GlaxoSmithKline to limit payments it makes to US doctors to $150 000 a year
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2315 (Published 30 October 2008) Cite this as: BMJ 2008;337:a2315
All rapid responses
An air of the surreal surrounds the news that a leading drug company
is capping US doctor’s honorariums to 150,000 dollars but leaving the
amount open for European doctors. The rationale offered to explain the
difference is that European doctors are not paid as well as their US
counterparts. The press release is framed around good corporate governance
in the US in response to concerns about commercial conflict of interest.
And it is marketed as corporate benevolence in response to underpaid
European doctors. It is difficult to know whether to laugh, cry or throw
hands up in frustration over the spin put on the incongruity. The global
financial crisis might help explain the situation.
An expected recession due to the financial crisis is leading to belt
tightening in the corporate sector. Reducing US honorariums to 150,000
dollars might reflect the trend. While it is noted that the amount shows
the depth of drug company pockets, it also indicates some belt tightening
given the reported amounts of money some US doctors have received from
drug companies. Also, corporate patronage and conflict of interest are now
major issues and have gained strong public attention due to the impact of
the financial crisis. These issues mirror public concerns surrounding drug
companies. Questions over a lack of transparency and accountability in a
self regulating market economy that has produced a financial crisis are
being raised constantly by the media. Nor have concerns abetted in light
of a bail out process that has also lacked transparency and accountability
to date and revelations that public money has been earmarked by Wall
Street for bonuses. (1) Given the impact of the financial crisis and its
governance concerns about patronage and conflict of interest, drug
companies will likely engage in greater public relations and market their
governance image. While reducing US honorariums to 150,000 dollars is
hardly loose change and has patronage leverage, it is in keeping with the
corporate culture and theater of the absurd that plays on Wall Street.
1. The Guardian, October 18, 2008
Competing interests:
None declared
Competing interests: No competing interests
Public disclosure of physician payment
There are two issues to be considered when contemplating the issue of
physician compensation by pharmaceutical companies: firstly, which
payments should be made public, and secondly, how much physicians should
be allowed to receive. A previous issue of the BMJ reported that
GlaxoSmithKline is limiting the amounts it pays US physicians (1), but
this is a small step in encouraging complete transparency between
physicians and the public they treat. Other companies have already begun
this process, such as Eli Lilly and Company, a US-based pharmaceutical
firm, who will launch an online database of physicians under their payroll
accessible to the public as soon as the second half of 2009(2), and other
companies should follow suit. The US Physician Payment Sunshine Act
(introduced as S.R. 2029, currently H.R. 5605 (3)), if passed, will make
this mandatory for all companies.
This legislation already exists in certain states, such as Vermont,
who require that pharmaceutical companies report all physician payments,
including travel payments, grants, food and honoraria(4). There is leeway
however, as this legislation allows for companies to not report payments
if they are considered “trade secrets” (4). Ross and colleagues found that
“trade secrets” encompasses many different definitions and varies
significantly; GlaxoSmithKline reported all of their payments as trade
secrets in this study, while overall, 61% of payments made to physicians
in Vermont were classified as trade secrets(4). Even then, companies were
not required to show which doctors received remuneration, and 75% of
publicly disclosed payments lacked any identifying information, simply
referring to the recipient as “doctor,” “nurse” or “health care
professional.” These efforts to force disclosure are important and need to
be monitored for their consequences on prescribing patterns. The size of
the gift has been shown to not matter, and simply receiving a gift from a
drug company can impact a physician’s perception of the company and their
tendency to prescribe certain drugs as a result (5). These disclosure
loopholes need to be closed or standardized to protect the public and
ensure complete transparency.
Citations
1. Kmietowicz Z. GlaxoSmithKline to limit payments it makes to US
doctors to $150,000 a year. BMJ. 2008 Oct 30;337:a2315.
2. Lilly set to become first pharmaceutical research company to
disclose physician payments [homepage on the Internet]. Indianapolis: Eli
Lilly and Company. 2008. Available from:
http://newsroom.lilly.com/releasedetail.cfm?ReleaseID=336444.
3. H.R. 5605-110th congress (2008): Physician payments sunshine act
of 2008 [homepage on the Internet]. GovTrack.us. 2008. Available from:
http://www.govtrack.us/congress/bill.xpd?bill=h110-5605&tab=analysis.
4. Ross JS, Nazem AG, Lurie P, Lackner JE, Krumholz HM. Updated
estimates of pharmaceutical company payments to physicians in Vermont.
JAMA. 2008 Nov 5;300(17):1998-2000.
5. Blumenthal D. Doctors and drug companies. N Engl J Med. 2004 Oct
28;351(18):1885-90.
Competing interests:
None declared
Competing interests: No competing interests