Pharma payments to rheumatologists revealed

One in four Australian rheumatologists receive payments from the pharmaceutical industry, with some accepting tens of thousands of dollars a year for advisory and speaker roles, a new study shows.

Researchers analysed payments from the pharmaceutical industry to doctors in different specialities between November 2018 and April 2019, based on data provided to the Disclosure Australia website, as required under the Medicines Australia Code of Conduct.

Over a six month period pharmaceutical companies paid a total of $7.3 million to 2775 medical practitioners.

The study in the Internal Medicine Journal estimated that 26% of Australian rheumatologists received payments in the six-month period, compared to around 30% of oncologists and haematologists and 11% of other internal medicine specialist physicians.

Rheumatologists received $435,787 in payments, a lower total figure than other specialist groups such as oncologists ($1.03 million), endocrinologists ($758,648) and cardiologists ($722,663).

In all, 103 of 404 rheumatologists received payments averaging  $4,231 per practitioner. Individual payments ranged from $132 to $37,260, most commonly for travel costs and service fees such as consulting and advisory panel payments.

The authors acknowledged that some interactions between physicians and the pharmaceutical industry were “unavoidable”, but cautioned that “any interaction creates a conflict of interest”.

“It is in the interest of patients to have access to major clinical trials, and these are frequently designed and sponsored by drug companies. Novel medications are often accessed by patients directly from drug companies ahead of federal funding, with cancer physicians acting as the prescribing intermediary,” they noted.

Lead author Dr Adrian Pokorny, a medical oncologist at Royal Darwin Hospital, told the limbic that the study highlighted the extent of pharmaceutical company influence, rather than criticising the behaviour of doctors who received payments.

“I have a lot of respect for all oncologists and don’t think ill of any of my colleagues,” he said.

While it was impossible for specialists to avoid interaction with pharmaceutical companies, Dr Pokorny said receiving payments meant there was potential for bias in prescribing.

Oncologists in the US were more likely to prescribe some anti-cancer drugs over their competitors if they have received payments from the drug’s manufacturer, despite no clear evidence of direct clinical superiority, the study authors noted.

Dr Pokorny said his personal policy was never to meet pharmaceutical company representatives, so he had not been offered any payments.

The COVID-19 era of telemedicine and online conferences had offered an alternative way for doctors to be involved in international conferences without any need for travel, he suggested.

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