When a specialist prescribes a medication, patients trust the decision is based solely on their clinical need. But what if that choice is being subtly shaped by financial incentives from the very companies that make the drugs?
The Scale of Pharmaceutical Payments to Doctors
Australian researchers have shed new light on this enduring ethical dilemma. Despite a 2016 mandate from the industry body Medicines Australia requiring disclosure, the full picture has only recently emerged.
An online repository, launched after significant delay, revealed that between 2019 and 2022, a total of 6,504 doctors – representing 4.9% of all registered practitioners in Australia – accepted at least one payment from a pharmaceutical company.
The total sum transferred exceeded AU$33 million. Individual payments ranged from a modest $30 to a staggering $300,000, with a median payment of $1,500.
The medical specialties receiving the largest sums were haematology and oncology (AU$6 million), cardiology (AU$3 million), and endocrinology (AU$2 million). These figures cover payments for consultancy fees, advisory board roles, educational sponsorship, and travel expenses, but notably exclude food, beverage, and broad "research" costs.
How Payments Influence Prescribing Behaviour
The industry argues these payments compensate doctors for valuable time spent advising on drug development and patient access programmes. However, evidence suggests a direct impact on prescribing habits.
A systematic review funded by the US National Cancer Institute found a consistent link between drug company payments and increased prescribing of the paying company's drug. This led to higher overall prescribing costs and a preference for branded medications over cheaper alternatives.
Economists point to a 'spillover effect', where a doctor deemed an 'influencer' can sway the prescribing patterns of their peers. More alarmingly, studies indicate payments can lead to increased prescriptions even for patients where the drug is not recommended or is contraindicated.
"When it comes to patient care, it is not apparent that doctors with 'access' to drug companies serve their patients any better," writes oncologist and author Ranjana Srivastava. She argues that if such access facilitates getting an unaffordable or unapproved drug, it poses a profound ethical question.
A Call for External Oversight and Transparency
Despite some regulation, a significant challenge remains the reluctance of many doctors to acknowledge any influence. Many dismiss the impact of even small branded gifts, like pens or notepads, despite psychological research on reciprocity.
The transactions largely occur outside public scrutiny, protected by the enduring trust society places in medical professionals. Patients are naturally reluctant to believe their doctor's judgement could be compromised.
Yet the financial consequences are real and public. In Australia, where the Pharmaceutical Benefits Scheme (PBS) subsidises medication costs, every unnecessary or overly expensive prescription represents a drain on taxpayer funds. Money misspent on healthcare is money not spent on housing, education, or infrastructure.
Dr Srivastava notes that while she has heard from conflicted pharmaceutical industry professionals, she has "yet to meet a doctor who accepts money and thinks there could be a problem." This leads her to a stark conclusion: the solution cannot rely on self-policing with the adage 'physician, heal thyself'.
What is required, she argues, is robust external oversight and genuine transparency to ensure that the only interest guiding a prescription is the patient's best interest.
