Pharmaceutical company-doctor relationship
It is in the patient’s interest that doctors interact with the pharmaceutical industry. This interaction will be for research, education, post-marketing surveillance and 'detailing' of products.
This necessary interaction is guided by the AMA Code of Ethics and the new Medicines Australia Code.
AMA Victoria supports the new Medicines Australia Code for the pharmaceutical industry and believes that where a doctor has a pecuniary interest in a pharmaceutical company (eg advisory boards) this should be transparent.
Doctors know interaction, especially detailing, is aimed at encouraging a doctor to use a particular product and would not continue unless the industry behind it believed it had an impact.
But it is wrong to assume this is always detrimental to our patients or the community.
Doctors, unlike other health groups (e.g. pharmacists and other industry groups) and other professionals and trades people, get no personal benefit or advantage from prescribing one medication over another. There is no commission. Contact with all the competing producers of a class of medications for the same condition ensures doctors are not beholden to any one provider and that they are well informed to best advise according to a particular patient’s needs.
All medications on sale in Australia are approved as safe and effective by the TGA.
All medication available on the PBS has been shown to be cost effective and Medicines Australia has audit capabilities to ensure approved prescribing.
Research has shown that in the vast majority of prescriptions, doctors allow the pharmacist to determine the drug brand.
Where doctors prescribe a medication that is off the PBS, there is usually extensive discussions between the doctor and patient prior to prescribing.
It is likely that the cost of marketing does increase the cost of medications but the industry has so far refused to declare the separate costs of research, development, education and marketing in a transparent way so this impact is difficult to assess.
Furthermore many PBS medications are price bracketed so when a class effect is present (eg all branded ACE Inhibitors, SSRIs, HMGCoA inhibitors, are one price to government) if a doctor is to advise or a patient choose one brand over another there is no cost impact.
From the individual patient perspective, the risk of no relationship between their doctor and the pharmaceutical industry is that their doctor will only have access to medication information from government, (which may have its own bias) journals, some can take up to four and a half years to publish an article; and internet. All these sources can lag behind industry information. There is also considerable expense and time involved. This time, in an environment of doctor shortages is, from the patient perspective, best to be after hours and the cost, again from the patient perspective, is best born by someone other than the doctor who would need to pass it on to the consumer.
Overall doctors are there to help patients. An open and appropriate relationship with the pharmaceutical industry, is in the interests of patients.
AMA is reviewing its Code of Ethics in relation to sponsorship/relationship with the pharmaceutical companies to clarify the responsibility for accountability and professional independence.
No matter how strongly we feel in regard to our independence in these matters, if we do not as a profession meet the standards set by the ACCC we risk (a) losing our patients’ confidence as their independent adviser and (b) subsequent increased government regulation.