COURTESY MIRROR MAY 14

The doctor-industry nexus
Should doctors accept payments from the pharma industry?
The public and even doctors are concerned about payments made to doctors by the pharma industry. I am often asked to comment on the ethics behind this. If I am called to speak about a certain drug, it would require some preparation to inform the doctors and laymen in the audience about it. The presenting doctor must be able to answer questions about the advantages and disadvantages of the drug compared to other existing options in an informed way. In this situation, if a doctor quotes a fee it is ethical in my opinion, because it takes several days of homework to learn about a new product. It is important to know that nowhere in the talk must the doctor refer to the product by the available name; they should only mention the pharmacological name.

In the US the Physician Payments Sunshine Act, which is part of the Patient Protection and Affordable Care Act, requires manufacturers of drugs and medical devices to track and then report certain payments and items of value given to physicians and teaching hospitals. The manufacturers collect this information on a yearly basis and then report it to Centers for Medicare and Medicaid Services. CMS then posts the reported payments and other transfers of value on its website. This is done with the aim of increasing transparency to engender patient trust and improve care. But does it work? Do patients trust doctors more now that they can access this information?

Two researchers, Kathryn R Tringale and Jona A Hattangadi-Gluth, address this issue in a commentary written for JAMA Network, an international peerreviewed general medical journal.

They write that a study has found that only 12 per cent of Americans are aware this data is available, and only 3 per cent know if their doctor has received industry payment. They also note that a minority of doctors receive the largest amount of money. In fact, data from the Open Doctors database states that the median annual payment made to physicians in 2015 was $201.

It is also interesting to note that the 3 per cent of patients who knew if their physicians had accepted payments trusted the doctors more. The transparency improved their confidence.

The study was conducted in two phases: from September 26 to October 3, 2014, and from September 16 to October 2, 2016. Notwithstanding the 3 per cent above, the other 97 per cent were unaware of the payments. Patients who visited the same doctor during both phases reported a 2.2 per cent decline in trust in the medical profession as well as the physician.

In the Indian scenario, it is unethical for doctors to own drug and medical device companies. If they did it would lead to a conflict of interest. I have discussed the important issue of generic versus branded medication before. I would only state that if both are equivalent then the branded medication should cease to exist. Some will say but designer clothes and ordinary clothes exist side by side, but this analogy is not correct, as clothes are a matter of personal preference.

When it comes to drugs, one is guided by the physician and there are no benefits of having more expensive medicines. I remember when one of my own relatives had an angioplasty and was prescribed a thinner by my colleague, it was four times more expensive than the other market players. When I asked the cardiologist, he stated that he had faith in the drug as far as preventing recurrences was concerned, and in any case it is cheaper than another angioplasty. This is by and large true: Doctors do prescribe medication in which they have faith.

Also it may be true that expensive medications contain better excipients (substance that is added to allow the drug to be well absorbed and enter the blood stream) and therefore provide better blood levels of the drug and hence produce better outcomes.

As far as conference and facilities are concerned, I once again state that it is expensive for doctors to attend them. I see no harm when large groups of doctors are provided information and education. But at the same time it is not incumbent on doctors to repay the generosity in other ways. So no quid pro quo exists.

In the end we are guided by our own ethics, but we must install ethical values in medical schools. Senior doctors in the profession must provide leadership with exemplary behaviour.

When it comes to drugs, one is guided by the physician

Altaf Patel

The good doctor on modern medicine and age-old common sense

In the Indian scenario, it is unethical for doctors to own drug and medical device companies

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Altaf Patel at

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