Scrutinize the Pharma-Doctor Complex

Two drug executives walked into a bar. No, this is not the start of a joke. The workers for Roche, a Swiss drugs firm, had been dining with doctors after a medical conference. At the bar, alleged an anonymous complaint in a recent report by a British industry watchdog, they bought the doctors drinks (“shots of varying colours flowed like hot lava”). One executive danced on stage, prompting bar staff to throw him out. Roche maintains its managers ran into the doctors and did not buy them drinks. But the evening hardly seems like the finest moment in the history of ties between doctors and drug companies.

That relationship is a poorly regulated muddle. At one (beneficial) extreme, firms work with doctors to create new treatments. At the other end of the spectrum, firms bribe doctors to prescribe their drugs. America’s justice department has wrung huge settlements from companies over such charges. Between these poles is a lot of activity deemed standard by some, repugnant by others—and which is increasingly subject to new law.  This month American regulators released rules to implement a so-called Sunshine law designed to improve transparency. France passed a similar law in 2011. Firms in Britain are planning voluntary disclosures. By 2015 more than 70% of drug sales will be in countries with such measures, according to Deloitte, a consultancy.

America’s health-care market, the world’s biggest, is particularly busy. In 2012 pharmaceutical companies spent more than $24 billion marketing drugs to doctors, according to Cegedim Strategic Data, a research firm; 35% of doctors accept food, entertainment or travel from the pharmaceutical industry, said a survey by Deloitte last year, while 16% accept consulting or speaking fees. In most states, doctors take regular courses to maintain their licences. In 2011 drug and device companies sponsored nearly a third of the medical training tracked by the Accreditation Council for Continuing Medical Education. Such chumminess has long raised fears about undue influence. In 2008 two health-industry groups set tighter, voluntary standards for companies. In 2009 America’s Institute of Medicine, an advisory body, urged much stricter regulation to prevent conflicts of interest. Legislative action, though, has been slow, especially at the federal level. 

The Sunshine law, passed as part of Barack Obama’s health reform, is the first national requirement for transparency. Each year drug and device firms must disclose payments and other “transfers of value” to doctors. They must also report research fees and doctors’ investment interests. The first filing will appear on a public database by September 30th, 2014. The rule’s broader effects are uncertain. It does not limit firms’ interactions with doctors; it merely requires them to be reported. Certain marketing techniques, such as providing free drug samples, are exempt. And in some ways the law is already out of date. It regulates only doctors and some hospitals, not nurses, pharmacists or hospital bureaucrats who have a growing role in patients’ treatment. Nevertheless, the Sunshine law is likely to lead to at least one change. Firms already have data on each doctor’s prescriptions, points out Chris Wright of ZS Associates, a consultancy. The Sunshine law will also provide them with exhaustive data on how much they and their competitors spend to market drugs to that doctor. This will let firms track which type of marketing spurs the most prescriptions. Companies will not stop wooing doctors. They may simply get better at it.

Source - The Economist