Health professionals who are paid the most by UK drug companies for providing time and advice are the least likely to have voluntarily declared the payments, analysis of a new disclosure website indicates.
The data show that 70% of healthcare professionals in receipt of payments from companies required to register details on a website hosted by the Association of the British Pharmaceutical Industry (ABPI) agreed to have the data disclosed. But the 30% who didn’t agree to disclosure received 52% of the payments registered (fig 1⇓). However, The BMJ has been unable so far to determine how many healthcare professionals are included in the website and how many are doctors.
Mike Thomson, chief executive of the association, said that this meant that those receiving the largest payments were less likely to have agreed to have them disclosed. “I’m disappointed by that,” he said. “These are probably leading consultants whose services are highly valued by the companies. It’s understandable that we don’t want our neighbours to know how much we earn, but I hope that when they see this database published they may think it was a mistake to have given it a miss.”
The headline figures from the database, Disclosure UK (www.disclosureuk.org.uk), are that drug companies paid doctors and other health professionals £340m (€410m; $455m) in 2015 for services provided, two thirds of which was spent on clinical studies and trials.
The rest, £111m, was spent in different ways. The largest part, £46m, went on fees for services and consultancy. Donations and grants to healthcare organisations accounted for £30.3m and sponsorship agreements £16.6m. Smaller amounts were spent on travel and accommodation (£10.8m), registration fees (£4m), and joint working (£3.3m).
The company that spent the most was AstraZeneca, at £41.9m, a figure that Thomson said was not surprising because it is a British company and does much clinical research in the United Kingdom. The average spend for the 109 companies in the database was £3.1m, and most companies spent less than £5m. The average recipient got £1500, the highest £98 000.
Thomson called it “a milestone moment” for transparency in the industry and for the partnerships it has with health professionals and organisations across the UK. He said, “These partnerships matter and help our industry bring the right medicine to the right patient at the right time so we can improve quality of life and, in many cases, save lives. Getting advice from doctors, nurses, and health professionals across the NHS helps us do this—we can’t do it alone. We believe it’s right we pay for that expertise and insight, as this is work which health professionals undertake often in addition to their day job in the NHS.
“We’re committed to transparency. We believe it’s right that the public has the opportunity to see some of the detail behind how we work with doctors, nurses, pharmacists, and organisations to ensure that life enhancing medicines are developed for the patients who need them. Today is an important step in sharing as much as of that information as we can.”
Participation in the database is voluntary and part of a Europe-wide initiative in which 33 countries have made public such payments and benefits in kind. The companies have provided the data, but the professionals who are given the payments are not named unless they agree. This means that any patient can look up a doctor to see whether he or she has received payments from the industry, though with a fair chance that the search will prove fruitless. A doctor whose name does not appear may have received nothing or may, alternatively, have decided to keep payments secret.
Participation of companies in the database is now a requirement of the ABPI’s code of practice. There is, however, no means of ensuring that companies have fully disclosed all payments made, though to conceal any would be a breach of the code.
The database is a snapshot in time and will be constantly changing. Not only will payments change from year to year, but health professionals can opt in and out. Thomson said that he hoped more professionals would be inspired to opt in when they saw the database in action. “My hope is that doctors looking at this will say, ‘It’s a good thing,’ and opt in,” he said.
Robert Lechler, president of the Academy of Medical Sciences, welcomed the launch of the database. “Successful partnerships between industry, academia, and the healthcare sector can speed up the rate of scientific discovery and innovation, and they are key to accelerating the translation of research into benefits for society,” he said.
“However, many people are concerned about how these partnerships might compromise the integrity of research. That is why it is of the utmost importance that the nature of these collaborations and their impact on research are communicated to the public in a clear and transparent way. Disclosure UK is a welcome step towards creating the level of transparency and accountability that the public need to assess the trustworthiness of these partnerships.”
Jane Dacre, president of the Royal College of Physicians, said that the register of payment was a major sign of progress in the quest towards transparency. “The register shows the extensive contribution pharmaceutical companies make, working with health professionals and organisations on activities related to the research and development of new medicines.
“However, the register allows healthcare professionals to opt out of disclosure and does not support healthcare professionals who wish to declare that they have not received any funding from pharma. These issues must be addressed by the ABPI and the pharmaceutical companies in the coming year to enable the public to have confidence in the register as a true picture of the relationship between pharma and healthcare professionals.”