There is a longstanding trend of pharmaceutical companies organising "educational events" for doctors to "educate" them on their latest and upcoming drugs. This involves millions of dollars being spent on flight tickets, expensive dinners for doctors and sponsoring small medical journal clubs in hospitals. However, these events are usually camouflage for paying off doctors to encourage increased prescription of the drugs.

An investigation by news site ABC uncovered that pharmaceutical companies in Australia spent more than AUS$2.6 million on such events for doctors on a new generation of blood thinners, in just six months in 2015.

This included AUS$185,000 to fly 25 specialists to Vienna and AUS$86,000 to fly six doctors, business class to Canada for medical conferences. Yet, this is a practice that the pharmaceutical industry defends.

Influence of pharma companies pose health risks

Blood thinners are given to patients after operations or to prevent stroke. Conventionally, Warfarin was the only option and patients needed regular blood tests while on the medication. With the latest generation of blood-thinning drugs, oral anticoagulants such as Xarelo, Eliquis and Pradaxa, patients no longer need to be monitored.

The federal government revealed that more than 2.6 million prescriptions for new-generation blood thinners were written in 2016. This is worrying as for patients on Warfarin, doctors have an antidote to stop bleeding if needed, however, with the new-generation, only Pradaxa has an antidote.

These events might be to blame.

There is evidence that shows a doctor is more likely to prescribe a drug if they attended an event or received meals and travel sponsored by the drug manufacturer, said Barbara Mintzes from the Faculty of Pharmacy and the Charles Perkins Centre at the University of Sydney.

"That can be a problem because that's not necessarily the best drug for that specific person," she said.

Are doctors really influenced by pharma companies?

Epidemiologist John Attia, from the Hunter Medical Research Institute supported Mintzes, saying that there is much evidence suggesting that the new-generation blood thinners were prescribed more frequently to lower-risk patients.

"The people being started on these medications are younger, healthier and don't have as many health problems. Those people are the ones who are probably at less risk of stroke and so the risk-benefit ratio changes," said Professor Attia.

As most people in this group have a risk of stroke of 1% to 2%, and the risk of bleeding is 2% to 4% a year, the prescriptions are not justified.

However Australian Medication Association (AMA) president, Michael Gannon said that doctors took their role as prescribers very seriously and that doctors need to know about new medications and possible improvements in treatment for some of their patients.

Medicines Australia, which represented pharmaceutical companies, also said that the events were organised as a requirement by the drug regulator, the Therapeutic Goods Administration (TGA) to provide education to physicians as part of the drug approval process.

However, Dr Gannon also said that it would be "naive" to think that there would be no impact at all on the doctors who attended a sponsored event.

How big of a problem is it?

Bayer, the manufacturer of Xarelto, spent AUS$23,400 to fly specialists to Sydney's Sheraton Hyde Park to "reinforce the importance of adequately anti-coagulating non-valvular atrial fibrillation patients at risk of stroke" to doctors. Pfizer, manufacturer of Eliquis, spent AUS$175,000 including flights and accommodation for a 25-minute session on Eliquis at Sydney's Hilton Hotel for 107 doctors.

All these are part and parcel of a commitment to ensure "access to the latest innovations in medicines, biotechnology and important medical breakthroughs" which would be unattainable for most medical practitioners in Australia, if not for pharmaceutical companies, said a spokesman for Medicines Australia.

However to add to growing concerns, as of late 2016, pharmaceutical companies will no longer have to publish information about what they spend on these "educational events". They will only publish names of individual doctors and the "transfers of value" they receive for speaking at events or trips to conferences. Food and beverage spending will no longer have to be reported.

This has angered some academics and public health professionals, saying that this has put Australia in the backseat for transparency in comparison with the United States.

"If they were really serious about education, they would all put their money into a central education fund and that would be dispersed at arm's length for sponsoring independent education," said Professor Attia.

"There's still a long way to go until there's real transparency between doctor and drug company relationships," said Dr Ray Moynihan, Bond University senior research fellow. MIMS

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Sources:
http://www.abc.net.au/news/2017-02-13/rule-changes-to-wining-and-dining-of-doctors-by-drug-companies/8258520
http://www.abc.net.au/news/2017-02-12/prescriptions-for-new-blood-thinning-drugs-skyrocket/8250856