Back in the good old days, your good doctor could pop any commission from anybody into his left pantaloons pocket, and nobody would question it.
These days, the public quite reasonably expects higher standards of accountability. Some would argue that doctors should never accept money or payments-in-kind from pharmaceutical companies, because this would compromise their role in directing patient’s and taxpayer’s money towards one particular medicine over another.
I believe that some interaction is a matter of choice for the doctor, but I also believe that any payment should not be allowed to remain hidden. Hence, I joined the Medicines Australia Transparency Working Group, whose role was to produce a method for making such payments transparent.
Medicines Australia, which represents the pharmaceutical industry, was tasked by the ACCC to produce a workable system for publishing a register (pdf) of pharma payments to Australian doctors.
I was asked by the RACGP to write their official response to the proposed system. The RACGP endorsed my response and put it on their website, and you can also read some excerpts on this blog.
My stance has already earned me the ire in the medical media of some doctors, a few of whom are vitriolic in their opposition to anyone who would dare threaten to disclose their payments from a pharmaceutical company. While I understand that not much is to be gained for them, I deeply believe that this is the correct direction for our profession to head towards.
When I hear a presentation by a specialist, currently I have no way of finding out whether they have been paid by the pharmaceutical industry to present that talk. Yet clearly such knowledge can only benefit my judgement as to the reliability of the educational message.
It doesn’t mean that what they say isn’t true, but it does add some extra information that previously would have been impossible for me to obtain.
The specialist can still accept the money and give the talk, but understandably might not be keen on the audience (or media, or general public) finding out that money has changed hands. Regardless of the ‘down side’ for him or her in making that payment transparent, there is no down side for me or my patients, or indeed for the greater good.
In the RACGP response to the transparency proposal, I also discuss the lower-value payments-in-kind from pharma to doctors. This area will particularly affect GPs, who tend not to have thousands of dollars spent on flying, wining and dining them.
Here, I note:
We believe it is appropriate that if a doctor accepts payment (or transfers of value) of more than $100 from the one pharmaceutical company in the one calendar year, then this should be recorded on the transparency register. We accept that, for practical reasons, it is reasonable to exclude the requirement to record payments valued at less than $10.
We note that this transparency model in no way restricts the doctor accepting such payments; it merely serves to make the payments transparent. A doctor who wishes to avoid their name ever appearing on the transparency register may still accept an unlimited number of payments of less than $10, and also accept up to $99 from any number of pharmaceutical companies in each calendar year.
I believe in transparency in so many aspects of governance that I won’t bore you by attempting a list. But in general, the rule should be that more transparency is better unless special circumstances apply. Here, they don’t.
So despite the inevitable opposition from some doctors, I believe that this transparency model will make our profession stronger and more accountable, and that our health system will be the better for it.
I welcome comments.
Good work, Justin. Personally, I’m all for transperancy, both as a general principle, and in this particular circumstance. Leaving it to the doctor involved to decide whether or not he/ she will accept payment (in kind or otherwise), knowing that it will be on the public record, is a much better strategy than restricting payments, in my opinion. Payments are not necessarily inappropriate.
After reading your post, I reflected on whether such a register would change my behaviour, and the answer was a definite “no”.
In general, I avoid drug-company sponsored speaking engagements, but there have been a couple of exceptions.
1) I am an Implanon insertion trainer – which I did so that I was able to teach and certify our registrars who may otherwise struggle to get this training in a timely and local manner (given that they are mostly rural) – for the same reason as I’m a CPR trainer. I do not get paid by the drug company to deliver the twice yearly training sessions to registrars. However, on the request of the drug company (MSD), I have delivered training sessions for other groups, and have been reimbursed for these. I’m upfront about this to participants when I deliver the training, and do not feel obliged or pressured to toe the company line. e.g. I always talk about how awesome Mirena is, and ensure I present as honest and balanced a presentation as possible.
2) I was paid by a drug company to develop and deliver a facilitation training workshop for doctor presenters early this year. I was not teaching content, just teaching facilitation skills e.g. Small group management. I invoiced the company at my usual teaching rate for the preparation and delivery, which was paid without any fuss. It was one of the most enjoyable workshops I’ve ever had the pleasure of running.
I sleep well at night, and would continue to do so if these payments were made public.
Thanks Genevieve, that’s really interesting input.
If the current draft proposal is accepted, your situation would require the company to list the amount they paid you and categorise it under ‘education’. As you say, this then reflects the reasonable payment for your services in delivering education.
It would be unlikely that any of your patients would query it (I don’t imagine the website will be particularly popular and even less likely that any journalist would be interested in dollar figures under the thousands or tens of thousands), but if they did, you could quite comfortably explain the details.
The majority of data captured will be fairly routine, and merely serve as a point of consideration before a doctor accepts a payment.
Great work Justin. I sure would like to hear from those doctors who oppose this kind of transparency. I guess I’m a bit surprised that some doctors will openly oppose this proposal as it’s pretty hard to look good when you’re on the opposite side of the truth. I would be interested to know how they rationalise bribery and gross conflict of interest. I’d like to see this kind of thing in mental health. I’ll be watching 7.30 Report tonight! Cheers Dan