Issue 2 / 23 January 2012

TRANSPARENCY is the buzz word of the moment when it comes to the pharmaceutical industry’s financial relationships with doctors and other health care professionals.

In the US, the New York Times reports the Obama administration is poised to mandate public disclosure of all industry payments and gifts to individual doctors, from six-figure consultancy fees to the coffee and bagels a sales rep brings to a doctor’s surgery.

The industry in Australia is showing signs of trying to get on the front foot, with several of the big players recommending similar disclosure rules be introduced in the current review of the Medicines Australia code of conduct.

GlaxoSmithKline (GSK) went public last year with aggregate figures for its payments to Australian health care professionals and health-related organisations (in 2010, a total of just over $2 million, including about $800 000 in consultancy fees and about $400 000 in grants to individuals for attendance at conferences and symposiums).

GSK has since said it supports the further step of full disclosure, including naming all doctors who receive payments, though it seems unlikely the company would go it alone in the absence of an industry-wide requirement.

Transparency is, of course, a good thing. If there’s nothing wrong with these payments, then why would there be a problem in disclosing them?

It will be interesting, though, to see how such changes might affect relationships between practitioners and industry.

Would doctors become more reluctant to, for example, serve on advisory committees and would that, as is often claimed, undermine efforts to develop new and better treatments for patients?

There’s no doubt that doctors’ financial relationships with industry could be used — fairly or otherwise — to question their credibility.

In fact, this happened last week when Melbourne endocrinologist Professor Henry Burger and overseas colleagues published a re-evaluation of the results of the of the Million Women Study, disputing claims it showed a causal link between hormone replacement therapy (HRT) and increased breast cancer risk.

Predictably enough, the paper sparked a fiery debate. Some experts welcomed the finding; others disputed it and pointed to the authors’ financial relationships with manufacturers.

Dr Andrew Penman, of the NSW Cancer Council, told ABC radio the authors were “playing the game” of seeding doubt about well established scientific findings, “and you really do have to question their interest, given their association with the industry”.

No doubt, the HRT debate still has some distance to run, but the demand for greater public disclosure means doctors in all fields of medicine are likely to find themselves grappling with more of these kinds of conflict of interest allegations.

A leading specialist once told me he had deliberately entered into working arrangements with all the leading industry players, believing this would help prevent him from being biased, or being seen to be biased, in favour of any one of them.

However successful that strategy might be when it comes to individual products, it’s hard to see how it could protect a doctor from potential bias in favour of a whole class of drugs.

We humans are not very good at detecting our own biases, though we can be hyper-vigilant about those of others.

Studies in the past have suggested most doctors do not believe their own decisions are affected by industry gifts or payments — though they tend to be more sceptical about their colleagues’ ability to remain impartial.

In the interests of transparency, I should declare that I once attended a medical conference with the financial assistance of a pharmaceutical company. This was disclosed to readers and I am confident it did not affect the content of the articles I wrote.

But I suppose I would think that, wouldn’t I…

Jane McCredie is a Sydney-based science and medicine writer.

Posted 23 January 2012

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One thought on “Jane McCredie: Bias in eye of beholder

  1. Skeptic says:

    It is widely acknowledged that doctors with a financial conflict are likely to show bias where there is an apparent conflict of interest. What is much less accepted and often unrecognised is the commonly seen bias where the conflict is not financial but relates to other rewards, eg, doctors working in the public health system often perceive themselves as “pure” and above reproach when there is no apparent financial conflict but are often making decisions about methods or procedures that favour their particular hospital or health area, or favourably affect staffing in their domain.

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