What many patients want to know, but many doctors don’t want to tell
Here is an interesting juxtaposition of two sets of research findings about doctorsâ€™ disclosures of their financial relationships with pharmaceutical companies…
In the US, a survey of almost 2,000 doctors found nearly two-fifths did not completely agree they should disclose their financial relationships with drug and device companies to patients.
The survey, by researchers from the University of Massachusetts in Boston is reported in the current edition of Health Affairs,Â and also covers broader ethical issues (for example, about one-third of doctors did not completely agree with disclosing serious medical errors to patients).
Commenting at the HealthNewsReview blog, Harold DeMonaco, Director of the Innovation Support Center at the Massachusetts General Hospital, says this is a â€śmind bogglingâ€ť finding: â€śI would personally want to know if my physician was prescribing a drug based in some measure on a financial relationship with the manufacturer.â€ť
Meanwhile, the Australian arm of GlaxoSmithKline has released the results of a survey of 1,007 Australians aged 18 to 64, which concludes â€śthere is widespread scepticism and little support for the current system in which pharmaceutical companies pay undisclosed fees to healthcare professionals. Overall, those that disapprove of these payments (44%) outnumber those that approve (21%) by a factor of two to one.â€ť
Two-thirds of those surveyed said they would prefer that the pharmaceutical companies disclose each and every individual sponsorship of specific doctors and specialists.
It is worth noting that the survey questions put the best possible gloss on the relationships between pharma and healthcare professionals â€“ suggesting that payments are made for research funding, advisory committee work on new medicines, and clinical education. No mention that experts might be involved in industry marketing campaigns, for example (not that a firm line can always be drawn between these and research/education initiatives anyway).
As previously reported at Croakey (see here and here), Deborah Waterhouse, General Manager of GlaxoSmithKline Australia, is keen to see greater transparencyÂ around payments to health professionals, and has committed to working towards her company disclosing these on an individual and institutional basis. It has been disclosing individual payments to patient and community groups for the last three years.
In the article below, Deborah Waterhouse summarises the surveyâ€™s findings. Beneath her article, Dr Wendy Lipworth, who researches conflict of interest matters, cautions that focusing on transparency can distract us from more important matters – such as the impact of such financial relationships and whether they should be allowed in the first place.
What expectations do Australians have about the transparency of pharmaceutical sponsorships?
Deborah Waterhouse writes:
Do Australians really care about the way pharmaceutical companies sponsor healthcare professionals? What are the community expectations around these relationships? Will increasing transparency help to allay concerns?
Advocates for increased transparency (including GSK, as per this previous Croakey post) have generally seen it as the â€śright thing to doâ€ť.
And there have been plenty of people entering the debate. In November, industry newsletter Pharma In Focus reported that long term transparency advocate Dr Ken Harveyâ€™s submission to Medicines Australia (MA) advocated the â€śdisclosure of individual payments to healthcare professionalsâ€ť. It also reported that the Australian Medical Association had referred the matter to its Ethics Committee because â€śthe mood among Australians was for more disclosureâ€ť.
The question of the communityâ€™s â€śmoodâ€ť on this issue is important because the Medicines Australia (MA) Code of Conduct will take this into account. As part of the Code Review, MA will consult the community to seek feedback on the proposed revisions.
So trying to work out â€“ right now – whether the transparency of medical sponsorships is on the radar of Australians will clearly have long-term implications for the way these sponsorships are regulated in the future.
To â€śpulse checkâ€ť the community and help answer some of these questions, GSK Australia commissioned a survey through Galaxy Research to survey 1,007 Australians aged between 18 and 64 years.
The survey has confirmed something interesting. About two out of three Australians say the payment of fees to healthcare professionals is acceptable, so long as the pharmaceutical companies are completely open and publicly declare the fees paid.
People clearly also have some concerns.Â They are worried that pharmaceutical sponsorship of healthcare professionals might compromise a doctorâ€™s integrity (54%) or lead to patients not receiving the best medicine (52%), with the biggest concern (72%) being the potential for such payments to influence the advice that doctors give to patients.
While most Australians (90%) initially have negative views about pharmaceutical companies paying fees to healthcare professionals, these views soften when people are given further information about the purpose of the funding.
The majority of respondents (79%) also approved of pharmaceutical companies helping to fund medical research programs or clinical education projects (71%). Overall, 82 per cent of respondents approved of pharmaceutical companies funding some aspect of the health system once the purpose of the funding is explained.
So now we have some data that verifies community expectations for greater transparency in the relationships between pharmaceutical manufacturers and healthcare professionals.
In any case, GSK has already been a strong advocate for increased transparency about the relationships between manufacturers and healthcare professionals. We think increased transparency will increase confidence among consumers and help put the benefits of these arrangements in context.
The survey results seem to suggest that GSKâ€™s position on this topic is consistent with the communityâ€™s view.
Weâ€™ll have to wait to see the extent to which the 17th Edition of the Medicines Australia Code of Conduct also reflect these community expectations.
Greater transparency is no magic bullet
Dr Wendy Lipworth writes:
I think the survey looks fine as far as it goes, but for me the concern would be about over-playing the potential benefits of transparency.
There is evidence that simply requiring disclosure of financial ties does not necessarily change professional behaviour or prevent harm to the public.
Paul Komesaroff has written about this in relation to the practice of authors disclosing conflicts of interest to journal editors. He has argued that, while mandatory disclosure forms are an “admirable commitment to openness and transparency”, there is no evidence that they alter the practices of authors or readers.
Furthermore, disclosures can induce a false sense of security, because they implicitly promote the assumption that conflicts of interest have been dealt with, and they underplay the significance of non-pecuniary relationships that are not disclosedÂ but can haveÂ significant effects on behaviour.
My concern, therefore, is that the results of this survey will be used to promote greater transparency at the expense of questioning whether the relationships being disclosedÂ should be allowed in the first place.
â€˘ Wendy Lipworth is anÂ NH&MRC Postdoctoral Research Fellow, Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation at the University of New South Wales and an Affiliate,Â Centre for Values, Ethics and the Law in Medicine,Â University of Sydney
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