How many pharmacists are on the ‘gravy train’?

Budget 2015: $50 note in blue piggybank

An analysis has looked into how many pharmacists receive money from the pharmaceutical industry

A new analysis of pharmaceutical industry payments has shown that pharmacists accounted for only 2.9% of recipients, receiving 1% of the total spend.

But more data on payments to non-doctors is needed urgently, the researchers say.

The analysis, conducted by researchers at the University of Sydney and the University of Toronto, aimed to provide an insight into the nature and extent of payments to non-prescribing healthcare professionals such as nurses, pharmacists, physiotherapists, psychologists, dietitians and more.

“There is a mistaken idea that non-prescribing healthcare professionals don’t have much influence on medicine use, therefore their pharmaceutical industry ties aren’t that important,” said lead author Dr Emily Karanges from the University of Sydney’s Evidence, Policy and Influence Collaborative at the Charles Perkins Centre and School of Pharmacy.

“Yet healthcare professionals like nurses and pharmacists often assist with medication choice and encourage adherence to treatment – and the roles they play in chronic disease management are expanding too.”

The research team analysed payments to Australian healthcare professionals using publicly available reports submitted to regulator Medicines Australia by their member companies.

The data do not include all pharmaceutical companies, research-related payments or product details associated with payments, however the analysis provides the first comprehensive account of payments to non-physicians.

Between October 2015 and April 2018, 14,018 healthcare professionals were found to have received $62,695,095 in pharmaceutical industry payments.

Most of these payments – 77.9% – were to doctors. The other healthcare professionals who accounted for 22.1% of recipients received only 10% of the total spend.

Nurses were the primary recipients, comprising 17.8%, after doctors, receiving 8.3% of expenditure.

They were followed by pharmacists, who made up 2.9% of recipients and received 1% of the total spend.

The Daily Telegraph reported the findings with the first paragraph, “Nurses and pharmacists have joined doctors on the medical gravy train”.

“We found the most highly paid healthcare professionals were often working in hospitals in chronic disease management, and chronic diseases such as HIV and multiple sclerosis have expensive treatments that are required long-term,” said Dr Karanges.

The top contributing companies included: Biogen, a manufacturer of products for conditions including multiple sclerosis; Gilead, with an expanding market in HIV and hepatitis medicines; and Shire, whose products include drugs for attention-deficit hyperactivity disorder and binge eating disorder.

Payments were reported to support activity such as attendance at meetings and speaker and advisory board engagements, as well as associated travel and accommodation costs.

“For the benefit of patients, and to protect and maintain the integrity of our valued healthcare providers, we need better oversight, understanding and education of the potential impacts of such activity,” Dr Karanges said.

Co-author Professor Lisa Bero from the University of Sydney’s Charles Perkins Centre and School of Pharmacy said the findings had global implications.

“Pharmaceutical companies are clearly courting non-prescribing healthcare professionals as well as doctors in Australia, presumably because of the increasingly important role and influence they have in clinical care,” she said.

“Inevitably this type of activity and potential influence is happening around the world, but pharmaceutical influence on non-prescribers remains hidden because the data are simply not available in other countries. 

“There is an urgent and global need to extend mandatory transparency reporting and institutional policies that apply to all healthcare professionals.”

“In contrast to the high scrutiny and regulation of physician-industry relationships, interactions with non-physicians remain relatively hidden and unregulated,” the paper concludes.

“In light of the expanding roles of non-physicians in chronic disease and medication management, our findings suggest there is an urgent need to extend mandatory transparency reporting and institutional policies to all health care professionals.”

Pharmaceutical Society of Australia national president Dr Christopher Freeman told the AJP that while more transparency would be a positive thing, the study shows that pharmacists are managing their contact with pharmaceutical companies well.

“Pharmacists have, obviously, an integral and central role in medicines supply, and therefore there’s always going to be contact between the pharmacists and the pharmaceutical industry, due to the supply chain of the medicines,” he said.

“To suggest complete separation between the pharmacy sector and the pharmaceutical industry would be inappropriate because of this.

“This actually shows how well pharmacy and pharmacists are doing, in my view: the figures were less than 3% of recipients and 1% of the total spend, and that’s relative to the nursing and medical professions, which were at multitudes-higher rates.

“That suggests that pharmacists are actually doing quite well in terms of not engaging in payments from industry.”

He highlighted the PSA’s Code of Ethics, the first integrity principle of which indicates that a pharmacist delivering any services must manage actual or perceived conflicts of interest with transparency.

“This is of fundamental importance,” he said, saying it ensures pharmacy practice decisions are not impacted by commercial or business interests.

Dr Freeman agreed with the call for more data.

“I think more transparency is a good thing, but I think what it will show is that pharmacists are still performing to a very high level.”

Read the paper here.

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