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• Reply to the comment "A sandwich won’t sway a doctor"
  Alice Fabbri, Quinn Grundy, Barbara Mintzes, Swestika Swandari, Ray Moynihan, Emily Walkom and Lisa Bero
  Published on: 14 July 2017
• A sandwich won’t sway a doctor
  Milton Catelin
  Published on: 5 July 2017

• Published on: 14 July 2017

  Reply to the comment "A sandwich won’t sway a doctor"

  • Alice Fabbri, PhD student Center of Research in Medical Pharmacology, The University of Insubria, Varese, Italy
  • Other Contributors:
    • Quinn Grundy, Postdoctoral Research Fellow
    • Barbara Mintzes, Senior Lecturer
    • Swestika Swandari, Trainer
    • Ray Moynihan, Senior Research Fellow
    • Emily Walkom, Research Academic
    • Lisa Bero, Professor

  We acknowledge of course that the pharmaceutical industry produces many medicines that are an important part of healthcare. However, inappropriate use and overuse of medicines is detrimental to health, and use of an unnecessarily expensive medicine that is no better than a cheaper alternative represents wasteful health care spending.

  Although Mr. Catelin states “It’s ludicrous to suggest that a sandwich and a soda water would sway the opinions of medical practitioners”, the evidence shows otherwise. Among the studies that have examined the relationship between exposure to pharmaceutical industry information or payments and the quality, quantity and cost of prescribing, there is an overwhelming finding of no benefit. (1-4) Pharmaceutical industry payments, even small payments such as a meal, are associated with increased prescriptions of the promoted drug. One US study found a “dose-response effect” on prescribing of cholesterol-lowering drugs, blood pressure drugs and antidepressants, starting with even a single meal costing less than US $20: the more free meals a doctor ate, the more likely they were to prescribe the promoted drug. (2) Another study found that the more payments a doctor received from the industry, the more likely they were to prescribe expensive brand-name drugs rather than less expensive generic equivalents. (4)

  The aim of our study was neither to undermine patients’ confidence nor to call health professionals into disrepute. The aim was...

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  We acknowledge of course that the pharmaceutical industry produces many medicines that are an important part of healthcare. However, inappropriate use and overuse of medicines is detrimental to health, and use of an unnecessarily expensive medicine that is no better than a cheaper alternative represents wasteful health care spending.

  Although Mr. Catelin states “It’s ludicrous to suggest that a sandwich and a soda water would sway the opinions of medical practitioners”, the evidence shows otherwise. Among the studies that have examined the relationship between exposure to pharmaceutical industry information or payments and the quality, quantity and cost of prescribing, there is an overwhelming finding of no benefit. (1-4) Pharmaceutical industry payments, even small payments such as a meal, are associated with increased prescriptions of the promoted drug. One US study found a “dose-response effect” on prescribing of cholesterol-lowering drugs, blood pressure drugs and antidepressants, starting with even a single meal costing less than US $20: the more free meals a doctor ate, the more likely they were to prescribe the promoted drug. (2) Another study found that the more payments a doctor received from the industry, the more likely they were to prescribe expensive brand-name drugs rather than less expensive generic equivalents. (4)

  The aim of our study was neither to undermine patients’ confidence nor to call health professionals into disrepute. The aim was to provide public access to information on the extent of industry funding of professionals in Australia, and to stimulate an informed discussion on how to ensure that patients and clinicians base decisions on the best available evidence from independent sources.

  Finally, following the lead of other countries such as the US and France, we recommend that Medicines Australia report all payments to health professionals, including food and beverages of nominal value.

  We appreciate the opportunity to continue the discussion on these topics.

  Alice Fabbri, Quinn Grundy, Barbara Mintzes, Swestika Swandari, Ray Moynihan, Emily Walkom, Lisa Bero

  References:

  1. Yeh JS, Franklin JM, Avorn J, et al. Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts. JAMA Intern Med 2016;176(6):763-8.
  2. DeJong C, Aguilar T, Tseng C, et al. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med 2016;176(8):1114-10.
  3. Spurling G, Mansfield P, Montgomery BD, et al. Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS Med 2010;7(10):e1000352.
  4. Ornstein C, Grochowski R, Tigas M. Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds. Pro Publica: March 17, 2016. Available at: https://www.propublica.org/article/doctors-who-take-company-cash-tend-to.... Accessed July 7, 2017.

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  Conflict of Interest:
  All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). Dr. Mintzes reports that she was an expert witness on behalf of plaintiffs in a Canadian class action suit concerning cardiovascular risks of a testosterone gel. None of the authors received any payments, funding, or other financial support from pharmaceutical manufacturers. The authors declare no other relationships or activities that could appear to have influenced the submitted work.

