The number of specialists receiving cash payments and educational subsidies from industry is again in the spotlight, with researchers identifying nine specialties where over a quarter of doctors have recently benefited from pharma largesse.

Always controversial, the issue has been raised in a paper that reveals some 6504 doctors, or nearly 5% of those currently registered in Australia, received a payment or transfer of value from a pharmaceutical company in the three years to October 2022.

The figures were extracted from transparency reports published by Medicines Australia member companies and include subsidised registration fees, travel costs, or fees for service. Payments for food, beverages or research are excluded.

Some $33.44 million was paid or transferred all up, ranging from $36 to $299,161 at a median value of $1500, according to the report, published in the MJA this month (link here).

But the main concern is the high representation of certain specialties, say the authors, led by pharmaceutical industry researcher Professor Barbara Mintzes of the University of Sydney.

Leading the list were rheumatologists, 67% of whom received a subsidy over the three years of data analysed.

This was followed by respiratory and sleep medicine (42%), haematology and oncology (41%) and endocrinology (37%), but all up there were nine specialties in total with greater than 25% coverage, the researchers found.

Other specialties with high representation included neurology and cardiology (each 35%), nephrology (28%), gastroenterology and dermatology (each 26%).

On the other hand, haematology and oncology, which were grouped together, received the highest total payments, as well as the second highest median payment ($1200), which represented a potential risk to sustainable health funding, they argued.

“A 2021 systematic review (36 studies) found a consistent association between pharmaceutical payments and prescribing patterns; the authors noted a probable causal relationship,” the authors noted.

“United States evidence suggests that pharmaceutical companies target highly connected physicians to achieve spillover effects; that is, increased prescribing by the peers of payment recipients.”

“The high cost of new medicines has been a source of concern, particularly in haematology and oncology, and our finding that doctors in this specialty received the highest total amount of payments may have implications for health care costs.”

The true value of subsidies was likely higher, given the exclusion of food and drinks, and the fact that not all pharmaceutical companies operating in Australia were currently disclosing their payments on the Medicines Australia website, the authors said.

The researchers concluded by warning that, while legal, the financial relationship between doctors and industry could reduce trust in the medical profession.

“Australian doctors should reflect on their relationship with the pharmaceutical industry, considering whether they need to accept payments for continuing professional education, travel, and consultancy work, and whether it is consistent with public expectations,” they wrote.

“Greater transparency in the reporting of pharmaceutical company payments to health care professionals is needed, and payments should be linked with AHPRA numbers to facilitate the identification of individual recipients.”