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Are doctors swayed by big pharma largesse?

Health insurance up but drug prices down - Featured Image


Oncologists are much more likely to prescribe a company’s drug if that company has provided them with gifts, speaker fees, free meals, travel expenses or research money, a US study has found.

The study, published as a research letter in JAMA Internal Medicine, focused on two cancers: metastatic renal cell cancer (mRCC) and chronic myleoid leukaemia (CML), for which there are multiple drug options.

For mRCC, oncologists who had received money from a pharma company were almost twice as likely to prescribe that company’s drug, compared with doctors who had not received any money from the company. It was a similar story in CML, although the effect was not as great, with a 30% difference in prescribing rates between oncologists who did and did not receive money from the drug company in question.

The drug choices were sorafenib, sunitinib malate or pazopanib hydrochloride for mRCC, and dasatinib, imatinib mesylate or nilotinib for CML. For three of these drugs – sunitinib, nilotinib and dasatinib – prescribing rates were higher for oncologists who received payments from the respective drug companies.

Interestingly, prescribing rates for imatinib went down for physicians who received payments from the manufacturer Novartis. But that same company markets the newer drug nilotinib, and the study authors said their findings reflected the fact that Novartis was trying to get physicians to transition from imatinib, which is soon to go off patent, to nilotinib, which has many more years of patent to run.

The study involved around 3,600 oncologists with a history of prescribing for either of the two conditions.

In the US, big pharma spends around $7 billion wooing clinicians with consultancy fees, expenses and research grants. The figures are much smaller in Australia, but are still considerable. In 2016, Fairfax Media reported that big pharma had splurged around $43 million on health professionals over a period of six months.

That expenditure included a $70,000 trip to Sweden for six oncologists and a $176,000 “educational” trip to Vancouver for nine dermatologists.

Novartis flew 19 health professionals to an Amsterdam conference at its own expense, according to figures from Medicines Australia, and the company also sent five oncologists to a four-day conference in Austria, which included two weeks’ accommodation, at a cost of $32,569.

In 2015, Novartis fell foul of Medicines Australia’s Code of Conduct and was fined $90,000 over a breach of ethical guidelines. It concerned a seven-hour event for only three specialists, with no clear link to educational outcomes. Medicines Australia noted concern that the event was “a form of reward to these individuals who prescribed Novartis’s ophthalmological product”.