01.04.13
Payments to health professionals from the life sciences industry
Source: National Health Executive Mar/Apr 2013
The Ethical Standards in Health and Life Sciences Group (ESHLSG) is consulting on launching a public register of payments to healthcare professionals by commercial organisations. NHE hears from Andy Powrie-Smith, who leads on this issue for the Association of the British Pharmaceutical Industry (ABPI), and Sir Richard Thompson, co-chair of the ESHLSG and president of the Royal College of Physicians (RCP).
From 2016, the European Federation of Pharmaceutical Industries and Associations (EFPIA) intends to disclose financial relationships with healthcare professionals. From March 31 this year, pharmaceutical companies in the UK will publish aggregate payments to healthcare professionals annually, and the total number of healthcare professionals receiving such payments.
But the Ethical Standards in Health and Life Sciences Group (ESHLSG) is consulting on whether transparency should go further than that, for example through the disclosure of payments from commercial organisations to individually named healthcare professionals via a single, publicly searchable, central database.
‘A global journey to transparency’
We asked Andy Powrie-Smith, director of trust and reputation and Scotland director at the ABPI, who has been deeply involved in the transparency agenda, for his thoughts on how transparent the relationships are between healthcare professionals and the pharmaceutical industry at the moment.
He said: “It’s something that’s been evolving over a period of time – for example, there are stipulations now that when a speaker speaks at a conference, they declare if they’re being supported by a c o m p a n y or if the work they’re talking about is being supported by a company. There’s also lots of smaller provisions to increase the transparency of the relationship, and highlight where potential conflicts of interest exist and so on.
“We’ve also seen a kind of global journey towards greater transparency: the Sunshine Act in the US, a regulatory collaborative model in Holland emerging this year, and of course ABPI members took the early step of collecting data in 2012 for disclosure this year of the aggregate total paid to health professionals and the total paid to health professionals and the number of health professionals that they work with.
“There’s not a requirement to disclose the individual names at this stage, but it’s a step on that journey.
“It’s becoming increasingly important to the industry and also to the healthcare community – that’s where this collaborative consultation came from.”
A strong commitment
Powrie-Smith called these latest moves in public disclosure “a very significant milestone” which will “re-define” the relationship between health professionals and industry.
He noted that of the world’s top 100 medicines, about a quarter were developed in the UK, through collaborations between industry and health professionals. “There’s a real history of benefit to patients and good outcomes there, and we want to ensure for the future that those relationships are on the right footing and that the public and patients can have confidence in those relationships. Transparency is part of that.”
He said the debate was not about finding a ‘compromise’ between industry and transparency campaigners – the pharmaceutical industry has already shown a “strong commitment” to change, he said. “The ambition is to work with the health professional community to make that happen and to do it in a consultative and accurate way – the commitment is there in black and white from the industry’s perspective.”
Sharing responsibility
The consultation does not offer detail on exactly what a single searchable database would look like, or who would be on it, but the questions (see panel above) allow respondents to give their own views in some detail – such as how the responsibility for reporting should be split between healthcare professionals and pharma companies.
Powrie-Smith said: “It is up to the stakeholders involved to come up with a workable system that works for everyone. There are models internationally where people have sat down and done that and the system that comes from that kind of approach can work better than, for example, a legislative response [as has been seen in France and Slovakia] – which can sometimes be more problematic and perhaps not established in a way that is good for all the stakeholders involved.
“But I think the UK has a very strong reputation for good self-regulation around these issues.”
Sir Richard Thompson, co-chair of the ESHLSG and president of the Royal College of Physicians (RCP), said: “This consultation is intended to establish whether there is, in principle, support for a publically available, single, searchable system for disclosure of payments that is inclusive of all commercial life science organisations working in healthcare.”
Who pays who?
Payments to health professionals are common at every stage of a medicine’s life cycle – payments to clinicians to attend medical education and information meetings, to share expertise in particular therapy areas, to sit on advisory boards to advise on the direction of travel in research, to help determine where a medicine should fit into the care pathway, and so on.
The consultation – which defines ‘health professionals’ as members of the medical, dental, pharmacy, pharmacology, nursing and allied health professions and anyone who, in the course of their professional activities, may purchase, recommend, prescribe, supply or administer a medicine or device – classifies such payments into three broad categories:
1) Fees for consultancy services, including: speaking at and chairing meetings; participating in advisory board meetings; involvement in medical/scientific studies, clinical trials or training services; undertaking media activity, including writing articles, filming and participation in market research activity (under relevant contractual agreement).
2) Financial sponsorship for attendance at independent medical education meetings, including: covering registration fees, international travel, accommodation and reasonable refreshments/subsistence.
3) Payments received for research and development activity.
Powrie-Smith said: “There are quite a considerable number of areas where health professionals and commercial organisations will work together on the research side or in how that medicine should be used.
“The aim is patient benefit.”
Sample questions from the consultation
Do you agree or disagree…
• With the principle that payments from commercial organisations to individually named healthcare professionals should be transparent?
• With the principle that payments from commercial organisations to individually named healthcare professionals should be publicly declared?
• That a system of disclosure of payments should take the form of a single, publicly searchable, central database?
• That individual healthcare professionals should play a role in the disclosure of payments received from commercial organisations (e.g. submitting information or validating the information submitted by others), alongside the submission of the same information by industry?
• That disclosure of payments to healthcare professionals should apply to all types of commercial life sciences organisations (e.g. devices, diagnostics and bio-pharmaceutical industry) and not only the pharmaceutical industry?
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