ven, Sep 15th 2023
Until a recent media-led investigation revealed the practice, it was largely unknown to the public that a ‘transparent’ method of funneling money from large pharmaceutical firms to medical practices was going on. The investigation raises serious concerns about how what were once ‘underground’ payments became (mostly) legalized and ‘transparent’, while still remaining hidden from view. The question arises, ‘How do such payments, legal and transparent or not, color the judgments of doctors in their practice of medicine?’
Zurich (sda) – The Swiss pharmaceutical industry paid around 218 million Swiss francs (~$240 million) to doctors and hospitals last year. The front-runner was @Novartis with 31 million francs. This is according to the self-declaration of 65 pharmaceutical companies.
The industry has been reporting its payments since 2015 on the basis of its Pharma Cooperation Code. Since then, these benefits to professionals and health organizations amounted to 1.4 billion francs.
The research network of the publishing house Ringier Axel Springer evaluated the figures and published them on Thursday. The publications “Beobachter”, “Handelszeitung”, “Blick” and “SonntagsBlick” participated in the data analysis.
Scienceindustries [@swiss_science], the association of pharmaceuticals and chemicals, confirmed the payments at the request of the Keystone-SDA news agency. Behind Novartis is @Roche in 2022 with an expenditure of 21.9 million Swiss francs. Third place is taken by U.S. group Pfizer, which came up with 20 million.
200-million Mark Cracked in 2022
Since the beginning of the self-declaration, the comparison shows that the pharmaceutical companies have made their contacts with specialists and clinics cost more each year. In 2015, they still paid 141 million Swiss francs. In addition to doctors, pharmacies and hospitals, medical societies, patient organizations and other players in the healthcare industry also receive payments.
Jürg Granwehr, Head of Pharma and Legal at Scienceindustries, explained the growth in payments to Keystone-SDA also with the number of companies that are members of the code. In 2015, only about 50 companies belonged to the code; currently, there are 65.
In the meantime, however, far more than 15 companies have joined the transparency initiative, as some of the signatory companies have disappeared from the list again due to mergers, but their donations have remained in total.
In 2022, the amount exceeded the 200 million mark for the first time; in 2021, the groups had still distributed 196 million Swiss francs, and in 2020 183 million.
7.5 Million to Doctors
In 2022, pharmaceutical companies paid 7.5 million Swiss francs to physicians, broken down by individual items, 15 percent more than in the previous year. According to the industry association, the pre-Covid 19 pandemic level of 11 million Swiss francs was not reached again. In general, direct support is shifting from professionals to organizations, it added.
This was reflected in sponsorship payments to hospitals, physician networks, patient organizations, professional societies and other players. They amounted to 121 million Swiss francs, up from 106 million in 2021.
Under “Research and development,” companies financed clinical research in hospitals with 89.7 million Swiss francs. This is 7 million more than in 2021. According to the association, this fluctuates greatly from year to year, which can be explained by changing intensity of activities in clinical research. The hospitals are not shown individually under this item. The pharmaceutical industry refers to research secrecy.
The List of Names
Granwehr also pointed to the high level of individual transparency in the industry’s payments. For example, an average of 92.4 percent of the supported physicians and pharmacists agreed to make their names and the amounts they received public on the Internet. For the institutions receiving support, the figure was 97.2 percent.
That those affected must agree to the disclosure is stipulated by the Data Protection Act. According to Granwehr, the level of transparency in Germany or Austria is much lower.
Payments made by pharmaceutical companies to players in the healthcare sector are regulated by law. Payments for consulting services, research and training are permitted. To prevent excessive fees in consulting contracts, only reasonable rates may be agreed upon. Supervision is carried out by the Federal Office of Public Health.
Credit: Keystone/SDA
Scienceindustries Comments
In response to a query from @TheSwissTimes regarding the above Keystone/SDA report, Scienceindustries spokeswoman Pia Guggenbühl commented back to us with this statement:
“Each company is disclosing its data according to its processes based on requirements of the European Pharma Association (EFPIA). Each company explains in a “methodological note” the company-specific characteristics (e.g. inclusion of VAT or not) about the data disclosed so that the statement can be understood by interested parties. There is therefore no direct comparability of the data between individual companies. This was and is not the goal of the TI. Rather, it is about creating the greatest possible individual transparency. A searchable platform on which you can find data concerning single HCP or HCO was and is not in scope of the transparency initiative of the pharmaceutical industry.“
– Pia Guggenbühl email to @TheSwissTimes, 14-09-23 (our bold)
As the first sentence indicates, the ‘database’ of recipients of pharma largesse is fragmented across a daunting galaxy of pharma companies. 65 of them, to be precise. This can be seen directly on the Scienceindustries website:
The large fragmentation of data makes these sites totally impractical to search, assuming the average consumer even finds the above link. The last sentence by Ms. Guggenbühl confirms that there is no single search platform, nor is one contemplated. Making matters worse, the reporting is a hodge-podge of formats, most using varying flavors of PDF layout, but in at least one case (@Janssen_CH) a difficult set of 29 sequential non-downloadable pages, albeit searchable. @TheSwissTimes has reached out to Janssen for a proper XLS format for analysis purposes but as of press time, none has been received.
