Who pays this doctor?

Today in the BMJ myself and colleagues have a letter discussing the need for patients and the public to see easily what potential conflicts of interest a doctor may have.

As we say in the letter

“The Association of the British Pharmaceutical Industry has estimated that the drug industry pays £40m (€48m; $65m) a year to doctors for speaking fees, flights, hotels, and other travel expenses.2 Yet who is being paid what is opaque. ..

The General Medical Council (GMC) says, “You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals . . . If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision making.”7 Yet there is no formal way to declare such interests, especially when conflicts may subtly influence a doctor’s practice—such as small gifts from the drug industry. The lack of a system to document payments means that patients cannot routinely be informed whether their doctor receives benefits from companies that may affect their prescribing…

There is a need for change. The current system of self declaration is variable, opaque, and unreliable….

We would discourage the long and potentially irresolvable discussion about what does or does not represent a conflict or interest (membership of a political party, board membership of a charity, ownership of a nursing home, or ownership of a primary care service while working as a commissioner of care). Rather, we suggest that patients may be good judges of this. Moving from the notion of an academic conflict of interest being something “that would embarrass you if it were to emerge after publication and you had not declared it”9 the question should become, “Is there anything that would embarrass your relationship with your patients or the public if you do not declare it now?” Although having an interest is not necessarily by itself a problem, failure to disclose some declarations might be. It is likely that doctors’ professionalism would lead to more over-declaration than under-declaration. However, patients are most likely to be concerned about payments from the industry, PR companies, and declarations of interest over commissioning of services.”

(The full version with references is available via the link, and Martin Brunet, @DocMartin68 was a signatory but his name is not on the list, unfortunately, my fault).

The http://www.whopaysthisdoctor.org/website which has been set up (by volunteers, unpaid, working late into the night) is an attempt to try and get this information to patients and the public.

It is not a perfect system, or solution – doctors who receive very large sums from pharma may be unwilling to voluntarily disclose this. That’s why we want the GMC to consult on a statutory register of declared interests. In the meantime, doctors can voluntarily declare their interests on the website. (Beware – confirmatory emails from the site have a tendency to go into email spam folders.) There will also be a delay period from a doctor making a declaration to it appearing to allow verification.  If the site doesn’t work for you please let us know margaret@margaretmccartney.com and I will forward it on.

I think this is a good first step. To make it work, we need doctors to sign up. Please spread the word!


4 Responses to “Who pays this doctor?”

  1. Supersub January 16, 2014 at 11:41 pm #

    Honestly, talk about missing the bigger picture. There are bigger villains in the NHS than a few doctors being paid “travel and expenses” for attending conferences…PFI? Privatisation? Management consultancies? Pharma price-gouging?
    Funnily enough, I have received travel expenses from pharma to attend some specialty society conferences for which I would never have got funding through the NHS study leave. That got me economy class travel, two or three nights in a generic, plastic travel lodge and a few days stuck with a load of doctors, away from family & friends. Usually on a bloody weekend as well, then straight back to work when I got back. And no, that doesn’t make me in debt to some massive corporation and nor does it ever affect my choice of therapies for my patients.
    I note most of Margaret’s co-authors are university academics who, presumably when they’re not invited speakers themselves, get adequate funding from their grants to attend meetings.
    Why not pick a slightly bigger target, eh?

  2. Supersub January 18, 2014 at 12:41 pm #

    No comments posted yet I see. Or are you waiting for some positive ones?

    • AmoxycillinPrescriber February 24, 2014 at 6:46 pm #

      This doctors acceptance of pharma support to attend his conference might not feel, to him, to be influencing his prescribing but the massive amount of support the industry gives to doctors in the UK must be having some influence because the companies have an obligation to maximise returns for shareholders so it can’t be altruistic can it. I suggest if the NHS isn’t prepared to support his attendance then it probably isn’t in the greater good of the NHS for him to do so and he should review what benefits, professionally, not personally he gets from attendance. I’m not sure I would want to be treated by him on a Monday after he’s indured such an uncomfortable weekend. Was he refreshed enough to work?

  3. margaretadmin January 19, 2014 at 11:53 am #

    why don’t you leave your name?
    The evidence is very much against you I am afraid – even small gifts adversely effect doctors prescribing. That’s why they offer it. Pharma marketing are not stupid.

    If you read the letter you will see that pharma is only one of many potential conflicts of interest. I hope you sign up.