may arise in practice.
Re: Health professionals and the pharmaceutical industry
Press Release from York University:
U.S. pharmaceutical industry marketing-driven: York study
TORONTO, January 3, 2008 -- A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.
The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.
“The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States” is co-authored by PhD candidate Marc-André Gagnon, who led the study with Joel Lexchin, a long-time researcher of pharmaceutical promotion, Toronto physician, and Associate Chair of York’s School of Health Policy & Management in the Faculty of Health. Their study appears in the January 3, 2008 issue of PLoS Medicine, an online journal published by the Public Library of Science, at http://medicine.plosjournals.org
“In our paper, we make the case for the need for a new estimate of promotional expenditures by the U.S. pharmaceutical industry,” says Gagnon. “We then explain how we used proprietary databases to construct a revised estimate and finally, we compare our results with those from other data sources to argue in favor of changing the priorities of the industry.”
The study is important because it provides the most accurate image yet of the promotional workings of the pharmaceutical industry, says Lexchin.
The authors examined the 2004 reports of IMS Health (IMS) and CAM Group (CAM), two international market research companies that provide the pharmaceutical industry with sales/marketing data and consulting services. IMS obtains its data by surveying pharmaceutical firms, while CAM surveys doctors, which explains important discrepancies in the data they provide.
The researchers used 2004 as the comparison year because it was the latest year in which information was available from both organizations.
CAM reported total promotion spending by the U.S. pharmaceutical industry as US$33.5 billion in their 2004 report, while IMS reported US$27.7 billion for the same year. The authors observed, however, important differences in figures according to each promotion category. By selectively using both sets of figures provided by IMS and CAM, in order to determine the most relevant data for each category, and adjusting for methodological differences between the ways IMS and CAM collect data, the authors arrived at US$57.5 billion for the total amount spent on pharmaceutical promotion in 2004. The industry spent approximately US$61,000 in promotion per physician during 2004, according to Gagnon.
“Even our revised promotion figure for 2004 is apt to be understated, as there are other promotion avenues that are not likely to be taken into consideration by IMS or CAM, such as ghost-writing and off-label promotion,” says Gagnon. “Also, seeding trials, which are designed to promote the prescription of new drugs, may be allocated to other budget categories.”
IMS and CAM data were used for comparison purposes because data from both are publicly available, both operate globally and are well regarded by the pharmaceutical industry, and both break down their information by different promotion categories. Most importantly, the two organizations use different methods for gathering their data, allowing the researchers to triangulate on a more accurate figure for each promotion category.
The authors focused their study on the United States because it is the only country in which information is available for all of the major promotion categories, and it is also the largest market for pharmaceuticals in the world, representing approximately 43% of global sales and global promotion expenditures.
Gagnon’s and Lexchin’s new estimate of total promotional costs is also consistent with estimates of promotional spending by the U.S. pharmaceutical industry from other sources they scrutinized, including reports by Consumers International, a non-governmental organization which represents consumer groups and agencies worldwide; Office of Technology Assessment, which extrapolated results from the cost structure of Eli Lilly, a global pharmaceutical company; Marcia Angell, former editor-in-chief of the New England Journal of Medicine, who extrapolated data from Novartis Inc., a company which distinguishes marketing from administration expenditures in its annual reports; and the United Nations Industrial Development Organization.
As well, note the authors, the number of meetings for promotional purposes has dramatically increased in the U.S. pharmaceutical industry, jumping from 120,000 in 1998 to 371,000 in 2004, further supporting their findings that the U.S. pharmaceutical industry is marketing-driven.
Thus, the study’s findings supports the position that the U.S. pharmaceutical industry is marketing-driven and challenges the perception of a research-driven, life-saving, pharmaceutical industry, while arguing in favour of a change in the industry’s priorities in the direction of less promotion, according to Gagnon and Lexchin.
As calls to end drug companies’ direct sponsorship of doctors’ education echo round the world, an investigation in Australia reveals sponsor involvement in the education of thousands of general practitioners, writes Ray Moynihan
We’ve all been there—the educational seminars, the medical symposiums, and the scientific conferences generously sponsored by big drug companies. The visible signs of sponsorship at these events are obvious: the smiling drug company representatives, the colourful company logos, and the high tech stalls in the exhibit halls. But what about inside lecture theatres, where high quality education is delivered to doctors by respected speakers? Surely the sponsors have no input into those sacred places of independent education?
