A recent report detailed for the first time how much pharmaceutical companies paid individual doctors in Australia over a six-month period. The data, published by Medicines Australia, showed thousands of doctors had received payments for their services or contributions towards them attending educational activities, including flights, accommodation and registration fees for conferences.
Seeing the headlines in The Age that drug companies were paying doctors “millions” and citing a “rich list” of those being paid the most confirmed my unease at readily disclosing these interactions. It implied that a bridge had been crossed, that interests were conflicted and that people had been caught doing something wrong.
“When I first started my career, I felt an uncertain discomfort about the relationship that pharmaceutical companies had with some medical professionals.” Photo: Louie Douvis
I am an oncologist who has worked with pharmaceutical companies for the past 14 years. It is impossible to avoid pharmaceutical companies in oncology as there are rapid advances, an increasing number of trials and several access schemes where our patients can use a drug even though it is not funded by the pharmaceutical benefits scheme.
In the past five years since becoming more established as both a researcher and clinical triallist, I have been paid by several companies to attend advisory boards, educate my peers about using drugs that I gained experience with during the trials, and organise symposiums where other experts can share their knowledge and experience. I don’t believe I’ve done anything wrong.
When I first started my career, I felt an uncertain discomfort about the relationship that pharmaceutical companies had with some medical professionals. The freebies, it seemed to me, were not free. “Big Pharma” did not supply pens, gadgets, sandwiches and trips to overseas conferences for nothing. The investment in these gifts supposedly swayed a doctor to prescribe a product. These practices have rightly been increasingly scrutinised; some are now disallowed and the rest will need to be on the public record.
However, over time I realised that it was not as sinister as might seem, and that doctors could work ethically with industry while maintaining impartiality. More importantly, I realised that my relationship with the industry could have an impact on therapeutic options for my patients.
While a lot of basic research is funded philanthropically or through government programs, only large pharmaceutical companies have the resources to fund a global clinical trial.
Working on these trials means researchers often get access to experimental therapies for their patients faster than their colleagues who are not doing this work. Having a relationship with industry also means that if a medicine is shown to be safe and effective but not yet available or affordable in Australia, a doctor can ask for compassionate access.
My own involvement in many industry-led trials has been life-saving for many patients. I can think of scores of people who would have died if they had not been given a new medicine coming through the research pipeline that I was connected to through my clinical trial work.
While these companies obviously want to find a market for their product, there are safeguards to ensure the research testing these products is conducted in an unbiased and transparent way. All researchers are required to declare conflicts before conducting research with a compound, presenting any data in the area and publishing their own data.
The great majority of doctors receiving money from pharmaceutical companies have nothing to hide and transparency ensures that inappropriate influence is not in play, except in isolated cases.
I am there to provide clinical expertise and experience and contextualise it for the Australian setting. Providing such advice to companies is something I do in my own time and I feel it is not unreasonable to be reimbursed for this.
Some of my colleagues feel we should not engage with industry at all. Their view is that we should wait years, possibly up to a decade, for clinical trials to be repeated and published in medical journals, and then ticked off by health authorities including the PBS before we make them available to patients. I disagree.
We are treating real people with life-threatening illnesses and the sense of urgency is palpable. My international colleagues also talk of begging companies for access to the next drug, which is only possible through an existing relationship. So while it is easy to add up the dollars and tarnish medical practitioners for engaging with the pharmaceutical industry, it is important to consider why many of us do so. Transparency is important, but so is the access it provides to cutting-edge treatments in a timely way.
Associate Professor Thomas John is a medical oncologist at Austin Health.