Doctors and drug companies are locked in "vicious circle"
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《英国医生杂志》
A radical new approach to paying drug companies should be introduced—rewarding them for improving health rather than maximising sales, the UK parliamentary health committee has been told.
The proposal, by Healthy Skepticism, an international watchdog group based in Australia that is concerned with misleading drug marketing, was put to committee members during a week long visit to Australia that ended last week.
The MPs met doctors, academics, and drug companies and other groups as part of their inquiry into the influence of the drug industry. They also held meetings related to previous inquiries into child migrants and HIV and AIDS.
Dr Peter Mansfield, director of Healthy Skepticism, said in a memorandum given to the MPs that doctors and drug companies were locked in a "vicious circle," encouraging each other to do the wrong thing.
"If companies overpromote their drugs effectively, doctors reward them via higher drug sales," he said. "If doctors over-prescribe drugs, companies have more money for gifts and for promotion, reinforcing doctors' beliefs that they are doing the right thing."
Rather than paying for research, education, and promotion through drug prices that are much higher than production costs, taxpayers would get better value by paying for those functions through separate competitive tenders, Dr Mansfield said.
One option could be to pay a combination of the traditional payments according to sales volume, but at lower prices, supplemented by bonus payments for achieving performance targets, such as appropriate use.
"The main difference would be a shift from paying drug companies to do the wrong thing (overpromoting drugs) to paying them more according to their contributions to improving health," Dr Mansfield said.
Healthy Skepticism's memorandum made other suggestions:
In an ideal world promotion of drugs would be banned. If this was not achievable, the more it was limited the better the results would be for health;
Ideally doctors should be banned from receiving gifts or any other incentives from drug companies. An alternative would be to make all gifts to doctors taxable;
Doctors should be helped to become better decision makers.
Meanwhile Dr Rob Moodie, chief executive officer of the Victoria health promotion organisation VicHealth, said he told the MPs that investment in prevention was distorted by too much investment in drugs at the expense of more effective measures.
He said tens of millions of taxpayers' dollars had been spent on bupropion (Zyban) in Australia, with most patients not even finishing the smoking cessation treatment, and yet $A10m (￡4.1m; $7.4m; 5.8m) had not been forthcoming for a national antismoking campaign that would have been far more effective, he said.
"The system is designed to provide a lot more money for pharmaceuticals than it does for far more effective prevention approaches," Dr Moodie said.
Professor Les Toop and Dr Dee Richards, from the Department of Public Health and General Practice at the Christchurch School of Medicine and Health Sciences, told the MPs of several examples where direct to consumer advertising in New Zealand had been misleading and had led to inappropriate, expensive prescribing.
They said direct to consumer advertising should be banned and that industry self regulation did not work. They also gave examples of drug companies funding patients' groups in New Zealand and of engineering "disease creation" campaigns to expand markets.
Speaking to the MPs Dr Richards emphasised the need to limit mass exposure to drugs until long term safety had been studied.(Melissa Sweet)
The proposal, by Healthy Skepticism, an international watchdog group based in Australia that is concerned with misleading drug marketing, was put to committee members during a week long visit to Australia that ended last week.
The MPs met doctors, academics, and drug companies and other groups as part of their inquiry into the influence of the drug industry. They also held meetings related to previous inquiries into child migrants and HIV and AIDS.
Dr Peter Mansfield, director of Healthy Skepticism, said in a memorandum given to the MPs that doctors and drug companies were locked in a "vicious circle," encouraging each other to do the wrong thing.
"If companies overpromote their drugs effectively, doctors reward them via higher drug sales," he said. "If doctors over-prescribe drugs, companies have more money for gifts and for promotion, reinforcing doctors' beliefs that they are doing the right thing."
Rather than paying for research, education, and promotion through drug prices that are much higher than production costs, taxpayers would get better value by paying for those functions through separate competitive tenders, Dr Mansfield said.
One option could be to pay a combination of the traditional payments according to sales volume, but at lower prices, supplemented by bonus payments for achieving performance targets, such as appropriate use.
"The main difference would be a shift from paying drug companies to do the wrong thing (overpromoting drugs) to paying them more according to their contributions to improving health," Dr Mansfield said.
Healthy Skepticism's memorandum made other suggestions:
In an ideal world promotion of drugs would be banned. If this was not achievable, the more it was limited the better the results would be for health;
Ideally doctors should be banned from receiving gifts or any other incentives from drug companies. An alternative would be to make all gifts to doctors taxable;
Doctors should be helped to become better decision makers.
Meanwhile Dr Rob Moodie, chief executive officer of the Victoria health promotion organisation VicHealth, said he told the MPs that investment in prevention was distorted by too much investment in drugs at the expense of more effective measures.
He said tens of millions of taxpayers' dollars had been spent on bupropion (Zyban) in Australia, with most patients not even finishing the smoking cessation treatment, and yet $A10m (￡4.1m; $7.4m; 5.8m) had not been forthcoming for a national antismoking campaign that would have been far more effective, he said.
"The system is designed to provide a lot more money for pharmaceuticals than it does for far more effective prevention approaches," Dr Moodie said.
Professor Les Toop and Dr Dee Richards, from the Department of Public Health and General Practice at the Christchurch School of Medicine and Health Sciences, told the MPs of several examples where direct to consumer advertising in New Zealand had been misleading and had led to inappropriate, expensive prescribing.
They said direct to consumer advertising should be banned and that industry self regulation did not work. They also gave examples of drug companies funding patients' groups in New Zealand and of engineering "disease creation" campaigns to expand markets.
Speaking to the MPs Dr Richards emphasised the need to limit mass exposure to drugs until long term safety had been studied.(Melissa Sweet)