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Friday, August 29, 2008

Free flights, meals and match tickets given to doctors by drug companies can damage patient care, say critics

Drug giants accused over doctors' perks
Article from the Guardian


"Drug companies are spending millions of pounds every year on all-expenses-paid trips to conferences around the world for doctors and other hospital staff, in what critics say is a massive marketing exercise dressed up as medical education.

The Guardian can reveal the scale of pharmaceutical company sponsorship following an examination of the registers of gifts and donations to doctors that all hospitals are required to keep. They show considerable largesse - from drug companies regularly picking up hefty bills for travel to international conferences in Europe, Asia and America, to specialist nurses' salaries, and weekly sandwich lunches for hospital staff training sessions.

All-expenses-paid trips to conferences in the US, Vietnam or Hungary are a regular feature of the registers, costing the companies up to £5,000 per doctor. Many of the declarations by doctors do not put a price on the trip. The total amounts received by staff at individual hospital trusts with complete registers are substantial - Sheffield's staff received funding of more than £105,000 from pharmaceutical and medical devices companies in the 12 months to last June.

Examples of the firms' hospitality include:

· Astra Zeneca paid £2,500 for a doctor at the Royal Bournemouth trust and £1,500 for a doctor at Sheffield teaching hospital to attend a cancer conference in Texas

· Sanofi-Aventis, the world's fourth biggest pharmaceutical company, paid for doctors at the Countess of Chester trust to go to conferences in Cape Town, New Orleans and Barcelona. At Gateshead trust, their reps gave a breakfast for 30 staff "to discuss drugs for the treatment of breast cancer". The trust's register records that "the donor was seeking to secure business".

· Roche spent £2,000 for an oncology consultant at Addenbrooke's hospital in Cambridge to go to a conference in May last year.

· GSK, the biggest British pharmaceutical company, paid £1,200 for a consultant at Sheffield teaching hospital to attend the 11th international congress of Parkinson's disease and movement disorders in Turkey last June."

"Joe Collier, the recently retired professor of medicines policy at St George's hospital, London, a former member of the Medicines Commission and an adviser to the select committee, said: "Through its orchestrated campaigns affecting all those involved in the use of medicines, the pharmaceutical industry enormously influences what patients are prescribed. On the whole these influences are detrimental to best practice."

Payments to doctors are far from transparent. The Department of Health requires NHS trusts to compile registers of their medical staff's and directors' possible conflicts of interest and to make them available to the public. Only a minority do so. The Guardian requested the registers for 90 hospital trusts under freedom of information legislation. Only around a quarter returned data that included the names of the doctors and the sponsoring companies and the amounts of money received. Some refused to give any information at all.

Collier said this was unacceptable. "Declarations of interest are a key way to help break the pharmaceutical industry's stranglehold. It is not a trivial issue. Public declarations by doctors are essential if prescribing is to be sensible and appropriate and according to patients' needs.""

"Labour MP Paul Flynn described as "codswallop" the companies' claim that their only intention was to help educate doctors. "It's not true. It's part of a huge marketing budget. It's all about maximising their profits, not helping people in life-threatening situations," he said. "The influence of these companies is enormous."

Doctors who receive funding believe they are not influenced by it. Robert Storey, a consultant cardiologist at Sheffield involved in drug trials, took four trips to conferences in the year to June 2007 courtesy of Astra Zeneca at a total cost of £12,000. However, he regards these as business trips because he is asked to disseminate research findings and are funded from the R&D budget. More junior doctors have their funding arranged through the drug rep and must fly economy class under Association of the British Pharmaceutical Industry (ABPI) rules.

"If it is done through the local rep, who may expect some sort of favour in exchange for that sponsorship, there is more stringent regulation," said Dr Storey. "[Those doctors] are seeing reps on a regular basis and although it is explicitly stated in the ABPI rules that there shouldn't be any conflict or conditions [on the funding], it probably does influence doctors' behaviour because they are unsure whether they will get further sponsorship for going to further meetings, so it is useful to them to engender good relationships with different reps."

I personally regard most of these expenses-paid junkets as bribery.