It’s a sunny day today, a nice change from winter darkness. What, though, lurks in the dark corners of the healthcare business? A bill put forward to the US 111th Congress two years ago proposed letting everyone see.
Known as the Physician Payments Sunshine Act of 2009, but never passed into law, it would have required formal disclosure of payments and other financial links between doctors and drug companies in the United States.
The reason for the Bill was that there has been widespread unease about the way drug companies (‘big pharma’) market their products. A typical ploy is thought to be for them to pay or otherwise reward ‘thought leaders’ who can influence the medical profession as a whole.
The effectiveness of thought leaders has long been known, but it was once demonstrated vividly when researchers hired an actor, whom they called Dr. Fox, to give a spoof lecture to a medical audience. The tale is told in: The Secret Lives of Big Pharma’s ‘Thought Leaders’
Over all, almost every member of every audience loved Dr. Fox’s lecture, despite the fact that, as the authors write, it was delivered by an actor “programmed to teach charismatically and nonsubstantively on a topic about which he knew nothing.”
Written by ghosts
Another drug company technique came to light recently when it was claimed that the manufacturers of Paxil (Seroxat, an SSRI used to treat depression) had hired a PR company to ghost-write an entire textbook, Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care. Then, it is said, the company arranged for two real psychiatrists to be credited as the authors.
Although there is controversy around how much of the book was actually ghost-written, the book’s support for Paxil is confirmed by a reviewer in Nemeroff and Schatzberg’s “Textbook” Pushed Paxil :
Documents posted on the internet hint strongly that the book was ghostwritten by a PR firm hired by the drug company. And an analysis of the book’s content shows that it was crafted to encourage primary care doctors to prescribe Paxil preferentially over its competitors…
Closer to home
Drug companies’ marketing techniques came closer to home in a strange way when they moved to Australasia, the opposite side of the planet. The drug company Merck hired a well-known publisher of academic journals to produce an entire journal for its own marketing purposes. The tale is told in Merck published fake journal:
Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles—most of which presented data favorable to Merck products—that appeared to act solely as marketing tools with no disclosure of company sponsorship.
This is closer to home, the UK, because here important decisions about drugs are made centrally for the NHS by the quango NICE, and NICE bases its findings on published scientific research.
In the UK there is relatively little point in advertising drugs directly to doctors, although that does go on, and UK clinicians do receive fees from drug companies. The big decisions, however, are taken on the basis of scientific evidence.
Therefore, for a company to influence drug sales in the UK, making payments to doctors would be little use, even if those doctors are thought leaders. Instead, they would have to pay researchers and academics.
There’s been a recent report that the Physician Payments Sunshine Act has been revised and reintroduced to the US Congress. This time it might pass into law, because the need for disclosure of these payments has become more widely accepted. The proposed penalties for non-disclosure are now greater, according to a medical marketing industry report: Sunshine bill is back with sharper teeth
If only we could have a similar little ray of sunshine to illuminate the relationship between UK academics and NICE, that would be nice.