Again, notably, payment disclosures are voluntary for doctors and hospitals. While the Keystone/SDA report indicates 92.4% of doctors consent to disclosure, that leaves almost 8% who do not. Who are they? Furthermore, the most recent disclosure reports are only from 2022, leaving more contemporaneous data totally obscured. In our era of instant electronic account reporting, the methods and means of immediate payment tracking are readily available for this application but curiously are not employed. Why? And why does industry-funded Sciencedirect not provide a consolidated database for easy searching?
Les high level of individual transparency mentioned by Mr Granwehr in the Keystone/SDA report therefore seems to be less than an accurate state of play. While it can certainly be claimed by Sciencedirect and their partner pharma firms that disclosures are being made according to the rules, the lack of accessibility and obscurity of the information means that, in practical terms, there is no transparency at all. One can write a book disclosing the deeds of the powerful and then hide it deep in the stacks of a large library and ex-post-facto declare transparency, but does that make it true? Or is this just a clever means of keeping things dark while proclaiming a moral high ground?
By way of further clarification, Scienceindustries’ Pia Guggenbühl goes on to explain relative to the @Blickch version of the story [https://bit.ly/48sIqwa] –
“…the title of the Blick article which claims “Millionen-Geschenke” – this wording is wrong:
- Already from a legal point of view pharma industry has to comply with strict integrity rules (cf. TPITO esp. Art. 3) which are enforced by the Bundesamt für Gesundheit (BAG).
- In addition the pharma self-regulation established already in 2015 a even stricter ban on gifts (cf. PC section 15.2). We are not disclosing any “gifts” but pecuniary benefits in the frame of various collaborations.
- The exchange between the pharmaceutical industry and the actors in the health care system is essential for the research of new treatments and the further development of proven therapies. This is a decisive contribution to improve the quality of medical care for patients.
- The term pecuniary benefits as defined by the PCC means remuneration granted either directly or indirectly in connection with pharmaceuticals for human medicine available on prescription only.
- The disclosure includes payments made e.g. for consultancy and the provision of services, financial support for research and development in the healthcare sector and cost contributions for the attendance of professionals at events.”
Playing devil’s advocate:
Just because a justification is provided does not mean that that is the actual reason the transaction transpired, or that a payment wasn’t made through a non-reporting category ‘off the books’. If someone wanted to keep a relevant transaction private or obfuscated, myriad methods are possible.
The revelations can be interpreted in two different ways.
One view is that the industry is trying hard to be transparent, bringing to light what was once a dark practice pursuant to pressure from the government and consumer watchdog groups alike. Therefore, the payments and benefits are all legitimate and (it is implied but strangely not plainly stated) do not create conflicts of interest at the physician-patient interface. The publication of tables containing recipients of money and benefits (travel, honoraria, and consultancy payments) shows that this is all above board and describes honest, open relationships.
Another view is that Pharma, courtesy of industry-created and funded Sciencedirect, has done nothing more than appease the opponents of the old, dark method of hidden benefits by ‘publishing’ them without detail as to the nature of each transaction and then effectively hiding these reports across 65 different obscure webpages in a way that prevents the average consumer from finding them or, especially, from finding relevant conflicts of duty in their personal physician. In other words, the old ‘black’ system of backhanders thrives to this day, basically unaltered, but with a freshly minted veneer of acceptability via an industry-funded association’s self-imposed rules. Via this veneer, the practice of old can continue and even thrive.
In either case, one has to wonder how these payments and benefits ‘bend’ doctor-patient relationships. Are we to really believe that a doctor in the past who prescribed deadly Vioxx™ because he was blinded by his all-expenses-paid trip to Ibiza would act differently today if the trip was eventually listed as a generic compensation on an obscure webpage that not one person in 1,000 even knew existed?
At the physician (and hospital) level, should we be concerned that these ‘benefits’, washed clean and white, haven’t already created an alliance between doctors and pharma that is stronger than that between doctor and patient? Is it accurate to say today that the situation is even worse than before the advent of the Pharma Cooperation Code, precisely because there is now a veneer of respectability?
Bottom line: Who is your doctor really working for?
16.09.23 – This article was updated for credits and clarity.
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