UK pharma to consider ban on doctor gifts
pharmafile | February 5, 2009 | News story | Medical Communications |Â Â ABPI, Code of Practice, ethicsÂ
All gifts from pharma companies to doctors and to medical students – should be banned, according to a new report that urges a radical re-positioning of the relationships.
A working party set up by the Royal College of Physicians (RCP) to examine the relationship between pharma, doctors and academics says there needs to be a cultural change on all sides, but that more meaningful collaboration is possible.
Richard Horton, editor-in-chief of the Lancet and primary author of the report, says: “We need to rewrite the contract between the industry and the NHS with patients at the heart of that.”
The report has been two years in the making, and the working party includes senior figures from all sides, including the ABPI’s director of medicine Dr Richard Tiner and Pfizer’s medical director Dr David Gillen.
It concludes that some doctors have an ‘unhealthy dependency’ on industry in some respects, whilst not collaborating enough on areas of strategic importance.
The report, “Innovating for Health: Patients, physicians, the pharmaceutical industry and the NHS”, set out 42 recommendations this week.
The tone of the report is optimistic, creating a vision of new more transparent and collaborative relationships fostering better research and patient care. Nevertheless it pulls no punches in criticising what it sees as current deficiencies, concluding: “in many places the relationship between the NHS, academic medicine and the pharmaceutical industry is broken”.
Some of the most eye-catching recommendations are those relating to payments and gifts to doctors from the industry.
The group suggests the giving of gifts should be banned, and that any payments to doctors for services to the industry should be registered on a publicly accessible database.
Richard Horton says: “Gifts create the impression that doctors are tainted and this harms the basis of independent prescribing.
“Also, the industry does not want to be the cheque book for doctors’ entertainment. It’s humiliating and disrespectful. Doctors don’t see pharma companies as equal partners.”
He suggests this is part of a wider problem. “There is a bit of a slanging match between groups which has escalated to the point where it has become ridiculous and is not serving patient interests at all.”
The report wants the ABPI Code – which currently allows some types of hospitality to be given to doctors by companies – changed to outlaw the practice altogether.
“Acting on this single recommendation alone would do much to rebalance the relationship between medicine and industry to one based on equality and mutual respect, with improved patient outcomes as the overriding objective of that relationship,” the report says.
Richard Tiner, ABPI director of medicine, says the Code will be reviewed once again in light of the new report.
“The Code evolves, it tries to respond to current situations and cases,” he continues. “As a result of this report, the future of promotional aids will be looked at again.
“We already have a working group looking at the report and the recommendations that affect us, and gifts will be one of those. The industry is ready to have that debate but I can’t predict what the outcome will be.”
David Gillen, UK medical director of Pfizer, says that pharma companies are more aware of their responsibilities in this area than previously. “We have made some progress away from the past where there was a more endemic gift culture,” he says.
He would not comment on whether Pfizer would endorse the “no gifts” initiative as a company. “But as part of the working party I sign up to this idea,” he says.
The RCP report also calls on the ABPI to “work harder to disseminate and implement” the Code more generally and recommends that it organise an annual conference for medical professionals and policy makers to look at pharma companies’ role in shaping doctors’ attitudes.
“Most patients are probably fairly laid back about the link between physicians and industry but get upset when that link is not transparent,” suggests Derek Calam of the Royal College of Physicians patient and carer network.
When it comes to medical education, the working party acknowledges that pharma companies have “an important and positive” part to play.
It says that educational funds should be distributed from a centralised funding pool, rather than by individual companies.
But the report also recommends: “The goal should be to wean the education of doctors in-training off pharmaceutical industry support over a time-bound period, such as five years.”
Horton clarifies: “We don’t say industry should be eliminated from education. We think it should be treated as an equal, mature partner. Industry’s voice is a very distinctive one, and in fact we say that students don’t hear enough from industry.”
However, Horton is scathing about what he sees as the NHS’s failure to invest in continuous professional development (CPD).
“The traditional criticism has been of [the pharma] industry pushing itself into the educational environment,” he says.
“We take a different view: the NHS should have a long-term interest in CPD for staff in prescribing and medicines usage. But the NHS has abdicated its role and the pharma industry has stepped into that space. The NHS needs to recognise its responsibility.”
NHS investment in CPD should be scaled up – for example, through personalised and portable study leave and education budgets.
The report adds that new ways should be found to reduce the reliance of postgraduate med ed on pharma or biomedical sponsorship, with royal colleges and the Department of Health explored as other potential sources of finance.
Elsewhere among the recommendations, labelling comes under scrutiny with manufacturers urged to ensure the same medicine will always have a similar colour, shape and size of tablet.
The working party also says NHS organisations and the MHRA should make it easier for doctors to report adverse drug reactions.
The GMC and royal colleges should help place greater emphasis on a doctor’s professional obligation to report adverse events at all stages of a medicine’s life.
In addition, the MHRA should publicise and promote the system to enable patients to report potential adverse reactions online or in writing.
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