The links and associations between health care professionals, health care organisations and the bio-pharmaceutical industry has long been a source of deep concern. This is perfectly understandable.
When we go to see our GP, pharmacist, dentist or hospital doctor, we have every right to expect that they will be acting in our personal interest as opposed to the commercial interest of the various drug producing companies.
In other words, we want a disinterested medic and not a salesman to be the one doing the prescribing. Thankfully the vast majority prioritise the former ahead of the latter.
But concerns such as these do tend to re-emerge with particular force during a major public health crisis, like the one we find ourselves in at present. It is only right therefore that we are aware of the commercial links that exist between the various bio-pharmaceutical companies, GP’s and all other medical professionals practicing within the state.
This is a view that the industry itself has come to accept rather reluctantly.
Indeed, following EU rumblings of a threatened statutory requirement that would force the publication of all such details, the industry representative body, the Irish Pharmaceutical Healthcare Association (IPHA), began ‘voluntarily’ publishing partial accounts of these links in 2015.
These accounts cover everything from sponsorship, registration fees for conferences, travel and accommodation and the always beautifully opaque category of ‘Related Expenses.’
All of these categories of payments and reimbursements fall under what are technically known as ‘Transfers of Value’ or ToV’s.
Here is the standard definition of what constitutes a Transfer of Value:
“A “transfer of value” is defined as “a direct or indirect transfer of value, whether in cash, in kind or otherwise, made, whether for promotional purposes or otherwise, in connection with the development or sale of medicines”. The concepts of “direct” and “indirect” transfers of value are included.”
So, and purely because companies like Pfizer and AstraZeneca are in the headlines at present, let us start by taking a closer look at what these two companies paid out to Irish Health Care Professionals and Health Care Organisations from 2017 to 2019, which are the only years for which information is immediately accessible.
Starting with Pfizer Healthcare Ireland. In 2019 alone Pfizer handed over €1,546, 997 to 276 individual Health Care Professionals (HCP’s) and 76 Health Care Organisations (HCO’s) in Ireland.
In 2018 the amount was €743,302 and in 2017 the amount was €753,763. This amounts to just over three million euro covering everything from hotels, taxis, advertising, ‘placement of a brand logo in a conference program’ or ‘funding an event in return for a display booth.’
By comparison, AstraZeneca paid just over of a quarter million (€256,976) to 135 individual Health Care Professionals and 69 Health Care Organisations in 2019.
In 2018 it handed over €446,195 and in 2017 the total was a ‘mere’ €138,191. Again, all of this cover’s expenses such as conference registration fees and even ‘Speaker Training.’
This is not a patch however on the cumulative amount of fees and expenses paid by out in 2019 by the 47 bio-pharmaceutical companies listed on the Irish Pharmaceutical Healthcare Association website. That total amounted to €20,586, 866.
There on the IPHA website you also will see that the pharmaceutical company Allergan, for example, disbursed a staggering €8.4 million to HCP and HCO’s in 2019. This was a significant jump from the previous year’s amount of €3.5 million and the 2017 total of €3.8 million.
What is a genuine cause for concern however is the fact that Allergan only provided details of where thirty five thousand of this went.
The remaining eight plus million falls into the category of ‘Other’ where ‘information cannot be disclosed on an individual basis for legal reasons.’
This lack of transparency was something that former Fianna Fail TD and now MEP, Billy Kelleher tried to tackle back in 2017 when he brought forward his Medical Practitioners (Amendment) Bill 2017.
Unfortunately, this rather excellent piece of legislation lapsed with the dissolution of the last Dáil and has not been taken up since.
The aim of the Bill was to “require medical practitioners to declare any income or gift received from medical suppliers or pharmaceutical companies to the Medical Council in statutory declaration annually.”
As we have seen this is currently done on a voluntary basis by the IPHA. But as we also have seen, there are millions of euro in fees, travel and accommodation expenses, research supports, that are not being disclosed.
We should work to change that in the interests of greater accountability and indeed, of being better able to ward off the worst excesses of the conspiracy theories that circulate around these issues.