03.Under the influence
There are many players involved in the complex world of pharmaceutical production, from the development of a new drug through to a doctor prescribing it for you, and drug companies influence the players at every level — whether it be during research, licensing or promotion.
Medicines Australia administers the Code of Conduct that sets the standard for the ethical marketing and promotion of prescription medicines. It also represents the pharmaceutical industry in Australia, so there’s an obvious conflict of interest.
The Pharmaceutical Benefits Advisory Committee decides which drugs are listed on the Pharmaceutical Benefits Scheme (PBS). The government subsidises the cost of the PBS-listed drug to the patient above the prescription charge or co-payment. More than two thirds of the GPs we surveyed use the PBS to assist them in making prescribing decisions. Drug companies can receive considerable financial benefits from having their products listed under the PBS, so they frequently lobby PBAC either directly or via patient groups.
Although drug companies can’t market prescription-only drugs to patients directly, information about these drugs still reaches them via the media, patient groups and information online. One GP told us, “I dislike greatly the [drug company] practice of promoting new drugs to the public via ‘news releases’ to the media. It may get patients asking their doctors for the drug, but is frustrating to deal with as a doctor trying to give a balanced view to the patient.” In our survey, 37% of GPs said patient requests help them decide whether or not to prescribe a new drug.
These represent the interests of patients suffering various illnesses and offer support services and information to patients, families and carers. But many groups receive funding from drug companies, and while the funding is much needed, it can compromise the independence of the group and the information it provides.
In an environment where information is updated rapidly and there’s so much doctors and healthcare professionals need to know, they have to rely on many sources to prescribe the right drug for you. In our survey, 73% of GPs said they use drug companies or their reps as a source of information.
Published research helps prescribers to choose treatment — 53% of the GPs we surveyed use medical journals such as the Medical Journal of Australia as a source of information. Clinical evidence is most often the main source of information for prescribing decisions made by the GPs we surveyed, but a large proportion of drug trials rely on industry funding, and not all trial results have to be published, so those with inconclusive or negative outcomes may not be seen.
The Therapeutic Goods Administration (TGA) is the government body responsible for issuing licences and ensuring that drugs and medical devices are safe. It assesses new drugs for quality, efficacy and safety and regulates the manufacture, research and marketing of drugs. The TGA is wholly funded by fees the industry pays to get its drugs approved, so it’s in the TGA’s interest to approve drugs, and in a timely fashion.