A question of funding and control

 Dr Tim Woodruff  President

Doctors Reform Society

The  Age  Opinion  August 11, 2006

WE HAVE seen sufficient evidence in The Age this week that many within and outside the medical profession are concerned about the effects on our patients of the marketing efforts of the pharmaceutical industry. From the industry's influence on the direction and publication of research, through its support for patient lobby groups and its indirect advertising in the infotainment media, to its influence on opinion leaders and ultimately on the prescribing patterns of doctors at the coalface, this is an issue well recognised by professional colleges and sadly rejected by the largest medical political lobby, the Australian Medical Association.

Having documented the problems, we have heard little about what might be done. There is no easy solution. There is an almost total reliance on self-regulation, and the evidence suggests that this has failed dismally to minimise the negative influence of the pharmaceutical industry.

Self-regulation can be improved. The industry writes its own code of conduct and effectively administers it itself. The Australian Competition and Consumer Commission must authorise the code but has admitted it is not its role to improve the code itself. The ACCC's recommendation that the industry publish on its website details of financial dealings is designed to improve this self-regulation through shaming both doctors and the industry. It could be useful but is simply tinkering at the edges.

The professional colleges have their own guidelines for members, and the most recent set released by the Royal Australasian College of Physicians goes a long way to addressing the problem. Most members of the college will not have read it, and many would not adhere to its constraints if they did read it. The professional colleges have no power to compel any adherence to such guidelines. Despite their limitations, guidelines are worthwhile for education.

For every small success against any particular marketing strategy, however, any good industry will find an alternative. Over the past decade there has been a huge growth in funding for patient support groups and in pseudo-advertising on infotainment shows.

To seriously address the total problem, two broad areas need to be considered. These are funding and regulation. The industry is powerful, first because of the limited regulation of the conduct of the industry and of doctors, and second because there is a huge funding gap in medical education, research, and patient support. The industry fills the gap. Medical conferences, seminars, and training courses would be decimated without industry funding. At many such events funding from industry is pooled and the agenda of the meeting is determined independent of industry. The industry is then given the marketing opportunities around such meetings. At many such events, however, the industry has a much bigger input, setting the agenda and providing the speakers. In the research field, 80 per cent of drug trials would cease without industry funding. Many patient support groups would struggle to stay afloat without industry funding.

An alternative method of funding must be found. First, more government money needs to be spent. Second, the money the industry provides needs to be pooled and distributed independent of the industry. This requires regulation; governments must take the lead.

In education, this already occurs to a small extent through the National Prescriber Service and through various more targeted support for education. But the total Government budget for this is less than $30 million a year. The industry spends $1 billion a year. In research, the issue is even more difficult to address because much of the industry-funded research is itself international. Australian researchers would be delighted, however, if there was funding available in Australia for clinical research. Research whose agenda is controlled directly by the researchers rather than by industry-paid experts from overseas would be far more appealing to most researchers. Such funding must either come from government or be distributed by independent agencies, whatever its source.

Advertising through infotainment can be controlled by a code of conduct regulated by government. Patient support group funding also requires regulation to ensure that there is a separation between the company and the activities of the particular group. If that happens, funding will decrease. Government should consider appropriate funding support.

The Federal Government is to be commended for its increasing but still small contribution to the education of doctors. Such funding must be increased. It reflects a recognition that there is a need for education, independent of the pharmaceutical industry. But it addresses only one part of a multifaceted problem that requires national leadership. This can only come from Government.

The pharmaceutical industry is an essential part of our health system. It must be profitable. At the same time it must be controlled to prevent its perfectly understandable profit-driven practices from having negative effects on our patients and on the costs of our health care system. These negative effects are mediated through doctors and patients. We need help. Self-regulation is not enough. The Federal Government must acknowledge the problem and work with the industry, professional bodies and patient groups to address the issue. It must regulate and it must invest taxes that will result in better health for our patients and ultimately a cheaper, healthier health system.