It seems that invisible influence may be flowing through these sponsored seminars—even those accredited by august associations—far more often than many of us realise. In a rare look behind the scenes of sponsored medical education, the Australian Broadcasting Corporation’s Background Briefing programme (www.abc.net.au/rn/backgroundbriefing/) will this weekend show that it is not uncommon for drug company sponsors to suggest speakers at sessions that are assumed by the thousands of general practitioners who attend them to be totally independent. Drug industry representatives have confirmed that similar practices take place in the United Kingdom, where roughly half of all education for doctors is sponsored by drug companies.
In the case of one popular Australian provider of medical education, HealthEd, leaked documents and emails from a range of sources show drug company sponsors having input into the selection of some speakers at seminars held in recent years, despite the fact that these have been aggressively sold to general practitioners in brochures claiming that "all content is independent of industry influence." ....
Re: Health professionals and the pharmaceutical industry
CTV.ca are reporting: CMAJ says system relies on pharma 'free-lunch'
The system that keeps working doctors abreast of medical developments is too reliant on drug company funding and organization and needs an overhaul, the Canadian Medical Organization Journal said in an editorial published Tuesday.
The strongly worded editorial, written by the journal's editor-in-chief, said giving drug companies such control over the continuing medical education of doctors distorts medical practice and compromises the ethical underpinnings of the profession.
The author, Dr. Paul Hebert, placed much of the blame on doctors themselves, saying they have developed a sense of entitlement to the lavish perks often paired with continuing medical education or CME programs -- things like tickets to the ballet or professional sporting events, cruises or access to exclusive golf courses.
"Over the years, the powerful pharmaceutical enticements have resulted in physicians believing that strong industry involvement is not only normal but also that they are entitled to receive the benefits. This culture of entitlement is one of the most difficult obstacles to overcome,'' Hebert wrote.
"We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals.''
Critics of the broad influence the pharmaceutical industry exerts over medical education, medical journals and the prescribing practices of doctors were quick to endorse Hebert's call.
At a recent conference on continuing education involving many major US stakeholders and the CMAJ, participants agreed that our current system of continuing professional development is in dire need of a major overhaul. Currently, continuing medical education activities are, for the most part, sponsored by the pharmaceutical industry, which has a vested interest in promoting its products. This is big business: of the $2.6 billion spent in the United States on accredited continuing medical education activities in 2006, $1.45 billion (60%) came from pharmaceutical and medical device manufacturers. Although there are no reliable data in Canada, there is also no evidence that the situation is any different here.
Worldwide, IMS, a private company specializing in pharmaceutical intelligence, reports that in 2004 the pharmaceutical industry spent US$27.7 billion on promotional activities, and US$29.6 billion on research and development.
Some would argue that physicians are getting a good deal on their continuing professional education, so what is the problem?
First, the evidence suggests that education sponsored by the pharmaceutical industry frequently distorts the topic selection, embellishes the positive elements of studies and downplays the adverse effects. In effect, the industry focuses primarily on treatments and treatment-related issues at the expense of the larger therapeutic picture, including quality of care and patient safety not involving drugs, determinants of health, prevention and health promotion and other modalities of treatment.
Second, there is no doubt that the current continuing education enterprise compromises the ethical underpinnings and the reputation of the medical profession. Physicians are seen as being aligned with the pharmaceutical industry and with its commercial priorities. We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals.
There is also the question of whether the type of education offered by the pharmaceutical industry actually works. Many of these heavily subsidized events use lectures and emphasize counting hours of credit, rather than measuring improved knowledge, competence, performance and, most importantly, clinical outcomes. Learning techniques, such as academic detailing, small group workshops and audit feedback, have demonstrated more substantial impact5 but are less frequently offered.
Finally, the current system focuses on physicians rather than on interdisciplinary teams. A team-based perspective is essential if our goal is to improve quality of care rather than market share.