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• Published on: 5 July 2017

  A sandwich won’t sway a doctor

  • Milton Catelin, Chief Executive Medicines Australia

  A sandwich won’t sway a doctor.
  Milton Catelin
  Chief Executive, Medicines Australia

  Pharmaceutical companies and medical professionals collaborate on clinical research, share knowledge and support education to ensure that medicines are constantly improving and are used safely and appropriately by health care professionals and their patients.

  Our members are proud of the work that we do to ensure that the public can continue to have confidence in our local medicines industry. We consider transparency to be a key component of the bond of trust with the Australian public.

  Engagement with pharmaceutical companies is an important and legitimate part of a medical practitioner’s ongoing education; foremost, because patients want to be sure that their doctors know how to use the medicines they’re being prescribed.

  The developers of these medicines are the highest authority on how a medicine works, its interactions with other compounds, its efficacy and other information. It stands to reason that a medical practitioner would consider information from the maker of the medicine when making an informed decision about prescribing a medicine. It’s not however, the only source. Medical practitioners do their own research, network with their peers, consult with other clinical experts, read independent medical journals and receive information from independent bodies such as NPS MedicineWise.

  It’s ludicrous to suggest that a sandwich and a so...

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  A sandwich won’t sway a doctor.
  Milton Catelin
  Chief Executive, Medicines Australia

  Pharmaceutical companies and medical professionals collaborate on clinical research, share knowledge and support education to ensure that medicines are constantly improving and are used safely and appropriately by health care professionals and their patients.

  Our members are proud of the work that we do to ensure that the public can continue to have confidence in our local medicines industry. We consider transparency to be a key component of the bond of trust with the Australian public.

  Engagement with pharmaceutical companies is an important and legitimate part of a medical practitioner’s ongoing education; foremost, because patients want to be sure that their doctors know how to use the medicines they’re being prescribed.

  The developers of these medicines are the highest authority on how a medicine works, its interactions with other compounds, its efficacy and other information. It stands to reason that a medical practitioner would consider information from the maker of the medicine when making an informed decision about prescribing a medicine. It’s not however, the only source. Medical practitioners do their own research, network with their peers, consult with other clinical experts, read independent medical journals and receive information from independent bodies such as NPS MedicineWise.

  It’s ludicrous to suggest that a sandwich and a soda water would sway the opinions of medical practitioners. Suggestions like the one published in the Conversation and in the BMJ article do nothing but undermine a patient’s confidence in a robust and accountable system, and call healthcare professionals into disrepute.

  Moreover, when a doctor is working a 12 hour day, and uses their lunchbreak to inform themselves of the latest developments in medicines, it seems appropriate that they be provided with lunch.

  It’s also important to note, the 18th Edition of the Medicines Australia Code of Conduct clearly states:

  Any meals or beverages offered by companies to healthcare professionals must be secondary to the educational content. Meals and beverages must be appropriate for the educational content and duration of the meeting and should not be excessive.
  The maximum cost of a meal (including beverages) provided by a company to a healthcare professional within Australia must not exceed $120 (excluding GST and gratuities).

  This maximum would only be appropriate in exceptional circumstances, such as a dinner at a learned society conference with substantial educational content. In the majority of circumstances, the cost of a meal (including beverages) should be well below this figure.
  For hospitality in association with overseas educational meetings this maximum and/or local guidelines should be used as a guide.

  The Code of Conduct is the Australian benchmark for accountability and transparency reporting in the therapeutic goods sector. This is the same standard that pharmaceutical companies are held to in Europe, and significantly more detailed than industry self-regulation in the USA.
  Medicines Australia members are proud of their Code of Conduct.

  They have voluntarily submitted themselves to this significant transparency despite the fact that non-Medicines Australia members do not, that includes generic medicines manufacturers and the makers of medical devices. Our positive experience with increasing transparency of our members should stand as a beacon to others to join us on the journey.

  A better informed patient has more confidence in the relationships between doctor and company. They are more likely to understand the value of these relationships in the development of better medicines and devices, including a doctor’s or patient’s participation in Australian-based clinical trials.

  Australian patients should be assured that their medical practitioners are keeping up to date with the latest innovation in medicines and the sharing of knowledge so that medical practitioners can determine the best outcomes for their patients.

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  Conflict of Interest:
  Medicines Australia, in partnership with our members, drives the creation and development of an environment for the continued sustainable growth of the innovative research based prescription medicines industry. Our members all subscribe to the 18th Edition of the Code of Conduct - Administered by Medicines Australia.

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